| 02-01 |
10-25-01 |
Section 408.125(d) requires the Commission to adopt the impairment rating of the designated doctor if the injured employee and the carrier have agreed upon a doctor instead of using the designated doctor chosen by the Commission. Now the carrier does not agree with the percentage of impairment given and wants a letter of clarification.
Do we write to the designated doctor? Is the request for the letter of clarification considered a dispute? If we write the designated doctor and he changes his impairment rating, would the Commission adopt this new rating? |
11-06-01 |
408.125(d) does not include any allowances or procedures for disputes after the parties have chosen the designated doctor; the commission shall adopt the impairment rating made by the designated doctor. |
| 02-02 |
11-07-01 |
An injured employee is prescribed medicine (narcotics, AKA - pain pills) for their workers' compensation injury. These Medicines caused the injured employee confusion and he/she could not remember from one dose time to another, resulting in an accidental overdose. The patient had to be taken to the Emergency room and treated for the overdose. The hospital is billing the injured employee.
Shouldn't this be covered as being related to the W/C claim as would treatment for an injury while receiving treatment? |
11-13-01 |
Yes, based on the facts provided, an injury sustained during treatment for a compensable injury is also compensable. |
| 02-03 |
11-13-01 |
Initial Certification of MMI/IR was prior to 10-15-01 using the 3rd Edition. Carrier disputed and the designated doctor finds not at MMI. Subsequent certification is now to be done after 10-15-01 by the treating doctor. Should the new rating be done using the 3rd or 4th Edition and if disputed which Edition would the designated doctor use? |
11-19-01 |
Refer to Advisory 2001-08 for the determination of which Guides to use when assigning an impairment rating. In the few cases described in the question that may occur during the transition from the 3rd edition second printing, February 1989 to the 4th edition, the following direction is provided:
The designated doctor certification that the injured employee has not reached MMI does not constitute either the withdrawal by agreement of a prior MMI/IR certification under the 3rd Edition or having a prior MMI/IR certification under the 3rd Edition overturned by a final decision. Therefore, the subsequent certifications should be under the 3rd Edition.
However, if the parties confirm that their failure to pursue the MMI issue further after the designated doctor's decision constituted their agreement to withdraw the dispute, the 4th Edition should be used for subsequent certifications. |
| 02-06 |
3-21-02 |
TWCC staff delayed the approval of reduction of TIBs for seasonal adjustment and the carrier overpaid TIBs as a result. Can the carrier recoup the overpayment from TIBs for the seasonal adjustment?
Claim Information: On May 29th the carrier requested to reduce for seasonal adjustment from 5-29-01 to 8-31-01. On 11-16-01 the OAO approved the reduction from $230.00 per week to $80.00 per week for the 11 week period. |
04-16-02 |
Yes, the carrier is entitled to reduce TIBs for the eleven week period approved by the commission on 11-16-01for seasonal adjustment. |
| 02-09 |
04-17-02 |
TWCC-32's are being received that are signed by an adjuster/attorney of the board rep and not the handling adjuster. Should these be denied since the handling adjuster is not signing the form? |
04-23-02 |
As long as the form is signed by an adjuster/attorney that is a representative of the insurance company, it does not have to be the handling adjuster. The party signing the TWCC-32 is deemed to be guaranteeing the validity of the information on the matrix and if it is not valid, that person will be held responsible. |
| 02-10 |
04-19-02 |
An injured employee reached statutory MMI on May 15, 2001. In January of 2002 the first certification was done using the 3rd edition. A designated doctor was selected and instructed to use the 4th edition to perform the impairment evaluation. Since stat mmi was reached on May 15, 2001, which edition should be used? |
04-23-02 |
The statutory MMI date would have no bearing on the edition to be used. According to Rule 130.1(c)(2)(B) since the first evaluation was held after October 15, 2001, all certifications should have been done using the 4th Edition. |
| 02-12 |
04-26-02 |
If an injured employee receives an extension of MMI because of a pending spinal surgery, and then decides to not have the surgery. Is the extension of MMI null and void? |
05-18-02 |
If the injured employee decides not to have the surgery, the carrier may request a BRC and the Commission will determine if the order for extension should be rescinded on a case by case basis. |
| 02-13 |
06-11-02 |
When a field office is requesting a designated doctor appointment, would it be appropriate to fax the entire TWCC-32 to the designated doctor or should only the first page be sent? |
06-08-02 |
Only the first page should be sent as the matrix is only a tool for the commission to use in choosing the doctor. |
| 02-16 |
07-11-02 |
Would the match that an employer makes in a 401 K plan be considered a fringe benefit, i.e. the employee puts in $100 and the employer matches the $100? Would vested or not vested play a part in this? |
07-23-02 |
Employer matches to 401k plans are considered a pecuniary fringe benefit that vest on the effective date of payment to the 401k plan. |
| 02-17 |
08-08-02 |
ยง 410.006 states that a claimant may be assisted by an individual of the claimant's choice who does not work for an attorney or receive a fee. Does this section of the law prohibit an individual, who works part time for an attorney, from assisting an un-represented claimant at a BRC, even though that attorney has no connection to the claimant? |
|
Yes, unless that person is related to the claimant. The statute makes an exception for a relative as long as no fee is paid. |
Texas Department of Insurance
