Title: 

APD 011030

Significant Decision

Date: 

June 20, 2001

Issues: 

Other Income Benefit Issue

Table of Contents

APD 011030

This appeal arises pursuant to the Texas Workers’ Compensation Act, TEX. LAB. CODE ANN. § 401.001 et seq. (1989 Act). Following a contested case hearing held on March 29, 2001. The hearing officer resolved the disputed issues by finding that on February 1, 2000, the appellant (claimant) abandoned the appointment for his required medical examination (RME) without good cause and that the RME was completed on May 2, 2000; and by concluding that because the claimant did not have good cause for not attending the RME, he is not entitled to temporary income benefits (TIBs) from February 2, 2000, through May 1, 2000. The claimant appeals, asserting essentially the same facts he testified to below. The respondent urges the sufficiency of the evidence to warrant our affirmance.

DECISION

Affirmed.

The claimant testified that when he presented himself for the RME by Dr. S at the appointed hour on February 1, 2000, he was expecting to undergo a physical exam; that he was “suspicious” about going to this office in the first place because of the adjuster’s attitude towards his claim and when he was asked to complete some “paperwork” before the exam, he felt he should review the documents with his attorney first; that Dr. S’s staff agreed to fax the documents to his attorney and also offered to let him use the office phone to call his attorney; and that he decided to leave the office and use a phone elsewhere. The claimant further stated that he spoke to one of his attorney’s employees and was advised that the paperwork was routine and to go ahead and complete it; and that when he returned to Dr. S’s office, he was advised that the time set aside for his RME had expired; that Dr. S had to leave for other medical duties; and that he would have to make another appointment. Dr. S wrote that it was his recollection that the claimant left his office a second time, still refusing to complete the forms after they were faxed to his attorney’s office; and that the claimant had not returned before he had to leave to make medical rounds. The claimant stated that he was not able to obtain another appointment until May 2, 2000. He agreed that he spoke to an employee of the Texas Workers’ Compensation Commission on March 17, 2000, but denied information in a Dispute Resolution Information System note to the effect that he had missed a rescheduled appointment with Dr. S on March 2, 2000.

Tex. W.C. Comm’n, 28 TEX. ADMIN. CODE § 126.6(h) (Rule 126.6(h)) provides that a carrier may suspend TIBs if an employee fails to attend an RME without good cause. The hearing officer stated that the claimant’s failure to reasonably cooperate with Dr. S by completing the intake documents preparatory to the actual physical exam was tantamount to a failure to attend the exam and that the claimant therefore forfeits his TIBs for the period February 2 through May 1, 2000. We are satisfied that the hearing officer did not abuse his discretion in determining that the claimant did not establish good cause for not undergoing the RME and that the challenged factual determinations are not so against the great weight and preponderance of the evidence as to be clearly wrong or manifestly unjust. Cain v. Bain, 709 S.W.2d 175, 176 (Tex. 1986); In re King’s Estate, 150 Tex. 662, 244 S.W.2d 660 (1951).

The decision and order of the hearing officer are affirmed.

Philip F. O’Neill – Appeals Judge

CONCUR:

Elaine M. Chaney – Appeals Judge

Michael B. McShane – Appeals Judge