The Texas Department of Insurance (Department), Division of Workers’ Compensation (Division) has adopted amendments to Rule §130.1, concerning Certification of Maximum Medical Improvement (MMI) and Evaluation of Permanent Impairment.
The purpose of these adopted amendments is to clarify the consequence of noncompliance with 28 Texas Administrative Code (TAC) §130.1(c)(3). The adopted amendments to §130.1(c)(3) clarify that an impairment rating is invalid if it is based on the injured employee’s condition on a date that is not the maximum medical improvement (MMI) date. The adopted amendments reiterate the Division’s interpretation of §130.1(c)(3) since 2004. These adopted amendments further clarify that an impairment rating and its corresponding MMI date must be on a Report of Medical Evaluation to be valid.
The Division contends that these amendments are necessary to implement Labor Code §408.123, concerning Certification of Maximum Medical Improvement; Evaluation of Impairment Rating. The Division interprets §130.1(c)(3) to require an impairment rating to be based on the MMI date for the impairment rating to be adoptable, as found in Appeal No. 040514 (4/28/2004), Appeal No. 070867 (7/6/2007), and Appeal No. 071398 (9/28/2007 These amendments reiterate the Division’s longstanding position that in accordance with the Act, an impairment rating is valid only when it is assigned and tied directly to an injured employee’s certified date of MMI. Division rules implementing the Act do not allow matching one doctor’s certified MMI date on a report and an assigned impairment rating from another report. Consequently, the finder of fact cannot match a doctor’s certified MMI date from one report with an assigned impairment rating from another report.
The amendments provide that an impairment rating based on a date other than the MMI date is invalid and cannot be adopted for settlement, at hearing, or at trial.
Statutory objectives require that the impairment rating be based upon an injured employee’s condition on the date of MMI.
James L. Williams, Jr.
Williams, Lacy, McClure & Parmelee
Williams, McClure & Parmelee is dedicated to high quality legal representation of businesses and insurance companies in a variety of matters. We are experienced Fort Worth, Texas workers’ compensation attorneys in Tarrant County who know Texas courts and Texas law. For more information, please contact the law firm at 817-335-8800. The firm’s office location is 5601 Bridge Street, Suite 300, Fort Worth, Texas 76112.