Appeals Panel Clarifies MMI/IR Requirements

The Appeals Panel has reversed a hearing officer’s determination that a designated doctor’s certification could not be adopted. In so doing, the appeals panel also held that a certification of MMI that was internally inconsistent (the narrative contained one date while the DWC-69 recited a different date) could not be adopted. In Appeals Panel Decision Number 151803, the appeals panel first explained that the hearing officer had improperly rejected the designated doctor’s certification: “Although he did not specifically state in his narrative report that he assigned a 1% impairment for 70 degrees of internal rotation, Dr. B clearly included this impairment in his 7% UE impairment.”

The Appeals Panel next rejected the adoption of one of the remaining certifications that had been admitted into evidence because of the internal inconsistency.

The remaining MMI/IR certification in evidence is from (Dr. C), a referral doctor acting in place of the treating doctor. Dr. C examined the claimant on April 15, 2015, and in a DWC-69 dated April 16, 2015, Dr. C certified that the claimant reached statutory MMI on “[September 5, 2014],” with a 15% IR. However, in her narrative report Dr. C opined that the claimant reached “[s]tatutory [MMI] on [September 15, 2014].” Dr. C does not state in her narrative report that she opined the claimant reached statutory MMI on September 5, 2014. We note that the parties did not stipulate or discuss the date of statutory MMI at the CCH. There is no DWC-69 in evidence from Dr. C certifying that the claimant reached MMI on September 15, 2014. There is an internal inconsistency between the MMI date Dr. C certified in her narrative report and the MMI date Dr. C certified on the DWC-69. Accordingly, Dr. C’s MMI/IR certification cannot be adopted. See Appeals Panel Decision (APD) 141281, decided August 7, 2014.

Don’t assume that a certification of MMI by any doctor is valid without verifying that the date of MMI listed on the DWC-69 is the same date certified as the date of MMI in the doctor’s narrative report.