The Morris Law Firm Blog

February 6, 2014

TEXAS WORKERS COMPENSATION: MAXIMUM MEDICAL IMPROVEMENT

Filed under: Workers' Compensation — Tags: , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 7:42 pm

If you are dealing with a work related injury in Texas, you will quickly find out that the administrative system puts a lot of importance on dates.  There are many deadlines that must be complied with and dates which change how your claim will be handled.

Probably the most important and most litigated date is the date of Maximum Medical Improvement, commonly referred to as MMI.  The Division of Workers’ Compensation Rules define Maximum Medical Improvement as:

The earliest date after which, based on reasonable medical probability, further material recovery from or                             lasting improvement to an injury can no longer reasonably be anticipated

The date may not be after 104 weeks from the accrual date of disability, unless it is extended due to spinal surgery.

After the date of Maximum Medical Improvement, the injured worker is no longer eligible to receive Temporary Income Benefits.  You will receive your date of Maximum Medical Improvement on a DWC-69 form.  If you are not in agreement with this date, you have ninety days to dispute it from the date you receive it by verifiable means.

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

November 19, 2013

Impairment for Cauda Equina Syndrome In Texas Workers Compensation

Filed under: Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 3:20 pm

The Appeals Panel of the Texas Workers Compensation recently published an appeal regarding a claimant that had been diagnosed with Cauda Equina Syndrome.  This syndrome occurs when the nerve bundles of the lumbar region of the spine.  The nerve roots are compressed and paralyzed, cutting off sensation and movement. Nerve roots that control the function of the bladder and bowel are especially vulnerable to damage.

The hearing officer found that although the compensable injury included Cauda Equina Syndrome, but that it did not include bowel dysfunction.  It appears that the hearing officer had to choose from an impairment rating that included radiculopathy without Cauda Equina Syndrome (DRE Cat III), or an impairment rating that included Cauda Equina Syndrome, but also included bowel dysfunction (DRE Cat VII).

The hearing officer stayed on the conservative side and found the DRE Cat III, which yielded a 10% impairment rating.  Claimant appealed and the Division’s Appeals Panel reversed the decision and remanded it back to the hearing officer to get an impairment rating which included all the compensable conditions in the rating.

This case establishes that not only must an impairment rating provide a rating for each of the different conditions; it must rate the entire extent of those conditions.  The rating must be based upon the injured workers condition on the date of maximum medical improvement.  (Appeals Panel Decision No. 132173).

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

October 15, 2013

How to Dispute My Texas Workers Comp Impairment Rating

Filed under: Workers' Compensation — Tags: , , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 2:30 am

The Rules for Texas Workers Compensation injuries provide that the first valid certification must be disputed within 90 days of receipt by verifiable means.  If the certification is from a designated doctor, it may be disputed by filing a DWC-45 (Request for a Benefit Review Conference) disputing the impairment rating.  If the certification is from another doctor, it may be disputed by either filing the DWC-45 or by filing a DWC-32 (Request for a Designated Doctor) for maximum medical improvement and impairment rating.

There are currently many exceptions to the 90 day rule to dispute the impairment rating.  These exceptions can be very tricky and you should consult with an attorney before making any decisions regarding the dispute.  Once the decision is determined final, you cannot reopen the dispute.  Therefore, make sure that you use the right exception to dispute any rating after the 90 has run.

To dispute a rating, make sure that you have an alternative rating that abides by the AMA Guides and includes the entire compensable injury.  There are deadlines for exchanges of evidence, so it is best that you have the alternative rating prior to requesting any hearing.

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

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

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

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.

September 15, 2011

Texas Workers’ Compensation Not Ready for Maximum Medical Improvement

Filed under: Workers' Compensation — Tags: , , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 9:55 pm

I know that most of the Texas Workers’ Compensation news seems to limit benefits and injured workers’ rights within the system.  However, once in a while a ray of light shines in and gives us a glimmer of hope.  One of these recent rays was provided by the Texas Workers’ Compensation Appeals Panel.

In Appeal No. 110670, the Division of Workers’ Compensation found that “it is impossible for a claimant to have reached MMI, since he has only had a minimal trial of post-operative care.”  In this case, the Appeals Panel overturned the findings of a designated doctor in finding maximum medical improvement, prior to the injured worker attending a pre-authorized chronic pain management program.  This allowed the injured worker to continue to receive Temporary Income Benefits (TIBs), while off work.

It is nice to see that in spite of all the forces trying to push injured workers out of the system prior to substantial recovery, there are still avenues for the injured worker to claim the statutory benefits for which his labor paid the insurance premiums.

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.

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