The Morris Law Firm Blog

April 9, 2013

Exceptions to Finality of Maximum Medical Improvement In Texas Workers Compensation Claims

Filed under: Workers' Compensation — Tags: , , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 11:58 pm

In most Texas Workers Compensation claims, your impairment rating and date of maximum medical improvement becomes final ninety days from the date you receive the certification by verifiable means.  However, there are Statutory exceptions to this found under Texas Labor Code §408.123(f).

The exceptions exist when there is compelling medical evidence of a mistaken medical diagnosis, an undiagnosed condition, improper or inadequate medical treatment or other compelling circumstances.  I’ve already blogged about inadequate treatment in http://themorrisfirm.net/blog/?p=332.

This Statute was clarified regarding medical diagnosis in AP No. 121007 when the Appeals Panel Reversed and Rendered a hearing officer after a finding that Claimant did not meet an exception to the ninety day rule because there was no misdiagnosis before the date that Claimant received the certification by verifiable means.

The Appeals Panel held that there is no requirement in the in §408.123(f)(1)(B) that the previously undiagnosed medical condition must have been present at the time of the first certification of MMI/IR.

The Morris Law firm, (214)357-1782 info@themorrisfirm.net

February 22, 2013

TEXAS WORKERS COMPENSATION IS MY NETWORK DOCTOR TAKING CARE OF ME?

Filed under: Workers' Compensation — Tags: , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 6:59 pm

With the creation of Texas Labor Code §408.031, the Texas Division of Workers’ Compensation, created health care networks to provide treatment for injured workers.  Prior to September 1, 2005, injured workers were able to select their own doctor to provide treatment for their injuries.

Now many injured workers are limited in the selection of doctor that can provide them treatment for their work related injuries.  The injured worker must make a decision if that doctor actually has their best interest in regards to the treatment.  The injured work must ask themselves the following questions:

a)      Does the doctor contact the employer to help make medical decisions;

b)      Does the doctor only treat a portion of the injury, explaining that they must treat one condition then another later;

c)      Does the doctor fail to make referrals for diagnostic testing or to specialist that would help to define or treat the conditions;

d)      Does the doctor fail to place proper restrictions on an ability to work; or

e)      Does the doctor act like the patient is not his first interest?

If a doctor’s priority is not the care and recovery of their patient, it may be time to seek a new doctor.  Although doctors within the networks are very limited by the insurance carriers, there are options.  Attorneys that handle workers compensation claims can assist in finding the doctors whose first concern is for their patient and not only cost control.

Ultimately, the injured worker is in charge of their care.  There are many deadlines that can affect both the financial and medical benefits in a Texas Workers Compensation claim.  Make sure that these deadlines are understood and find assistance that is familiar with them.

The Morris Law Firm info@themorrisfirm.net (214)357-1782

January 21, 2013

MUSCLE GUARDING/SPASMS IN SPINAL INJURIES

We have recently seen a dramatic decrease from designated doctor’s impairment ratings for sprain/strain spinal injuries in Texas Workers Compensation claims.  The Fourth Edition of the AMA Guides generally uses Diagnosis Related Estimate (DRE) Categories to provide for spinal injuries.  Most sprain/strain injuries result in either a DRE Category I or a DRE Category II.

To find a DRE Category I, it must fit under the following description and verification:

The patient has no significant clinical findings, no muscle guarding or history of guarding, no documentable neurologic impairment, no significant loss of structural integrity on lateral flexion and extension roentgenograms, and no indication of impairment related to injury or illness.

The description and verification for a DRE Category II are:

The clinical history and examination findings are compatible with a specific injury or illness.  The findings may include significant intermittent or continuous muscle guarding that has been observed and documented by a physician…

The doctors state that upon examination they found no neurological impairment and no loss of range of motion.  However, they seem to ignore the inclusion of intermittent muscle guarding documented by a physician.

The Appeals Panel finally has provided support for our position that the impairment rating must properly use the AMA Guides.  In Appeals Panel Decision No. 120897, they found that the designated doctor improperly applied the AMA Guides in finding a DRE Category I for a cervical sprain/strain injury.  The Appeals Panel found that to meet the requirements of a DRE Category II, the injury worker need to only meet one of the three differentiators (muscle guarding, muscle spasms or non-uniform loss if ROM).  The differentiator may be present at the time of examination or have been documented by a physician to be used.

This helps to clarify for the doctors that only one differentiator is necessary to find a DRE Category II.  This provides a 5% greater impairment rating than a DRC Category I, which calculates to 15 additional weeks of impairment income benefits.

Daniel L Morris, info@themorrisfirm.net (214)357-1782

September 14, 2012

Bad Faith in the Texas Workers Compensation System

Filed under: Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 6:34 pm

The Texas Supreme Court recently determined that injured workers under the Texas Workers Compensation system do not have a statutory right to sue their insurance carrier for Bad Faith.  The Court had previously determined that injured workers did not have a common law right to sue for Bad Faith.  (Texas Mutual Insurance Company v. Ruttiger, 2012 Tex. LEXIS 501, (Tex. June 22, 2012).

In their decision, the Court agreed with the insurance company’s argument that the New Act (1991) eliminates the need for a judicially imposed cause of action outside the administrative process and other remedies in the Act.  This being said, the Court felt that the Texas Department of Insurance, Division of Workers Compensation was able to give administrative violations for violations done by the injured workers insurance carrier.

As a result of this determination, injured workers need to be more diligent in handling their claims.  Insurance carriers no longer have the threat of a law suit for their actions done in Bad Faith.

We have seen a rise in totally denied claims and hearings to resolve those claims.  Injured workers must have a clear understanding of the burden needed to establish their claim and how to collect the evidence to prove it.  This must be done within strict deadlines set by the Division of Workers Compensation.

Daniel L Morris (214)357-1782 info@themorrisfirm.net

July 16, 2012

TEXAS WORKERS COMPENSATION PURPOSE OF DESIGNATED DOCTOR APPOINTMENTS

Filed under: Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 6:56 pm

The Texas Department of Insurance, Division of Workers Compensation has recently changed some of the purposes and the procedures for the use of designated doctors in dealing with injured workers in the system.  See http://www.tdi.texas.gov/wc/rules/adopted/documents/ddrulesm0712.pdf

Under Texas Administrative Code §270.1, a party may request a designated doctor to resolve questions about the following:

(1) the impairment caused by the injured employee’s compensable injury;

(2) the attainment of maximum medical improvement (MMI);

(3) the extent of the injured employee’s compensable injury;

(4) whether the injured employee’s disability is a direct result of the work-related injury;

(5) the ability of the injured employee to return to work; or

(6) issues similar to those described by paragraphs (1) – (5) of this subsection.

Under the new rule, the Division of Workers Compensation shall deny a request for a designated doctor if the insurance carrier has denied the compensability of the claim or otherwise denied liability for the claim as a whole and the dispute is not yet resolved.  However, a Benefit Review Officer (BRO) or a Hearing Officer (HO) may appoint a designated doctor may order an injured employee for the reason of causation that would require an expert medical opinion expert medical opinion would be necessary to resolve a dispute as to whether the claimed injury resulted from the claimed incident.

Any denial of the request for a designated doctor must be in writing and explain why the request was denied.

Daniel L Morris, The Morris Law Firm, PLLC (214)357-1782

April 18, 2012

Complex Regional Pain Syndrome in Texas Workers’ Compensation Cases

I first started handling Texas Workers’ Compensation claims in 1996.  During my first year of practice, a lady walked into the office that had been diagnosed with Reflex Sympathetic Dystrophy (RSD).  The insurance carrier had accepted injuries to her bilateral hands and wrists, but they were disputing the RSD.

At that time it was difficult to even find doctors that were able to treat her symptoms, let alone assist with the causal connection to her compensable injury.  It required a lot of research into how to help her.  Since then we see a few of these cases per year.

Reflex Sympathetic Dystrophy (RSD) is also known as Complex Regional Pain Syndrome (CRPS) or Causalgia.  It is a chronic progressive neurological condition that can affect your skin, muscles, joints and bones.

Reflex Sympathetic Dystrophy generally arises from limb that has been injured.  This is true even from what appear to be minor sprain/strain injuries to an extremity.

The symptoms include:

-          Burning pain                                                   -Extreme sensitivity

-          Skin color changes                                       -Skin temperature changes

-          Muscle Spasms                                                -Tremors

-          Weakness                                                        -Migraine headaches

-          Excessive sweating

Reflex Sympathetic Dystrophy is difficult to diagnose.  A thorough history and neurological examination should be done.  The medical provider should note if mild sensory stimuli produces severe pain.  The examination should include notation of swelling and vascular reactivity, overgrown and grooved nails, stiff or weak joints and atrophy.

To be found compensable, you must prove by a preponderance that the RSD/CRPS naturally resulted from the compensable injury.

Daniel Morris

The Morris Law Firm, PLLC

(214)357-1782

info@themorrisfirm.net

January 30, 2012

Texas Workers’ Compensation Why Have My Temporary Income Benefits Stopped?

The State of Texas allows employers to voluntarily subscribe to the statutory workers’ compensation program.  If your employer is a subscriber to the Texas Workers’ Compensation program, when you are injured at work and are not able to perform your normal job duties, you may receive Temporary Income Benefits until you reach maximum medical improvement.

If your Temporary Income Benefits have been suspended by the insurance company, it is likely to be for one of the following reasons:

A) Carrier has completed their investigation. Insurance carriers have 60 days to investigate a work related claim.  They should initiate benefits while the claim is pending.  If they began paying your benefits, they may suspend those benefits within 60 days when they’ve completed the investigation.

B) You were released to return to work by your doctor. If your doctor has released you to full duty work, you are not currently entitled to Temporary Income Benefits.  If your doctor places you under restrictions in the future, you may be eligible for Temporary Income Benefits at that time.

C) Your employer made a bona fide offer of employment. If your doctor has you under restrictions, your employer may make you an offer of employment within those restrictions.  This offer must meet the Rules set forth by the Division of Workers’ Compensation.

D) You were found to be at Maximum Medical Improvement. If your doctor or a state designated doctor has found you at maximum medical improvement, your Temporary Income Benefits end.

If your benefits have been suspended for any of the above reasons, you need an attorney.  It may take months to get your benefits re-instated after they have been suspended.  There are now restrictions on how to get a hearing and how many hearings are allowed.  Do not hesitate to get competent advice.

The Morris Law Firm is located in Dallas Texas.  (214)357-1782. email info@themorrisfirm.net

May 1, 2011

Texas Workers’ Compensation Assistance

Filed under: Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 8:08 pm

Once you had a work related injury in Texas, who should you rely upon for help?  Generally, after a work related accident, you will receive a call from an investigator who works for the insurance company.  The investigator will ask a lot of questions; many of which have nothing to do with your injury.  These questions can help a private investigator to find you, or to give the insurance company alternative reasons as to how you may have been injured.

In Texas, the insurance company may assign a nurse case manager to control the medical costs associated with your claim.  Additionally, the insurance carrier may require you to treat with a doctor that is in one of their networks.

Who is on your side of this claim?  The medical expenses of a workers’ compensation claim can become very expensive.  You need to have a medical provider who not only provides the care you need, but will help fight for that care.

How do you find the right medical provider?  How do you know the instructions you receive from the adjuster are in your best interest?  Are your Temporary Income Benefits being paid at the correct rate?  Your recovery and income benefits are too important to risk without experienced advice.

At the Morris Law Firm, we have provided professional assistance to injured workers in Texas.  We work with great medical providers who will have your medical care as their first interest (in or out of network).  We can help to have your claim accepted, start or continue your Temporary Income Benefits, find the proper rate of your income benefits, and discover the extent of your injuries, dispute your date of maximum medical improvement and your impairment rating and we can help with supplemental or lifetime income benefits.

You can reach the Morris Law Firm’s Dallas office at (214)357-1782 or via email at info@themorrisfirm.net.

January 29, 2011

Texas Workers’ Comp Neck & Back Impairment Ratings (DRE V)

As has been previously discussed, neck and back injuries are some of the most common work related injuries in Texas.  The Texas Division of Workers’ Compensation currently uses the 4th Ed. of the AMA Guides to Permanent Impairments.  The DRE category V is the first level where the findings for the neck and back are substantially different.

Neck: The patient has objectively demonstrated a significant upper-extremity impairment requiring the use of upper-extremity external functional or adaptive device(s).  There may be total neurologic loss at a single level or severe, multilevel neurologic loss.  A DRE category V to the cervical spine will yield a 35% whole body impairment rating.

Back: Radiculopathy and loss of motion segment integity.  Significant lower-extremety impairment is indicated by atrophy or loss of reflex(es), numbness with an anatomic basis, or electromyographic findings as in lumbosacral category III and loss of spine motion segment integrity as in lumbosacral category IV.

If you have any questions about your impairment rating or workers compensation claim.  Call the Texas Workers’ Compensation department at the Morris Law Firm (214)357-1782 or email at info@themorrisfirm.net.

January 16, 2011

Texas Workers’ Comp Back Neck Injury Impairments “DRE Category III”

In the previous posts I explained the DRE Categories for neck and back injuries when a Texas Workers when the injured worker suffered a minor impairment to their back or their neck.  Some of the most common injuries to workers in the state of Texas are to their neck and back.

The Division of Workers’ Compensation uses the Fourth Edition of The AMA Guides for Permanent Impairments for workers’ compensation injuries.  When the injured worker gets to a DRE category III, it is because there is radiculopathy.

For a Texas Workers’ Compensation claimant to qualify for a DRE category III, the patient will have significant signs of radiculopathy, such as loss of relevant reflex(es), or measured unilateral atrophy of greater than 2 cm above or below the knee, compared to measurements on the contralateral side at the same location.  The impairment needs to be verified by electrodiagnostic findings.

A DRE category III to the neck will yield a 15% impairment rating, which will qualify the injured worker to supplemental income benefits.  A DRE category III to the back will yield a 10% impairment rating.  To receive a DRE category III, the proper diagnostic testing must be done.  Do not allow a medical provider that does not have your best interest or is not experienced with Texas Workers’ Compensation claims.

If you have questions about your impairment rating or any Texas Workers’ Compensation Claim, do not hesitate to contact the Morris Law Firm at (214)357-1782 or via email at info@themorrisfirm.net.

Powered by WordPress