Current through Reg. 49, No. 38; September 20, 2024
(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.
