Appeals Panel Reverses Hearing Officer’s MMI Determination

The appeals panel posted a new decision on the Division’s website on June 5, 2015. In Texas Division of Workers’ Compensation Appeals Panel Decision No. 150341 the appeals panel reversed a hearing officer’s decision that the claimant had reached MMI on a particular date. The appeal was taken by the claimant.

A designated doctor’s certification of MMI and assignment of impairment rating is contrary to the preponderance of the evidence and cannot be adopted where the doctor states that there is no documentation to suggest a follow-up ESI had been prescribed or recommended, or that any surgical or treatment procedure was pending after a certain date, when, in fact, one medical report stated that the claimant had zero relief from a repeat ESI injection and opined that a surgical consultation was recommended, while a second medical report stated that the claimant has failed conservative treatment and recommended lumbar spine surgery.

In this case the designated doctor did not have all the medical records to determine the date that the claimant reached MMI. Therefore, his certification that the claimant reached MMI was contrary to the preponderance of the evidence and cannot be adopted.

The certification of MMI in this case was made by a designated doctor. This case highlights the importance of providing the designated doctor with all relevant medical records in existence at the time of his examination.