Current through Reg. 49, No. 38; September 20, 2024
(a) The
certifications and assignments that may become final are:
(1) The first valid certification of MMI
and/or IR assigned or determination of no impairment;
(2) The first valid assignment of IR after
the expiration of 104 weeks from the date income benefits begin to accrue or
the expiration date of any extension under Section 408.104, if the employee has
not been certified as having reached MMI; or
(3) The first valid subsequent certification
of MMI and/or assignment of an IR or determination of no impairment received
after the date a certification of MMI and/or assignment of an IR or
determination of no impairment is overturned, modified or withdrawn by
agreement of the parties or by a final decision of the commission or a
court.
(4) A designated doctor may
provide multiple IRs if there is a dispute over extent of injury. Whichever
rating from the designated doctor applies to the compensable injury once an
extent of injury (EOI) dispute has been resolved may become final if not
disputed. An EOI dispute does not constitute a dispute of the MMI/IR for
purposes of finality under this subsection.
(b) A first MMI/IR certification must be
disputed within 90 days of delivery of written notice through verifiable means,
including IRs related to EOI disputes. The notice must contain a copy of a
valid Form TWCC 69, Report of Medical Evaluation, as described in subsection
(c). The 90-day period begins on the day after the written notice is delivered
to the party wishing to dispute a certification of MMI or an IR assignment, or
both. The 90-day period may not be extended.
(1) Only an insurance carrier, an injured
employee, or an injured employee's attorney or employee representative under
150.3(a) may dispute a first certification of MMI or assigned IR under
§141.1 (related to Requesting and Setting a Benefit Review Conference) or
by requesting the appointment of a designated doctor, if one has not been
appointed.
(2) Use of the TWCC 69's
non-concurrence section is not a prescribed form and manner for a
dispute.
(3) A dispute may not be
revoked or withdrawn to allow the first valid certification of MMI and/or the
first valid assignment of IR to become final except by agreement of the
parties.
(4) The first
certification of maximum medical improvement and/or impairment rating may be
disputed after the 90-day period as provided in §
408.123(e)
of the Texas Labor Code.
(c) A certification of MMI and/or IR assigned
as described in subsection (a) must be on a Form TWCC 69, Report of Medical
Evaluation. The certification on the Form TWCC 69 is valid if:
(1) There is an MMI date that is not
prospective;
(2) There is an
impairment determination of either no impairment or a percentage impairment
rating assigned; and
(3) There is
the signature of the certifying doctor who is authorized by the Commission
under §130.1(a) to make the assigned impairment determination.
(d) This section applies only to
those claims with initial MMI/IR certifications made on or after June 18,
2003.
