IR Certification Became Final Despite Absence of Extent of Injury Dispute
On June 9, 2015 the Division of Workers’ Compensation appeals panel issued a new decision that construes the 90-day rule of finality for certifications of MMI and impairment ratings. The decision has been designated as a “significant decision.”
In Texas Division of Workers’ Compensation Appeals Panel Decision No. 150457-s the panel held that a doctor’s “failure to rate a medical condition to which the parties have stipulated at the CCH to be included in the compensable injury does not, by itself, constitute compelling medical evidence of a significant error in applying the appropriate AMA Guides under Section 408.123(f)(1)(A).”
The appeals panel relied upon two prior decisions in reaching its conclusion.
First, it noted that under Texas Division of Workers’ Compensation Appeals Panel Decision No. 132594-s, it had previously held that although a subsequent resolution of the extent of the compensable injury may be an element of one of the three exceptions contained in Section 408.123(f), that resolution in and of itself was not an exception to finality. The appeals panel reasoned that there was “no provision in either Section 408.123 or Rule 130.12 that provides that the exclusion of a condition in an assignment of IR constitutes an exception for finality,” and it declined to read any such interpretation in those provisions and declined to follow any prior cases that may have read such an interpretation.
Second, it considered the holding of Texas Division of Workers’ Compensation Appeals Panel Decision No. 132117 (a decision that has not been designated as a “significant” decision.) In that case, the appeals panel held that a certifying doctor’s impairment rating that included a condition that was not determined to be a part of the compensable injury could become final even when the extent of the compensable injury was not in dispute.
Therefore, the appeals panel in Appeals Panel Decision No. 150457-s adopted the holding that it had announced in Appeals Panel Decision No. 132117 and made this now considers this holding to be “significant.” It is now clear that a certification of MMI and impairment rating that includes a noncompensable body part can become final under the 90-day rule even though the extent of injury is not in dispute. A hearing officer’s determination that such a certification has not become final on this basis is legal error.
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