28 Tex. Admin. Code § 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.
Notes
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