Texas Workers' Compensation

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§ 130.2. Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by the Treating Doctor

(a) A treating doctor shall either examine the injured employee (employee) and determine if the employee has any permanent impairment as a result of the compensable injury as soon as the doctor anticipates that the employee will have no further material recovery from or lasting improvement to the work-related injury or illness, based on reasonable medical probability, or have another authorized doctor do so.

(1) A treating doctor who finds that the employee has permanent impairment but who is not authorized to assign impairment ratings as provided in § 130.1 of this title (relating to Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment), shall make a referral to a doctor who is authorized to do so on behalf of the treating doctor. Even if the treating doctor is so authorized, the doctor may choose to have another authorized doctor evaluate the employee for maximum medical improvement (MMI) and impairment in the place of the treating doctor. However, this evaluation shall be considered to be the report of the treating doctor.

(2) Other than subsections (c) and (d) of this section, nothing in this section requires a treating doctor to schedule an examination if the employee has been released from treatment and is not receiving temporary income benefits (TIBs). For example, when the patient is treated and released without further treatment for a minor injury, the treating doctor is not required to schedule and conduct an examination for MMI and permanent impairment.

(3) At the conclusion of an examination in which the treating doctor, or the certifying doctor in the event that the treating doctor is not authorized to certify MMI and assign an impairment rating, determines that the employee has reached maximum medical improvement and assigns an impairment rating, the doctor shall provide the employee with a written notice that the certification may be disputed. The notice shall be provided as a separate document included with the Report of Medical Evaluation provided in accordance with § 130.1 of this title. The notice must be provided in English, Spanish, or other language common to the employee, and shall include the following information:

(A) the date of maximum medical improvement;

(B) the assigned impairment rating;

(C) a statement that the impairment rating may become final if not disputed within 90 days, and if the employee, or the employee’s representative, disagrees with the certification, they may dispute the certification by contacting the Division of Workers’ Compensation and requesting a benefit review conference;

(D) the address and phone number of the local field office of the Division of Workers’ Compensation (Division); and

(E) a statement that the employee may contact the Division for more information at 1-800-252-7031.

(b) A certification of MMI and assignment of an impairment rating shall be performed and reported in accordance with the requirements of § 130.1 of this title.

(c) The Division shall mail a notice to a treating doctor, the employee, the employee’s representative, if any, and the insurance carrier on the expiration of 98 weeks from the date the employee’s TIBs began to accrue if the employee is still receiving TIBSs. The Division’s notice shall advise the treating doctor of the requirements under Chapter 408, Subchapter G of the Texas Workers’ Compensation Act, and this section, and require that an impairment rating report be mailed to the Division no later than 104 weeks from the date TIBs began to accrue.

(d) Upon receipt of the Division’s notice required in subsection (c) of this section, the treating doctor shall schedule and conduct an examination of the employee in accordance with § 130.1 of this title to certify a MMI date (if earlier than the statutory MMI date as defined in § 130.4 of this title (relating to Presumption that Maximum Medical Improvement (MMI) has been Reached and Resolution when MMI has not been Certified) and to assign an impairment rating. A treating doctor who is not authorized to certify MMI and assign impairment ratings, shall make a referral to a doctor who is authorized to do so on behalf of the treating doctor.

(e) If the carrier has not received a report of medical evaluation by the date of statutory MMI:

(1) the carrier may suspend TIBs and is not required to initiate impairment income benefits (IIBs) until such time as it receives a report of an impairment rating assigned in accordance with § 130.1 of this title;

(2) the carrier or the employee may request the appointment of a designated doctor under § 126.7 of this title (relating to Designated Doctor Examinations: Requests and General Procedures); and/or

(3) a carrier may make a reasonable assessment of what it believes the true impairment rating should be and, if it does so, shall initiate IIBs within five days of making the assessment. The carrier shall continue to pay IIBs until the assessment is paid in full or is superceded by an impairment rating assigned in accordance with § 130.1 of this title.

The provisions of this § 130.2 adopted to be effective March 7, 1991, 16 TexReg 1194; amended to be effective January 2, 2002, 26 TexReg 10910; amended to be effective January 1, 2007, 31 TexReg 6366.

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Title:

§ 130.2. Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment by the Treating Doctor

Title:

Title 28. Insurance

Status:

Current

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