This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). A contested case hearing (CCH) was held on October 29, 2025, in (city), Texas, with (administrative law judge) presiding as the administrative law judge (ALJ). The ALJ resolved the disputed issues by deciding that: (1) the compensable injury of (date of injury), does not extend to lumbar ankylosing spondylitis; (2) the first certification of maximum medical improvement (MMI) and assigned impairment rating (IR) from (Dr. C) on October 4, 2013, became final under Section 408.123 and 28 Tex. Admin. Code § 130.12 (Rule 130.12); (3) the date of MMI is April 1, 2013; and (4) the claimant’s IR is zero percent. The claimant appealed the ALJ’s determinations of extent of injury, finality, MMI, and IR. The respondent (self-insured) responded to the claimant’s appeal, urging affirmance of the ALJ’s determinations.
DECISION
Affirmed in part, reformed in part, reversed and rendered in part, and reversed and remanded in part.
The parties stipulated, in part, that: on (date of injury), the claimant sustained a compensable injury; the carrier accepted dengue fever as the compensable injury; and the parties agreed that the compensable injury of (date of injury), does not extend to rheumatoid arthritis. We note that the stipulation in Finding of Fact No. 1.G. incorrectly states that the date of statutory MMI is February 15, 2025. We reform Finding of Fact No. 1.G. to state the date of statutory MMI is February 15, 2015, to correctly reflect the stipulation made by the parties at the CCH. The claimant testified that he was working in (country) as a dynamics simulation engineer on (date of injury), when he contracted dengue fever.
EXTENT OF INJURY
The ALJ’s determination that the compensable injury of (date of injury), does not extend to lumbar ankylosing spondylitis is supported by sufficient evidence and is affirmed.
FINALITY
Section 408.123(e) provides that, except as otherwise provided by Section 408.123, an employee’s first valid certification of MMI and first valid assignment of an IR is final if the certification or assignment is not disputed before the 91st day after the date written notification of the certification or assignment is provided to the employee and the carrier by verifiable means. Rule 130.12(b) provides, in part, that the first MMI/IR certification must be disputed within 90 days of delivery of written notice through verifiable means, including IRs related to extent-of-injury disputes. The notice must contain a copy of a valid Report of Medical Evaluation (DWC-69), as described in Rule 130.12(c).
In Appeals Panel Decision (APD) 042163-s, decided October 21, 2004, the Appeals Panel discussed whether the deemed receipt provision of Rule 102.4 was applicable and what is meant by “verifiable means.” APD 041985-s, decided September 28, 2004, and APD 042163-s, supra, state that the 90-day period “begins when that party receives verifiable written notice of the MMI/IR certification” and that written notice is verifiable when it is provided from any source in a manner that reasonably confirms delivery to the party. This may include acknowledged receipt by the injured employee.
The ALJ found that the certification by Dr. C was the first valid certification on this claim. This finding is supported by sufficient evidence. The ALJ further found in Finding of Fact No. 4 that Dr. C’s certification with an MMI date of April 1, 2013, and zero percent IR was provided to the claimant by verifiable means on January 3, 2014. We note that the ALJ mistakenly stated in this finding that the date of the certification was February 27, 2024, instead of October 4, 2013. In the ALJ’s decision, the ALJ explains that in evidence is a Dispute Resolution Information System (DRIS) note that indicates the claimant contacted the Texas Department of Insurance, Division of Workers’ Compensation (Division) to dispute Dr. C’s certification on January 3, 2014. While a review of the record reflects conflicting evidence concerning the date the claimant may have received Dr. C’s certification, the ALJ relied on a DRIS note to find that Dr. C’s certification was delivered to the claimant by verifiable means on January 3, 2014.
In APD 152374, decided February 3, 2016, the ALJ similarly relied on a DRIS note that indicated the claimant called the Division regarding the dispute of a certification to find that the claimant was provided with written notice by verifiable means. In that case, the Appeals Panel disagreed that the DRIS note in question was sufficient to establish delivery by verifiable means and noted “[t]he DRIS note, which indicates only that the claimant’s attorney and doctor are disputing [the] report, does not constitute reasonable confirmation of delivery of written notice to the claimant on that date.” Likewise in the present case, the DRIS note dated January 3, 2014, indicates only that the claimant is disputing Dr. C’s report and is insufficient to establish that Dr. C’s report was delivered to the claimant by verifiable means on that date. Therefore, we reverse the ALJ’s determination that the first certification of MMI and assigned IR from Dr. C on October 4, 2013, became final under Section 408.123 and Rule 130.12, and render a new decision that the first certification of MMI and assigned IR from Dr. C on October 4, 2013, did not become final under Section 408.123 and Rule 130.12.
MMI AND IR
As we have reversed the ALJ’s finality determination and rendered a new decision that the first certification of MMI and assigned IR from Dr. C on October 4, 2013, did not become final under Section 408.123 and Rule 130.12, we also reverse the ALJ’s determinations that the claimant reached MMI on Apil 1, 2013, with a zero percent IR and remand the issues of MMI and IR to the ALJ for further action consistent with this decision.
SUMMARY
We affirm the ALJ’s determination that the compensable injury of (date of injury), does not extend to lumbar ankylosing spondylitis.
We reform Finding of Fact 1.G. to state the date of statutory MMI is February 15, 2015.
We reverse the ALJ’s determination that the first certification of MMI and assigned IR from Dr. C on October 4, 2013, became final under Section 408.123 and Rule 130.12, and render a new decision that the first certification of MMI and assigned IR from Dr. C on October 4, 2013, did not become final under Section 408.123 and Rule 130.12.
We reverse the ALJ’s determinations that the claimant reached MMI on April 1, 2013, with a zero percent IR and remand the issues of MMI and IR to the ALJ for further action consistent with this decision.
REMAND INSTRUCTIONS
On remand, the ALJ is to make a determination of MMI and IR that is supported by the evidence and consistent with this decision.
Pending resolution of the remand, a final decision has not been made in this case. However, since reversal and remand necessitate the issuance of a new decision and order by the ALJ, a party who wishes to appeal from such new decision must file a request for review not later than 15 days after the date on which such new decision is received from the Division, pursuant to Section 410.202 which was amended June 17, 2001, to exclude Saturdays and Sundays and holidays listed in Section 662.003 of the Texas Government Code in the computation of the 15-day appeal and response periods. See APD 060721, decided June 12, 2006.
The true corporate name of the insurance carrier is (a certified self-insured) and the name and address of its registered agent for service of process is
CT CORPORATION SYSTEM
1999 BRYAN STREET, SUITE 900
DALLAS, TEXAS 75201.
Cristina Beceiro
Appeals Judge
CONCUR:
Carisa Space-Beam
Appeals Judge
Margaret L. Turner
Appeals Judge