GQ Corner
Q. We have a claimant approaching statutory MMI and it appears he may be approved for back surgery in the near future. What are the general rules concerning extension of statutory MMI? Does the claimant have to apply or should we automatically extend it?
A. Texas Labor Code Section 408.104 and Rule 126.11 address the extension of statutory MMI and provide that, on application by the injured worker or insurance carrier, the commissioner by order may extend the 104-week period if the employee has had spinal surgery or been approved for spinal surgery within 12 weeks before the expiration of the 104-week period. The claimant generally fills out an application (the DWC-57 form) and sends it to the Division for consideration. Either party may dispute the Commissioner Order by requesting a BRC within ten days of the receipt of the order.
Q. We received a Decision & Order conveying determinations that the claimant had disability from the day after the date of injury “and continuing through the date of the hearing” thereafter. Should we continue temporary income benefits (TIBs) beyond the CCH date absent any other defenses?
A. Yes. The Administrative Law Judge does not have jurisdiction to find disability and order the payment of benefits after the date the CCH record closes, which is generally the date of the CCH. However, TIBs should continue beyond that date in the absence of some independent defense arising out of changed circumstances, such as a full duty work release, the claimant returning to work at full wages, or certification of MMI.
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