When clarification is required concerning one or more issues regarding the examination of an injured employee as it pertains to a workers’ compensation matter, the Texas Department of Insurance, Division of Workers’ Compensation (DWC) may issue a Workers’ Comp Letter of Clarification (LOC) to the designated doctor. Any and all parties to a workers compensation claim may submit an LOC to the DWC.
In accordance with 28 Texas Administrative Code (TAC) §127.20, parties filing the workers’ comp claim desiring clarification of a designated doctor’s report may file an LOC request with the DWC.
Parties may only request clarification on:
- Issues addressed by the designated doctor’s report
- Issues the aforementioned doctor was ordered to address, but failed to address
At The Krist Law Firm, P.C., our team of workplace accident lawyers is able to fight hard to help you recover compensation for the losses you have sustained due to your work-related injury.
Call us today at (281) 283-8500 or by using our contact form to request a free case evaluation.
LOC Request Timeframe
The submission of a Letter of Clarification to the DWC must take place before a Benefit Review Conference (BRC), or during a BRC or Contested Case Hearing (CCH). In the majority of cases, these requests have been submitted in advance of a BRC.
Approval or Denial of LOC Request
DWC Benefit Review or Contested Case Hearing officers will approve or deny all LOC requests. Any LOC request received by the DWC before a scheduled proceeding will be approved or denied by their review officer. If the officer determines that verification is required to resolve an issue regarding the report, the Workers’ Comp Letter of Clarification request will be approved.
According to 28 TAC §127.10(j), any disputes pertaining to entitlement to benefits that are affected by a designated doctor’s report shall be handled through the prescribed dispute resolution process.
Request for LOC Requirements
In accordance with 28 TAC §127.20(b)(1-4), any requests for a Workers’ Comp Letter of Clarification pertaining to a designated doctor’s report must:
- Include the designated doctor’s name, date of the examination, reason for the examination, and name and signature of the requestor
- Explain the need for clarification of the designated doctor’s report and why it is necessary in order to resolve a pending or future dispute
- Provide any medical records not previously given to the designated doctor. Explain why these records are necessary in order for the doctor to provide a proper response to the LOC request
- Provide questions for the doctor to answer – these questions must not be leading nor inflammatory
After the designated doctor has received the Workers’ Comp Letter of Clarification, the doctor has five working days to respond to the request. In certain cases, the DWC may issue an order for an examination by the designated doctor instead of approving a request for LOC.
Contact an Experienced Houston Workers’ Compensation Attorney
If you have suffered injuries in the workplace due to negligence or any other reason, you may be entitled to recover significant compensation for your losses. At The Krist Law Firm, P.C., we know how to fight hard on your behalf.
Contact us today at (281) 283-8500 to set up a free consultation.