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The general rule in the Texas system is that if a hearing officer determines a Claimant is not at MMI as of a specific date, then the Claimant cannot, as a matter of law, later be placed at MMI on or prior to that date.See Decision Nos. 131674, 140982, and 131655. However, in Decision No. 162510, filed on February 10, 2017, the Appeals Panel held that such certification must still be timely disputed invalid for purposes of determining whether the certification became final.
In this decision, the Appeals Panel acknowledged that in a prior, final decision and order dated January 16, 2016, a hearing officer had determined that Claimant did not reach MMI on November 18, 2015. Claimant was subsequently sent to a designated doctor who certified on April 1, 2016, that Claimant reached MMI on May 22, 2015 – a dateprior to the date the hearing officer determined Claimant had not reached MMI. The April 1, 2016 certification was the first certification of MMI after the prior first certification was overturned by the DWC.
Claimant failed to timely dispute within 90 days the April 1, 2016 certification, which was now, the first valid certification of MMI.The Appeals Panel rejected Claimant’s argument that the April 1, 2016 could not be adopted as a matter of law.
“The fact that the certified date of MMI of May 22, 2015, is prior to the previous decision holding the claimant had not reached MMI as of November 18, 2015, has no bearing upon whether or not the certification became final.”
The parties must always dispute the first certification of MMI/IR if the certification is, as a matter of law, not adoptable. –Dan Price, SLS, LLP.