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 December 10, 2024, 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 a left shoulder glenoid labrum tear, left knee medial meniscus tear, or major depressive disorder; (2) the appellant (claimant) reached maximum medical improvement (MMI) on March 15, 2023; (3) the claimant’s impairment rating (IR) is five percent; and (4) the claimant did not have disability for the compensable injury of (date of injury), from March 16, 2024, through the date of the CCH.
The claimant appealed the ALJ’s extent-of-injury, MMI, IR, and disability determinations. The claimant also contended on appeal that the ALJ erred in excluding the alternate certification he offered as evidence at the CCH. The respondent (carrier) responded, urging affirmance of the appealed determinations. The carrier noted in its response that (Dr. A), the subsequent designated doctor whose report was adopted by the ALJ, amended his assigned MMI date from March 15, 2023, to March 15, 2024, in response to a letter of clarification.
DECISION
Affirmed in part and reversed and rendered in part.
The parties stipulated, in part, that on (date of injury), the claimant sustained a compensable injury in the form of at least a cervical sprain, chest wall contusion, left elbow contusion, left elbow sprain, left shoulder sprain, left hip sprain, left ankle sprain, left knee lateral meniscus tear, left knee anterior cruciate ligament tear, and left knee trabecular fracture with bone bruise. The claimant, a cable splicing technician, was injured on (date of injury), when he fell backwards off a retaining wall.
EXCLUSION OF CLAIMANT’S EXHIBIT 7
At the CCH, the claimant offered as evidence an MMI and IR report from (Dr. M) dated October 9, 2024, as Claimant’s Exhibit 7. The ALJ sustained the carrier’s objection to the admission of the report on the basis that it was untimely exchanged on December 9, 2024, the day before the CCH, and there was no good cause for the untimely exchange.
The review of rulings on the admission or exclusion of evidence at the administrative level is under the abuse of discretion standard applied to trial courts. Gomez v. Texas Education Agency, 354 S.W.3d 905, 917 (Tex. App.- Austin 2011, pet. denied); City of Amarillo v. Railroad Commission of Texas, 894 S.W.2d 491, 495 (Tex. App.- Austin 1995, writ denied). In determining whether there has been an abuse of discretion, the Appeals Panel looks to see whether the ALJ acted without reference to any guiding rules or principles. See Appeals Panel Decision (APD) 051705, decided September 1, 2005. Because the evidence established that Dr. M’s report was untimely exchanged and that there was no good cause for the claimant’s untimely exchange, we hold the ALJ did not err in excluding the exhibit.
EXTENT OF INJURY
The ALJ’s determination that the compensable injury of (date of injury), does not extend to a left shoulder glenoid labrum tear, left knee medial meniscus tear, or major depressive disorder is supported by sufficient evidence and is affirmed.
DISABILITY
The ALJ’s determination that the claimant did not have disability for the compensable injury of (date of injury), from March 16, 2024, through the date of the CCH is supported by sufficient evidence and is affirmed.
IR
The ALJ’s determination that the claimant’s IR is five percent is supported by sufficient evidence and is affirmed.
MMI
Section 401.011(30)(A) defines MMI as “the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated.” Section 408.1225(c) provides that the report of the designated doctor has presumptive weight, and the Texas Department of Insurance, Division of Workers’ Compensation (Division) shall base its determination of whether the employee has reached MMI on the report of the designated doctor unless the preponderance of the other medical evidence is to the contrary.
The ALJ determined that the claimant reached MMI on March 15, 2023, with a five percent IR. In the Discussion section of his decision, the ALJ stated that the report from Dr. A was not contrary to the other medical evidence. Dr. A examined the claimant on July 11, 2024, and issued three alternate Reports of Medical Evaluation (DWC-69s). The DWC-69 that considers the compensable conditions indicates that the claimant reached MMI on March 15, 2023. However, in his corresponding narrative report, Dr. A explained that the date of MMI for the compensable injury is March 15, 2024, based on the date of exam of the first designated doctor. A letter of clarification dated September 16, 2024, asked Dr. A to reconcile the inconsistency in the MMI date on the narrative report and the one on the DWC-69. On September 23, 2024, Dr. A responded that the correct clinical MMI date is March 15, 2024, and submitted amended DWC-69s and a narrative report. The ALJ found the preponderance of the other medical evidence supports Dr. A’s certification; however, the ALJ mistakenly adopted Dr. A’s incorrect DWC-69 that the claimant reached MMI on March 15, 2023, rather than Dr. A’s amended DWC-69 that certified the correct MMI date of March 15, 2024.
It is clear from the ALJ’s discussion and the evidence that the ALJ was persuaded that Dr. A’s certification that the claimant reached MMI on March 15, 2024, with a five percent IR was not contrary to the preponderance of the other medical evidence. This is supported by sufficient evidence. Accordingly, we reverse the ALJ’s determination that the claimant reached MMI on March 15, 2023, and we render a new decision that the claimant reached MMI on March 15, 2024, as reflected by the evidence and the record. See APD 150665, decided May 21, 2015; see also APD 162622, decided February 27, 2017; and APD 221062, decided August 17, 2022.
SUMMARY
We affirm the ALJ’s determination that the compensable injury of (date of injury), does not extend to a left shoulder glenoid labrum tear, left knee medial meniscus tear, or major depressive disorder.
We affirm the ALJ’s determination that that the claimant did not have disability for the compensable injury of (date of injury), from March 16, 2024, through the date of the CCH.
We affirm the ALJ’s decision that the claimant’s IR is five percent.
We reverse the ALJ’s determination that the claimant reached MMI on March 15, 2023, and we render a new decision that the claimant reached MMI on March 15, 2024.
The true corporate name of the insurance carrier is OLD REPUBLIC INSURANCE COMPANY and the name and address of its registered agent for service of process is
CORPORATION SERVICE COMPANY
211 EAST 7TH STREET, SUITE 620
AUSTIN, TEXAS 78701-3218.
Cristina Beceiro – Appeals Judge
CONCUR:
Carisa Space-Beam – Appeals Judge
Margaret L. Turner – Appeals Judge