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 September 10, 2024, with the record closing on April 15, 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), extends to shortness of breath, breathing problems, pulmonary edema, and loss of consciousness; (2) the compensable injury of (date of injury), does not extend to chest pains, tremors, lumbar sprain, posterior right lower rib fracture, panic attacks, depression, or anxiety; (3) the first certification of maximum medical improvement (MMI) and assigned impairment rating (IR) from (Dr. K) on November 9, 2023, did not become final under Section 408.123 and Tex. Admin. Code § 130.12 (Rule 130.12); (4) the appellant/cross-respondent (claimant) reached MMI on November 16, 2024; (5) the claimant’s IR is zero percent; and (6) the claimant had disability from April 26, 2023, through the date of the CCH.
The claimant appealed, disputing the ALJ’s determinations of MMI, IR, and extent of injury against him. The respondent/cross-appellant (carrier) responded, urging affirmance of the appealed determinations. The carrier cross-appealed, disputing the ALJ’s determinations of MMI, IR, finality of Dr. K’s certification, disability, and extent of injury in favor of the claimant. The carrier also contends that the ALJ failed to make findings of fact or conclusions of law on the issue of finality of Dr. K’s certification. The appeal file does not contain a response from the claimant to the carrier’s cross-appeal.
DECISION
Affirmed in part and reversed and remanded in part.
The parties stipulated, in part, that the claimant sustained a compensable injury on (date of injury), that extends to at least an inhalation injury. The claimant was injured on (date of injury), when he was cleaning a tanker and exposed to sodium hydrosulfide.
EXTENT OF INJURY
The ALJ’s determinations that the compensable injury of (date of injury), extends to shortness of breath, breathing problems, pulmonary edema, and loss of consciousness, but does not extend to chest pains, tremors, lumbar sprain, posterior right lower rib fracture, panic attacks, depression, or anxiety are supported by sufficient evidence and are affirmed.
DISABILITY
The ALJ’s determination that the claimant had disability from April 26, 2023, through the date of the CCH is supported by sufficient evidence and is affirmed.
FINALITY OF DR. K’S CERTIFICATION
Section 410.168 provides that an ALJ’s decision contain findings of fact and conclusions of law, a determination of whether benefits are due, and an award of benefits due. Rule 142.16 provides that an ALJ’s decision shall be in writing and include findings of fact, conclusions of law, and a determination of whether benefits are due and if so, an award of benefits due.
The finality issue as agreed to by the parties and reflected on the Benefit Review Conference (BRC) Report reflects the disputed issue was whether the first certification of MMI and assigned IR from Dr. K on November 9, 2023, become final under Section 408.123 and Rule 130.12. The ALJ’s decision contains no findings of fact or conclusions of law on that issue, which was properly before her to resolve; therefore, the ALJ’s decision does not comply with Section 410.168 and Rule 142.16. See Appeals Panel Decision (APD) 142156, decided December 5, 2016. Accordingly, we reverse the ALJ’s decision as being incomplete and we remand the issue of whether the first certification of MMI and assigned IR from Dr. K on November 9, 2023, became final under Section 408.123 and Rule 130.12 for further action consistent with this decision.
MMI/IR
Because we have reversed the ALJ’s determination that the first certification of MMI and assigned IR from Dr. K on November 9, 2023, did not become final under Section 408.123 and Rule 130.12 as being incomplete, we also reverse the ALJ’s determinations that the claimant reached MMI on November 16, 2023, and that the claimant’s IR is zero percent. We 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), extends to shortness of breath, breathing problems, pulmonary edema, and loss of consciousness.
We affirm the ALJ’s determination that the compensable injury of (date of injury), does not extend to chest pains, tremors, lumbar sprain, posterior right lower rib fracture, panic attacks, depression, or anxiety
We affirm the ALJ’s determination that the claimant had disability from April 26, 2023, through the date of the CCH.
We reverse the ALJ’s decision as being incomplete and we remand the issue of whether the first certification of MMI and assigned IR from Dr. K on November 9, 2023, became final under Section 408.123 and Rule 130.12 for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant reached MMI on November 16, 2024, and we remand the MMI issue to the ALJ for further action consistent with this decision.
We reverse the ALJ’s determination that the claimant’s IR is zero percent and we remand the IR issue to the ALJ for further action consistent with this decision.
REMAND INSTRUCTIONS
On remand the ALJ is to make findings of fact and corresponding conclusions of law and a decision regarding whether the first certification of MMI and assigned IR from Dr. K on November 9, 2023, became final under Section 408.123 and Rule 130.12. The ALJ is then to make findings of fact, conclusions of law, and a decision on the issues of MMI and IR that is supported by the evidence.
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 Texas Department of Insurance, Division of Workers’ Compensation, 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 GREAT WEST CASUALTY COMPANY and the name and address of its registered agent for service of process is
MICHAEL METZGER
624 SIX FLAGS DRIVE, SUITE 240
ARLINGTON, TEXAS 76011-6370.
Carisa Space-Beam
Appeals Judge
CONCUR:
Cristina Beceiro
Appeals Judge
Margaret L. Turner
Appeals Judge