APD 250488
The Appeals Panel reversed the administrative law judge’s decision and held that the claimant did not sustain a compensable injury because the injury occurred while the claimant was intoxicated. Although the judge initially found that an injury occurred in the course and scope of employment, the unappealed finding of intoxication barred recovery under Texas Labor Code § 406.032(1)(A).
APD 250619
The Appeals Panel reversed the administrative law judge’s decision and remanded the case after finding the claimant had good cause for missing the contested case hearing due to an incomplete set notice that omitted his apartment number.
APD 250546
The Appeals Panel affirmed the administrative law judge’s decision that the compensable injury did not extend to Charcot’s arthropathy, that the claimant did not have disability from December 15, 2023, through the hearing date, and that the claimant reached maximum medical improvement on November 2, 2023, with a two percent impairment rating. The Panel reformed one factual finding to correct a clerical error regarding the designated doctor’s certification but upheld all substantive determinations based on the evidence.
APD 250625
The Appeals Panel upheld the ALJ’s determinations that the compensable injury did not include a concussion, that the claimant reached maximum medical improvement on July 11, 2024, and that the resulting impairment rating is 0 percent. However, it deemed the decision incomplete for failing to make findings on the average weekly wage, reversed that portion, and remanded the AWW issue for proper findings and a new order.
APD 250568
The Appeals Panel affirmed the ALJ’s determinations that the compensable injury does not include an L4-5 disc bulge, that the claimant reached maximum medical improvement on January 23, 2024, and that no disability existed thereafter. It reversed only the impairment rating, correcting the ALJ’s typographical error and rendering a five-percent rating in line with the designated doctor’s report instead of the zero-percent rating.
APD 250535
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination that the claimant had disability from November 2, 2023, through the date of the contested case hearing. However, the panel reversed the ALJ’s findings that the claimant had not reached Maximum Medical Improvement (MMI) and thus an Impairment Rating (IR) could not be assigned. It remanded the issues of MMI and IR for further proceedings, directing the ALJ to establish the statutory MMI date and to seek a new evaluation by the designated doctor for an updated opinion consistent with the statutory MMI date.
APD 250450
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determinations that the compensable injury did not extend to cervical radiculopathy, C6-7 disc herniation, right thumb sprain, lumbar radiculopathy, or L4-5 disc herniation, and that the claimant reached Maximum Medical Improvement (MMI) on October 5, 2022. However, the Panel reversed the ALJ’s impairment rating (IR) determination of 13% due to insufficient explanation of the calculations. The issue of IR was remanded for clarification and a new certification from the designated doctor. Additionally, the determination denying supplemental income benefits (SIBs) was also reversed and remanded pending the final IR determination.
APD 250466
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determinations that the compensable injury did not extend to additional claimed conditions and that the claimant did not have disability during the disputed period. However, the Panel reversed the ALJ’s findings regarding the finality of the initial certification of Maximum Medical Improvement (MMI) and Impairment Rating (IR), as the ALJ had not addressed possible exceptions to finality. These issues, along with the MMI date and IR assignment, were remanded to the ALJ for further proceedings to address whether exceptions to the finality rule applied.
APD 250240
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination regarding the extent of injury, confirming that the injury included cervical sprain and strain with exacerbation of underlying spondylosis, shoulder impingement and strain, lumbar spine strain, disc protrusions at C5-6, C6-7, and C2-3, head contusion, and left shoulder contusion. However, the Panel reversed the ALJ’s determination on Maximum Medical Improvement (MMI) and impairment rating (IR) because the ALJ failed to consider timely submitted evidence from the self-insured employer, thus depriving it of a full and fair hearing. These issues were remanded to the ALJ to properly consider all evidence and arguments before issuing a new decision.
APD 250409
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination that the compensable injury did not extend to PTSD, major depressive disorder, adjustment disorder with mixed anxiety and depressed mood, disc bulge at L4-5, disc bulge at L5-S1, or right knee internal derangement. However, the Panel reversed and remanded the decision because the ALJ failed to address the issue of whether the injury extended to a left shoulder rotator cuff tear. Consequently, the determinations regarding Maximum Medical Improvement (MMI) and the Impairment Rating (IR) were also reversed and remanded for further consideration consistent with resolving the extent-of-injury issue.