1. (a) The Commission may authorize a required medical examination (RME) for any reason set forth in the Texas Workers' Compensation Act (the Act), Texas Labor Code, §408.004, at the request of the insurance carrier (carrier) or a division of the Commission. The request shall be made in the form and manner prescribed by the Commission
2. (b) The Commission shall not require an injured employee (employee) to submit to a medical examination at the carrier's request until the carrier has made an attempt to obtain the agreement of the employee for the examination. The carrier shall notify the Commission in the form and manner prescribed by the Commission of any agreement or non-agreement by the employee regarding the requested examination. If an agreement is secured for RME beyond that which the carrier is entitled to require the employee to attend as provided in subsections (c), (d), (e), and (f) of this section, the written notification must also include an explanation of why good cause exists for the additional RME. A carrier's request for a medical examination order shall be delivered to the Commission and be sent to the employee, and the employee's representative on the same day in the manner prescribed by subsection (i) of this section.
3. (c) A carrier is entitled to only one RME, as allowed by the Act, §408.004, every 180 days, except as provided in subsections (d), (e), and (f) of this section.

4. (d) For dates of injury on or after September 1, 1997, the Commission may approve additional RMEs at the carrier's request before the expiration of 180 days in the event that a medical opinion is needed to determine if:

   1. (1) there has been a change in the employee's condition;
   2. (2) there is a need to change the employee's diagnosis;
   3. (3) the treatment should be extended to another body part or system, or if the extent of injury has changed;
   4. (4) the compensable injury is a producing cause of additional problems or conditions;
   5. (5) disability exists, because of newly discovered information;
   6. (6) proposed surgery, other than spinal surgery, is necessary to treat the compensable injury; or
   7. (7) the employee has reached maximum medical improvement and to determine the impairment rating when the examination relates to a body part or system that is outside the expertise of the carrier's required medical examination doctor selected under subsection (c) of this section.
5. (e) Except for the reason listed in subsection (d)(7) of this section, any request by a carrier for an additional RME shall be submitted only after the carrier has previously had an examination under subsection (c) of this section. Unless good cause exists, a request for an additional RME under subsection (d) of this section will not be approved during a 180 day period for the same reason or rationale and the employee shall not be required to submit to more than three RMEs at the request of the carrier under this section within any 180 day period.

6. (f) Notwithstanding subsections (c) and (d) of this section, a carrier may only require an employee to submit to an RME once per year and the purpose of that examination is limited to determining whether the employee's medical condition is a direct result of impairment resulting from a compensable injury, if, on or after the second anniversary of the date of the employee's initial entitlement to supplemental income benefits:

   1. (1) the employee is receiving supplemental income benefits; and
   2. (2) if, in the preceding year, the employee's medical condition resulting from the compensable injury had not improved sufficiently to allow the employee to return to work during that year.
7. (g) The Commission shall monitor all carrier requests for medical examinations that are requested before the expiration of the 180-day period under subsections (d) and (e) of this section through statistical analysis, audits, or other appropriate means.

8. (h) An unreasonable request for an additional medical examination under subsections (d), (e), and (f) of this section includes:

   1. (1) a request for an additional examination for a reason which does not comply with this section;
   2. (2) a request for a different doctor without sufficient grounds;
   3. (3) a request which would result in a violation of subsection (f) of this section; and
   4. (4) a request which provides false, incomplete, or misleading information.
9. (i) The carrier shall send a copy of the request for a medical examination order required by subsection (c) of this section to the employee and the employee's representative by facsimile or electronic transmission if carrier has been provided with a facsimile number or email address for the recipient, otherwise, the carrier shall send the request by other verifiable means.
10. (j) The carrier shall maintain copies of the request for a medical examination order and shall also maintain verifiable proof of successful transmission of the information. For these purposes, verifiable proof includes, but is not limited to, a facsimile confirmation sheet, certified mail return receipt, delivery confirmation from the postal or delivery service, or a copy of the electronic transmission.

Source Note:The provisions of this §126.5 adopted to be effective January 30, 1991, 16 TexReg 313; amended to be effective January 1, 1998, 22 TexReg 11693; amended to be effective December 26, 1999, 24 TexReg 11399.