Designated Doctor Examination:

A Designated Doctor is a doctor selected by Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) to provide opinions about an injured employee’s medical condition or to provide an expert opinion that can aid to resolve a dispute about a work-related injury or occupational illness.

• At the request of the insurance carrier, an injured employee or the injured employee's representative the division may order a medical examination by a designated doctor to resolve questions about the following:
  • the attainment of maximum medical improvement (MMI);
  • the impairment caused by the injured employee's compensable injury;
  • the extent of the injured employee's compensable injury;
  • the ability of the injured employee to return to work;
  • whether the injured employee's disability is a direct result of the work-related injury;
  • issues similar to those described by paragraphs (1) - (5) of this subsection.

If the requested evaluation includes MMI and IR, in the evaluation report, the healthcare must indicate one of the following:

• Yes, I certify that the employee reached STATUTORY or CLINICAL and provide a date of MMI ___/___/___. The date of MMI (may not be a prospective date) and have included documentation relating to this certification in the attached narrative. - OR
• No, I certify that the employee has NOT reached MMI but is expected to reach MMI on or about ___/___ / ___. The reason the employee has not reached MMI is documented in the attached narrative.

NOTE: The fact that an employee reaches either Clinical MMI or Statutory MMI does not signify that the employee is no longer entitled to medical benefits.

Maximum Medical Improvement (MMI):

Whether the employee has reached Clinical or Statutory MMI based upon the following definitions:

• Clinical Maximum Medical Improvement (Clinical MMI) is the earliest date after which, based upon reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated.
• Statutory MMI is the later of:
  • (1) the end of the 104th week after the date that temporary income benefits (TIBs) began to accrue; or
  • (2) the date to which MMI was extended by TDl-DWC pursuant to Texas Labor Code §408.104.

Impairment Rating (IR):

"Impairment" means any anatomic or functional abnormality or loss existing after MMI that results from a compensable injury and is reasonably presumed to be permanent. The finding that impairment exists must be made based upon objective clinical or laboratory findings meaning a medical finding of impairment resulting from a compensable injury, based upon competent objective medical evidence that is independently confirmable by a doctor, including a designated doctor, without reliance on the subjective symptoms perceived by the employee.

The healthcare provider certifies that the employee has permanent impairment as a result of the compensable injury. The amount of permanent impairment is ___ %, which was determined in accordance with the requirements of the Texas Labor Code and Texas Administrative Code. The attached narrative provides explanation and documentation used for the calculation of the impairment rating assigned using the appropriate tables, figures, or worksheets from the following edition of the Guides to the Evaluation of Permanent Impairment published by the American Medical Association (AMA): fourth edition, 1^st, 2^nd, 3^rd, or 4^th printing, including corrections and changes issued by the AMA prior to May 16, 2000.

NOTE: A finding of no impairment is not equivalent to a 0% impairment rating. A doctor can only assign an impairment rating, including a 0% rating, if the doctor performed the examination and testing as required by the AMA Guides.

Reports must be consistent with Rule 127.220 and reports must be sent to IE, treating doctor, insurance carrier, the TDI-DWC and the IE’s representative within 7 business days unless additional time is need for additional testing.

Compensable Injury:
Injurie(s) determined to be compensable by TDl-DWC or accepted as compensable by the insurance carrier.

Extent Of Injury (EOI):
The evaluating healthcare provider must determine if, “the accident or incident giving rise to the compensable injury was a substantial factor in bringing about the additional claimed diagnoses/conditions, and without it, the additional diagnoses/conditions would not have occurred?”

Return to Work Status (RTW):
Is the injured employee able to return to work in any capacity and what work activities can the injured employee perform?

The health care provider must provide the beginning and ending dates for each period covered by this request only if you are requesting the designated doctor to examine the injured employee's work status for a time other than the present. If multiple periods, list all dates. From ___/___/___ to ___/___/___. (mm/dd/yyyy) From NIA to NIA (mm/dd/yyyy).

Disability:
Is the employee's inability to obtain and retain employment at wages equivalent to the pre-injury wage a direct result of the compensable injury?

The healthcare provider must provide the beginning and ending* dates for the claimed periods of disability. If multiple periods, list all dates. From ___/___/___ to ___/___/___. (mm/dd/yyyy). *The ending date cannot be a future date. You may enter "present" for the ending date.

Speciality Impairment Rating Assessment:

ABACUS IME healthcare provider(s) are certified to perform impairment rating assessments through the Texas Department of Insurance-Division of Workers Compensation (TDI-DWC) to perform these examinations. Specialist impairment ratings can be included in your MMI/IR and/or Designated Doctor report. This allows healthcare provider(s) to include objective documentation into the final report. Additionally, the referring physician can charge for the incorporation of the findings into the final report.

Personal Injury Impairment Evaluation:

ABACUS IME healthcare provider(s) are certified to perform impairment rating evaluations. ABACUS IME healthcare provider(s) are able to provide an impairment rating based upon the American Medical Association, Guides to the Evaluation of Permanent Impairment for the 5th Edition as well as the 6th Edition.

Disability Evaluation:

ABACUS IME provides healthcare provider(s) in providing permanent disability ratings and evaluating medical descriptions of physical and mental impairment. The determinations are used by workers' compensation administrative law judges, injured workers and insurance claims administrators to determine permanent disability benefits.

ABACUS IME conducts comprehensive fitness exams to give both employers and employees complete peace of mind when returning to work. A fitness for duty exam is medical evaluation which tests a person’s level of fitness and strength upon returning to work. This ensures the returning employee has been matched exactly to the job tasks they are capable of performing and establishes whether the employee has made adequate recovery following a disability or injury. An employer can request this exam if:

The employer feels that the employee may pose a direct threat to the safety of others or themselves, or

The employer believes that the employee’s condition may prevent them from performing the functions necessary for the job.

Abacus IME provides our clients with health care provider(s) to help determine what extent of work an employee returning from an FMLA leave is able to perform safely.

Second Opinion Consultation:

ABACUS IME provides Second Medical Opinions to patients and treating healthcare provider(s) in order to get a different point of view regarding diagnosis and treatment plans.

Functional Capacity Evaluations:

A Functional Capacity Evaluation (FCE) is performed based upon the following clinical indication(s) of medical necessary to determine:

• Current functional abilities, capabilities and limitations.
• Current work status, ability to RTW and/or disability to help the treating doctor make appropriate RTW recommendation(s).
• Clarify additional and/or secondary condition(s) if any.
• Aid in case management to determine: Appropriate treatment; Provide treatment options; Coordination with medical care; Rehabilitative goals and objectives; A return to work plan.
• Initial or subsequent clarification of conflicting medical reporting on precautions and/or fitness for modified job and/or ability to work.
• Provide ergonomic assessment and recommendations if the injured worker has returned to work and an ergonomic assessment has not been made.
• If injured worker can be considered to be at MMI. An FCE provides critical functional information as to the stability of the compensable injury to the area(s) of injury in a similar manner that a stress EKG does to assess the stability of heart. While an individual may not be experiencing a full blown MI, a Stress EKG will aid in determining the stability of the heart.
• Functional impairment to clinically correlate whole body impairment and rating.

An FCE evaluates an individual’s postural, repetitive movement, material handling ability and psychophysical status and usually it is usually focused on the individual ability to perform the occupational functions, duties and tasks.

These FCEs should only be performed and interpreted by providers that are trained to perform FCEs and have an occupational and ergonomic understanding of occupational demands. There are many providers who perform and/or interpret FCEs but do not have an occupational and ergonomic understanding of occupational demands and as such either do not perform the FCEs correctly and/or do not interpret the FCE correctly.

The FCE’s results are correlated with other clinical parameters to make clinical decision and opinions regarding treatment and ability for an injured worker ability to work.

Range Of Motion (ROM) Evaluations:

Range of motion (ROM) evaluation measures the range of motion (ROM) in all planes of ROM for the joints of the body. The planes of ROM are (flexion, extension, right and left lateral flexion and right and left rotation). Some joints have special ranges of motion like the shoulder have ROM planes specific to the joint (flexion, extension, abduction, adduction, external rotation and internal rotation. Other joints like the fingers only two planes of ROM (flexion and extension).

Range of motion measurements is a very critical component of physical examination and should always be performed by physician who is experienced in performing ROM and regularly performs ROM in his/her practice. Performing ROM measurements is like listening to a heart through a stethoscope. ROM measurements are compared applicable criteria in the AMA Guides to the Evaluation of Permanent Impairment 4th Edition to determine an impairment rating.

There are many providers who perform ROM measurements but do not regularly perform ROM measurements and as such perform the ROM measurements correctly and other providers unfortunately do not perform the ROM measurement themselves and instead delegate the ROM measurement to a medical technician and as such perform impairment ratings based upon erroneous ROM measurements.