MEDICAL EXAM SERVICES

DESIGNATED DOCTOR EVALUATION:

A Designated Doctor is a doctor selected by Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) to make a recommendation about an injured employee’s medical condition or to resolve a dispute about a work-related injury or occupational illness.  The injured employee, the employee’s representative, the insurance carrier or TDI-DWC can request an examination by a Designated Doctor.   TDI-DWC will determine if a designated doctor should be appointed to conduct the exam. 

Issues addressed by Designated Doctors include:

  • Maximum Medical Improvement (MMI)
  • Determination of existence of permanent impairment (IR)
  • Return to Work Status (RTW)
  • Evaluation of Medical Care
  • Extent of Injury Determination
  • Result of Injury Determination
  • Any other medical questions regarding the injured workers medical condition

In their role as a Designated Doctor, all GENESIS physicians maintain the training, experience and certification necessary to perform these state-appointed examinations. 

MAXIMUM MEDICAL IMPROVEMENT:

GENESIS physicians maintain certification for the American Medical Association, Guides to the Evaluation of Permanent Impairment for the 4th Edition, 5th Edition as well as the 6th Edition. 

Maximum Medical Improvement is defined in part as the earliest date after which, based on reasonable medical probability, further medical recover from or lasting improvement to an injury can no longer be reasonably anticipated. 

PERMANENT IMPAIRMENT RATING ASSESSMENT:

GENESIS physicians maintain certification for the American Medical Association, Guides to the Evaluation of Permanent Impairment for the 4th Edition, 5th Edition as well as the 6th Edition. 

Impairment is based on the examinee’s condition as of the Maximum Medical Improvement date.  Impairment is any anatomic or functional abnormality or loss existing after MMI which results from a compensable injury and is reasonably presumed to be permanent. 

REQUIRED MEDICAL EXAMINATION:

A Required Medical Examination (RME) may be requested by the Texas Department of Insurance – Division of Workers Compensation (TDI-DWC) or the insurance carrier.  An RME is a medical examination to resolve questions about the workers compensation claim. 

Prior to a Designated Doctor Evaluation an RME can be ordered to address and resolve any issues about the appropriateness of health care and/or medical treatment. 

POST DESIGNATED DOCTOR EXAMINATION:

After a Designated Doctor Evaluation an examination can be ordered or requested by the insurance carrier, injured employee, injured employee representative, and/or the TDI-DWC  to address and resolve issues/disputes about

  • Impairment caused by the compensable injury/illness
  • Attainment of Maximum Medical Improvement
  • Extent of Injury
  • Result of Injury
  • Return to Work Issues
  • Any other medical questions regarding the injured workers medical condition

CERTIFYING DOCTOR EXAMINATION:

A Certifying Doctor Examination is requested by an injured employee’s treating physician for the determination of Maximum Medical Improvement and/or Impairment Rating Assessment.  

GENESIS  physicians maintain certification for the American Medical Association, Guides to the Evaluation of Permanent Impairment for the 4th Edition, 5th Edition as well as the 6th Edition. 

SPECIALTY IMPAIRMENT RATING ASSESSMENT:

GENESIS physicians are experienced in performing impairment rating assessments for treating physicians as well as Texas Designated Doctors to areas that may be out of the referring doctors’ expertise or outside of his/her Designated Doctor certification.  All GENESIS physicians 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 physicians to include objective documentation into the final report.  Additionally, the referring physician can charge for the incorporation of the findings into the final report.

  • Medical Specialist Consultation/Assessment
  • Visual Impairment/Assessment
  • Psychiatric/Psychological Impairment/Assessment
  • Neuropsychological Impairment/Assessment
  • Audiological Impairment/Assessment

PROSPECTIVE REVIEW OF MEDICAL CARE:

GENESIS Board Certified physicians are experienced in performing Medical Necessity Review which evaluates the care of the claimant to determine what, if any, medical care is required to treat the conditions presented.  A Medical Necessity Review is performed for the preliminary review of a claim or conducted if an appeal is necessary.  In addition to a complete review of the medical records presented for the case a peer to peer consultation between the reviewing and treating physicians is performed.  The Medical Necessity Review includes a comprehensive report including a detailed explanation of the assessment and the evidence based medicine resources used to certify or deny the request for services as presented.

INDEPENDENT MEDICAL EXAMINATION/SECOND OPINION ASSESSMENT

GENESIS provides Independent Medical Examination Services for a wide range of clients including workers compensation, federal insurance programs, insurance carriers, physicians, and other entities.  

Our clients use these examinations to address diagnosis, prognosis, extent of injury, disability determination, existence of permanent impairment, treatment recommendations, work capability, appropriateness of medical care and second opinions regarding surgical procedures.

Our experienced, Board Certified, diverse group of physicians in all areas of medical specialty provide expert medical opinions.  These medical specialists base their assessments on medical findings, objectivity, and an evidence based medical approach.    With a commitment to service, GENESIS employs both experience and integrity in developing criteria and service plans that meet the requirements of our clients.

MEDICAL PEER REVIEW/RECORDS REVIEW:

GENESIS provides our clients with access to a nationwide network of Board Certified physicians in all areas of medical specialty and expertise.  Each physician is highly experienced in performing thorough, complex medical record evaluation and assess each case using objectivity and an evidence based medical approach.

DISABILTY EVALUATION:

GENESIS provides our clients with access to a nationwide network of Board Certified physicians in all areas of medical specialty 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.

FMLA/Fitness for Duty Examinations  

GENESIS 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.

Genesis provides our clients with top-rated specialists within our network to help determine what extent of work an employee returning from an FMLA leave is able to perform safely.

Second Opinion Consultation

GENESIS provides Second Medical Opinions to patients and treating physicians in order to get a different point of view regarding surgical necessity, diagnosis, and treatment plans. In many cases, a patient’s insurance carrier will pay for this exam. GENESIS provides patients with Board Certified physicians in all areas of medical specialty.

To Schedule an appointment for Medical Examination or Diagnostic Testing Services at any of our centers contact our Central Scheduling Line at 713.993.0605 or complete our Appointment Scheduling Form.