APD 250273
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination that the claimant reached Maximum Medical Improvement (MMI) on December 21, 2023. However, the Panel reversed and remanded the Impairment Rating (IR) of 11% because the designated doctor’s calculation did not conform to the AMA Guides and lacked necessary range of motion data. The issue of IR was remanded for further clarification or reassessment, and the ALJ was also instructed to correct the carrier information in the decision on remand.
APD 250294
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination that the claimant reached Maximum Medical Improvement (MMI) on February 27, 2024. However, it reversed and remanded the Impairment Rating (IR) of 3% because the designated doctor failed to include a 10% upper extremity impairment for a distal clavicle resection performed as treatment for the compensable injury, as required by the AMA Guides. The IR issue was remanded for correction or reassessment by the designated doctor or a new doctor if necessary.
APD 250174
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination that the self-insured did not waive its right to contest compensability by failing to timely contest the injury. However, it reversed the ALJ’s finding that the self-insured specifically contested compensability under Section 409.022 and Rule 124.2(f), because the defense under Section 406.032(1)(D) was raised for the first time in a supplemental denial and not shown to be based on newly discovered evidence. The case was remanded for the ALJ to determine whether the newly raised defense qualifies as newly discovered evidence, and to reconsider whether the claimant sustained a compensable injury in light of that determination.
APD 250244
The Appeals Panel affirmed the Administrative Law Judge’s (ALJ) determination that the compensable injury did not extend to certain additional right knee conditions. However, it reversed and remanded the findings on Maximum Medical Improvement (MMI) and Impairment Rating (IR) because the designated doctor based the MMI date on an incorrect discharge date, rendering his certification clearly wrong. With no valid MMI/IR certification in evidence, the case was remanded for further proceedings, including clarification or reassessment by a qualified designated doctor.
APD 250132
The Appeals Panel reversed the Administrative Law Judge’s (ALJ) determinations that the claimant was entitled to Supplemental Income Benefits (SIBs) for the eighth and ninth quarters. The reversal was based on potential legal error in the ALJ’s finding that job contacts alone demonstrated an active effort to obtain employment, without evaluating whether those contacts met the standard for active work search efforts. The case was remanded for the ALJ to reconsider the SIBs entitlement using the correct legal standard under Section 408.1415 and Rule 130.102(d)(1).
APD 250067
The Appeals Panel reversed the maximum medical improvement ruling after finding that the administrative law judge had erroneously relied on the wrong certification rather than the doctor’s updated one.
APD 241724
The Appeals Panel reversed the decision after determining the administrative law judge did not address the certified issue pertaining to the designated doctor’s appointment.
APD 241728
The Appeals Panel reversed the decision because the Administrative Law Judge incorrectly found that the Employee-Decedent’s parents were not proper beneficiaries because they failed to prove they were dependents. The Appeals Panel noted that there is no requirement for eligible parents to show dependent status.
APD 241600
The Appeals Panel reversed the ALJ’s adoption of a 26% impairment rating, finding that it was based on a non-compensable traumatic brain injury and improper eye impairment calculations. Although the ALJ found no contrary evidence, the Panel determined the certification was clearly flawed. The panel instead adopted an alternate certification from the same designated doctor, which assigned a 9% impairment rating and properly excluded non-compensable conditions. The claimant’s MMI date of November 30, 2022, was affirmed.
APD 241572
The Appeals Panel reversed the decision because the Administrative Law Judge mistakenly used the wrong date of maximum medical improvement.