This appeal arises pursuant to the Texas Workers’ Compensation Act, Tex. Lab. Code Ann. § 401.001 et seq. (1989 Act). A contested case hearing was held on February 27, 2025, with the record closing on May 13, 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 a cervical sprain; (2) the compensable injury of (date of injury), does not extend to a right shoulder sprain, thoracic sprain, cervical facet syndrome, right shoulder adhesive capsulitis, C3 diminished disc space, C5-6 diminished disc space, C6-7 diminished disc space, slight retrolisthesis of C3 relative to C4, or endplate spurring/disc protrusion left of midline C3-4 accentuated by retrolisthesis; (3) the appellant (claimant) reached maximum medical improvement (MMI) on November 20, 2024; and (4) the claimant’s impairment rating (IR) is zero percent. The claimant appealed, disputing that portion of the ALJ’s determination of the extent of injury that was unfavorable to him. The claimant also disputed the ALJ’s determinations of MMI and IR. The respondent (carrier) responded, urging affirmance of the disputed determinations. The ALJ’s determination that the compensable injury of (date of injury), extends to a cervical sprain was not appealed and has become final pursuant to Section 410.169.
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), which extends to at least a right shoulder contusion, head contusion, and chest contusion; and the Texas Department of Insurance, Division of Workers’ Compensation (Division) appointed (Dr. H) as the designated doctor to address the issues of MMI, IR, extent of injury, and disability. The evidence reflected that the claimant was injured when a pallet fell on him.
EXTENT OF INJURY
The ALJ’s determination that the compensable injury of (date of injury), does not extend to a right shoulder sprain, thoracic sprain, cervical facet syndrome, right shoulder adhesive capsulitis, C3 diminished disc space, C5-6 diminished disc space, C6-7 diminished disc space, slight retrolisthesis of C3 relative to C4, or endplate spurring/disc protrusion left of midline C3-4 accentuated by retrolisthesis is supported by sufficient evidence and is affirmed.
MMI/IR
The ALJ determined that the claimant reached MMI on November 20, 2024, with a zero percent IR as certified by (Dr. M) a required medical examination doctor. However, Dr. M’s assessment cannot be adopted because the Report of Medical Evaluation (DWC-69) is not signed by him but rather another doctor. 28 Tex. Admin Code §130.1(d)(1)(A) (Rule 130.1(d)(1)(A)) provides that the DWC-69 “must be signed by the certifying doctor.” The rule goes on to state that the signature may be “a rubber stamp signature or an electronic facsimile signature.” See Appeals Panel Decision (APD) 042044-s, decided October 8, 2004, APD 061017, decided July 14, 2006, and APD 100510, decided June 24, 20210. Nowhere in the rule does it mention that someone other than the certifying doctor can sign his or her name on the DWC-69, authorized or not. Because the DWC-69 was not signed by Dr. M, it was error for the ALJ to adopt his certification.
There were several other certifications of MMI/IR in evidence. Dr. H, the designated doctor appointed by the Division, initially examined the claimant on September 23, 2024, and certified that the claimant had not yet reached MMI but should do so on November 23, 2024. (Dr. Hg), a treating doctor referral, examined the claimant on December 17, 2024, and certified that the claimant had not yet reached MMI but should do so on March 17, 2025. The ALJ correctly noted that both the opinions of Dr. H and Dr. Hg considered conditions that were not part of the compensable injury. Dr. M initially provided three alternative certifications, but none considered only the compensable conditions as determined by the ALJ. Additionally, the certifications provided by Dr. M could not be adopted because they were not signed by him.
Since there were no adoptable certifications of MMI in evidence, at the conclusion of the CCH the ALJ issued a presiding officer’s directive to order a designated doctor examination. Dr. H re-examined the claimant on March 31, 2025, and certified that the claimant had not reached MMI. However, Dr. H again considered conditions that have been determined not to be part of the compensable injury. The ALJ then sent a letter of clarification to Dr. H requesting that he address MMI specifying the compensable conditions and requesting that no other conditions be considered in making a determination of MMI and IR. However, Dr. H again opined that the claimant had not reached MMI considering conditions that have been determined not to be part of the compensable injury.
In response the carrier provided an amended certification from Dr. M after the conclusion of the CCH that the claimant reached MMI on November 20, 2024, with a zero percent IR considering the compensable conditions which was adopted by the ALJ. Dr. M’s amended certification cannot be adopted because, as previously discussed, it was signed by another doctor.
As there is no MMI/IR certification in evidence that can be adopted, 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), does not extend to a right shoulder sprain, thoracic sprain, cervical facet syndrome, right shoulder adhesive capsulitis, C3 diminished disc space, C5-6 diminished disc space, C6-7 diminished disc space, slight retrolisthesis of C3 relative to C4, or endplate spurring/disc protrusion left of midline C3-4 accentuated by retrolisthesis.
We reverse the ALJ’s determinations that the claimant reached MMI on November 20, 2024, and that the claimant’s IR is zero percent, and we remand the issues of MMI and IR to the ALJ for further action consistent with this decision.
REMAND INSTRUCTIONS
Dr. H is the designated doctor in this case. The ALJ is to determine whether Dr. H is still qualified and available to be the designated doctor. If Dr. H is no longer qualified or available to serve as the designated doctor, then another designated doctor is to be appointed to determine the claimant’s MMI and IR.
The ALJ is to inform the designated doctor that the compensable injury of (date of injury), extends to a cervical sprain, right shoulder contusion, head contusion, and chest contusion but does not extend to a right shoulder sprain, thoracic sprain, cervical facet syndrome, right shoulder adhesive capsulitis, C3 diminished disc space, C5-6 diminished disc space, C6-7 diminished disc space, slight retrolisthesis of C3 relative to C4, or endplate spurring/disc protrusion left of midline C3-4 accentuated by retrolisthesis. The ALJ is to request the designated doctor to give an opinion on the claimant’s MMI and rate the entire compensable injury in accordance with the Guides to the Evaluation of Permanent Impairment, fourth edition (1st, 2nd, 3rd, or 4th printing, including corrections and changes as issued by the American Medical Association prior to May 16, 2000) considering the medical record and the certifying examination.
The parties are to be provided with the designated doctor’s new MMI/IR certification and are to be allowed an opportunity to respond. The ALJ is then to make a determination on MMI and IR 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 ACE AMERICAN INSURANCE COMPANY and the name and address of its registered agent for service of process is
CT CORPORATION SYSTEM
1999 BRYAN STREET, SUITE 900
DALLAS, TEXAS 75201-3136.
Margaret L. Turner
Appeals Judge
CONCUR:
Cristina Beceiro
Appeals Judge
Carisa Space-Beam
Appeals Judge