The Morris Law Firm Blog

May 5, 2013

Texas Workers Compensation (Rate the Entire Injury)

Filed under: Workers' Compensation — Tags: , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 11:41 pm

The Texas Division of Workers Compensation has recently decided that to have an acceptable rating, they must rate every condition of the compensable injury.  This is a big benefit to Texas injured workers, who have seen many ratings ignore their injuries.

The Appeals Panel Number 121029, the Panel Reversed and Remanded the hearing officer after the two doctors who provided certified reports failed to include a contusion to the jaw, which was accepted as part of the compensable injury.  The AP found that since the doctor’s impairment rating did not consider the entire compensable injury when providing the impairment rating, that certification could not be adopted.

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

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

January 21, 2013

MUSCLE GUARDING/SPASMS IN SPINAL INJURIES

Filed under: Workers' Compensation — Tags: , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 8:05 pm

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

April 30, 2012

TEXAS WORKERS COMPENSATION DWC-69

Filed under: Workers' Compensation — Tags: , , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 7:40 pm

I was in a Contested Case Hearing this week.  The issue before the hearing officer was maximum medical improvement and impairment rating.  We had a DWC-69 from the treating doctor that said the claimant was not yet at maximum medical improvement.  The insurance company had a 5% impairment from a post DD RME.

Finally, we had the DD (Designated Doctor), who had a DWC-69 with a 5%.  But in the body of his report, the DD stated that the actual impairment was a 15%.  He went on to state that his previous report included the causation of the full injury and all together it should be 15%.  The 5% was for what the insurance company’s letter stated was compensable.

Thank you Matt Lewis (www.dallasworkcomp.com) for sending me over the Appeal Panel number I needed during the hearing.  I remembered the nature of the case.  But, I couldn’t remember the number and I was with a new judge who didn’t know it.

Appeals Panel Decision No. 111393 states that although there was no DSC-69 in evidence to support the hearing officer’s decision.  However, the Appeals found that it was proper for the hearing officer to rely upon the evidence in the medical records.

With all the pressure that the Division of Workers Compensation is placing on the Designated Doctors, it is nice to see that we can actually look at the reports and not just a form with the blanks filled in.

Daniel L Morris

The Morris Law Firm

(214)357-1782

info@themorrisfirm.net

October 10, 2011

Disputing Maximum Medical Improvement and Impairment Ratings in Texas Workers’ Compensation Claims

Filed under: Workers' Compensation — Tags: , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 8:16 pm

The Appeals Panel for the Texas Division of Workers’ Compensation has just made it more difficult for both parties to dispute maximum medical improvement and impairment ratings for workers’ compensation injuries.  In Appeal No. 111006-S, the Panel reversed a rendered the judge’s decision and found that the insurance carrier failed to comply with Rule §141.1(d).

In the case, the injured worker had a pending appointment with the designated doctor, when he received an impairment rating from the treating doctor.

The insurance carrier filled out the Request for a Benefit Review Conference to preserve the 90 day window to dispute.  However, they failed to provide documentation of efforts to resolve the disputed issues before requesting the Benefit Review Conference.

Therefore, the Appeals Panel found that the insurance carrier failed to submit a complete request and the date of maximum medical improvement and the impairment rating from the treating doctor became final.

The Division of Workers’ Compensation is strictly applying the rules regarding disputing impairment ratings.  If you are not in agreement with your date of maximum medical improvement and/or your impairment rating, make sure that you complete all the requirements to maintain your dispute.

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

June 7, 2011

TEXAS WORKERS COMPENSATION INJURIES FROM THERAPY

Filed under: Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 5:51 pm

Many workers injured at work in Texas go through extensive physical therapy.  What happens when a patient is treating for a workers compensation injury and suffers another injury going through therapy?

In a Texas Workers’ Compensation claim, the injury is not limited to the conditions affected at the time of the injury.  But, includes any conditions naturally arising out of the compensable injury.  This includes medical treatment for the compensable injury which causes damage to the physical structure of the body.

If you are injured during physical therapy, or while receiving medical treatment for your compensable injury, your insurance carrier is liable for the treatment to relieve the effects of the injury.  Additionally, if this portion of your injury creates a permanent impairment, make sure it is included in your impairment rating.

If you have any questions about your workers compensation claim, contact the Dallas office of the Morris Law Firm at (214)357-1782 or via email at info@themorrisfirm.net.

February 4, 2011

TEXAS WORKERS COMP NECK & BACK IMPAIRMENTS (DRE CAT VI)

Filed under: Workers' Compensation — Tags: , , , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 10:37 pm

Work related injuries in Texas are generally handled through the Texas Department of Insurance, Division of Workers’ Compensation.  In the last few blogs we have discussed impairment ratings to injured workers’ neck and back.  Injured workers whose neck or back injuries result in cauda equina syndrome without bowel or bladder impairment are at a DRE category VI.

For a injured worker to be found at a DRE category VI under the Texas Workers’ Compensation system, he/she must have a verified, severe impairment, with partial loss of use of one or both upper/lower extremities that require the use of an external ambulation device.  If an ambulatory device is not necessary, the injured worker is at a DRE category V.

If you have questions about your impairment rating or any Texas Workers’ Compensation issue, call the Morris Law Firm at (214)357-1782 or email us at info@themorrisfirm.net.

January 29, 2011

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

Filed under: Workers' Compensation — Tags: , , , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 11:23 pm

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 24, 2011

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

Filed under: Workers' Compensation — Tags: , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 4:35 am

Neck and back injuuries are some of the most common injuries seen in the Texas Wokers’ Compensation system.  For a Claimant to received a DRE Category IV for their neck or back impairment, there must be a loss of motion segment integrity or multilevel neurologic compromise.

The patient has loss of motion segment or structural integrity or bilateral or multilevel radiculopathy.  Loss of structural integrityis defined as more than 3.5 mm of translation of one vertebra on another, or angular motion at one motion segment that is more than 11 degrees greater than the angular motion at an adjacent motion segment.  Radiculopathy as defined in category III, if present, should be bilateral or involve several levels.  A documented history of muscle guarding and pain should be present.

If you have questions about your impairment rating or your workers compensation claim, call the Dallas office at (214)357-1782 or via email at info@themorrisfirm.net.

January 16, 2011

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

Filed under: Workers' Compensation — Tags: , , , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 3:01 am

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.

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