The Morris Law Firm Blog

May 1, 2014

Texas Workers Compensation, Designated Doctor’s Report

Filed under: Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 6:10 pm

Rule 127.220 of the Texas Administrative Code requires that the report meet the following guidelines:

(1) identify the question(s);

(2) provide a clearly defined answer for each question;

(3) sufficiently explain how the designated doctor determined the answer to each question within a reasonable degree of medical probability;

(4) demonstrate, as appropriate, application or consideration of the American Medical Association Guides to the Evaluation of Permanent Impairment, division-adopted return-to-work and treatment guidelines, and other evidence-based medicine, if available;

(5) include general information regarding the identity of the designated doctor, injured employee, employer, treating doctor, and insurance carrier;

(6) state the date of the examination and the address where the examination took place;

(7) summarize any additional testing conducted or referrals made as part of the evaluation;

(8) include a narrative description of the medical history, physical examination, and medical decision making performed by the designated doctor, including the time the designated doctor began taking the medical history of the injured employee, physically examining the employee, and engaging in medical decision making and the time the designated doctor completed these tasks;

(9) list the specific medical records or other documents the designated doctor reviewed as part of the evaluation, including the dates of those documents and which, if any, medical records were provided by the injured employee;

(10) be signed by the designated doctor who performed the examination;

(11) include a statement that there is no known disqualifying association as described in §127.;

(12) certify the date that the report was sent to all recipients required by and in the manner required by §127.10 of this title; and

(13) indicate on the report that the designated doctor reviewed and approved the final version of the report.

This Rule sates that the above requirements are the minimum that a designated doctor must comply with.  If you feel that your designated doctor did not comply with the above requirements, contact an attorney to assist you in disputing the designated doctor’s report.

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

April 22, 2014

Texas Workers’ Compensation Average Weekly Wage (AWW)

Filed under: Workers' Compensation — Tags: , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 11:12 pm

Texas work related injuries that are handled by the Texas Division of Workers’ Compensation will use your Average Weekly Wage to calculate your disability benefits and impairment benefits.  If your AWW is miscalculated by just a few dollars per week, you could lose hundreds or even thousands of dollars over the life of your claim.

You generally calculate Average Weekly Wage by adding up your gross salary for the thirteen weeks prior to your injury then divided by 13 to get an average.  This calculation should not only include your wage, but also any fringe benefits (i.e. bonuses, insurance, housing, food, clothing, etc.), that are discontinued after the accident.

If there are not thirteen weeks of employment prior to the date of injury, a similar employee may be used or an agreement between the parties.  If you question your average weekly wage, you may request a DWC-3 form which your employer should have provided to the insurance carrier.

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

February 19, 2014

COURSE AND SCOPE OF EMPLOYMENT TEXAS WORKERS COMPENSATION

Filed under: Workers' Compensation — Tags: , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 8:42 pm

There are many hurdles to overcome when dealing with a Texas Workers’ Compensation claim.  One of the earliest hurdles is did the injury occur while in the course and scope of the injured workers’ employment.  Only injuries which occur in the “Course and Scope” of employment will be covered by a Texas workers compensation policy.

The Texas Labor Code defines Course and Scope as “an activity of any kind or character that has to do with and originates in the work, business, trade, or profession of the employer and that is performed by an employee while engaged in or about the furtherance of the affairs or business of the employer.”  The definition allows for a pretty broad scope of activities to be covered.  However, there is a lot of case law which helps to define “activity” and “furtherance of the affairs”.

If there are questions as regarding the course and scope of a particular activity, make sure to consult with a person experienced in Texas Workers’ Compensation law.

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

January 27, 2014

TEXAS WORKERS’ COMPENSATION TEMPORARY INCOME BENEFITS (TIBS)

Filed under: Workers' Compensation — Tags: , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 1:45 am

If you have a compensable injury as a Texas worker, your insurance policy provides for medical and indemnity benefits.  Medical benefits are payments to your medical providers and the indemnity benefits include money for lost earnings and impairments to the injured workers’ body.

Temporary Income Benefits are paid to an injured worker who, as a result of their compensable injury, is unable to obtain and retain employment at equivalent wages.  The injured worker is eligible to receive these benefits until the date of maximum medical improvement.

Temporary Income Benefits are calculated by averaging the thirteen weeks of employment prior to the date of injury.  They are calculated using the gross wages and fringe benefits provided by the employer.  If there are not thirteen weeks of prior wages, a same or similar employee may be used.  The employer should provide a DWC-3 form to calculate Temporary Income Benefits.

It is very common to find errors in the calculation of Temporary Income Benefits.  Have your Temporary Income Benefits reviewed by a person with experience in the Texas Workers’ Compensation system.

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

January 15, 2014

WHAT DO YOU DO WHEN A FAMILY MEMBER IS KILLED ON THE JOB IN TEXAS

Filed under: Workers' Compensation — Tags: , , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 7:35 pm

Texas is the only State in the United States that does not have some form of a mandatory workers compensation law.  Therefore, if a loved one is injured or killed on the job, there will be different avenues to handles that claim depending upon their employer’s insurance.

If their employer is a subscriber to the Texas Workers Compensation System, a DWC-42 form must be filled out to be eligible for death benefits.  The policy will also cover up to $6,000.00 in burial benefits.  Death benefits are paid to the spouse and children of the deceased.  If there is no spouse or children, any dependant family members or immediate family members may be eligible to the death benefit.

If the death was the result of gross negligence, the deceased’s wife or children may file a wrongful death claim in addition to the death benefits.  If it was the result of the negligence of a third party, there may be a claim against that party.

If the employer was a non-subscriber to the Texas Workers Compensation System, a negligence claim may be brought against any liable party.

Daniel L. Morris, The Morris Law 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

November 2, 2013

Texas Workers Compensation Network Report Card 2013

In 2005, the Texas Legislature along with Governor Perry signed HB7 into law.  HB7 created healthcare networks for injured workers in the Texas Workers Compensation system. These networks limited the injured worker’s ability to select their own treating doctor.  The initial review of the networks found that the networks increased medical costs and lowered outcome and satisfaction.

The 2013 Workers’ Compensation Network Report Card Results have been published by the Texas Division of Workers Compensation.  Not much has changed since 2005.  Although a few networks are attempting to provide prompt and qualified care, most provide care that is more expensive with worse outcomes.

As a nation there is a lot of opposition to creating a nationally controlled medical system.  However, the great State of Texas is creating the same type of controlled system for its injured workers.  How can we believe that it may not work on a national level, but force it upon our injured workers?  They have done this even after it is seen that it does not work for our state.  Why do we refuse to give the Texas workers their right to choose their own doctor?

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

September 21, 2013

Texas Workers Compensation, Know Your Rights

Filed under: Workers' Compensation — Tags: , , , , — The Morris Law Firm 702 S. Beckley, Dallas, Texas, 75203 (214)357-1782 @ 12:16 am

When someone suffers a work related injury in Texas, it is extremely important to understand their rights.  Most people depend up the claims administrator or their employer to explain their rights to them.  However, both of those parties may have an adverse position to the injured worker.

If you are injured while in the course and scope of your employment, make sure you know how to handle your claim.  Were you injured through an act of someone not with your employer?  If you are receiving benefits, has your employer included your fringe benefits in the calculation of your Average Weekly Wage?  If you have returned to work at a restricted duty status, are you being paid your pre-injury weekly wage and is your employer abiding by the restrictions?  Does your doctor listen to what you need, or abide by your employer’s instructions?

The above are just a few of the questions you need to answer if you have been injured on the job.  The insurance carriers use attorneys to defend their position.  Should you do any less?

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

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