APD 260515
The Appeals Panel affirmed the ALJ’s determination that the claimant had disability from May 1, 2025, through the contested case hearing. It reversed the finding that Dr. R’s February 1, 2024 MMI/IR certification was not delivered by verifiable means, holding that delivery occurred on February 24, 2024, and remanded for findings on whether the certification became final, including the dispute date and any Section 408.123(f) exceptions.
APD 260374
The Appeals Panel reversed the ALJ’s denial of supplemental income benefits after finding the decision was based on a material misstatement of the evidence regarding the claimant’s job search efforts. The record showed the claimant met the required number of weekly job searches, contrary to the ALJ’s finding.
APD 251621
The Appeals Panel reversed all disputed determinations because the designated doctor did not have the complete medical record, including the missing emergency department records he expressly requested, before issuing opinions on extent of injury, MMI, IR, and disability.
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 240099
The Appeals Panel reversed the decision regarding jurisdiction because the Administrative Law Judge failed to make findings of fact, conclusions of law, or a decision regarding the issue.
APD 230302
The Appeal’s panel reversed the administrative law judge’s finding that the insurance carrier’s PLN-11 disputing disability was not timely under Rule 124.3, and therefore the insurance carrier was liable for payment of accrued benefits. The Appeal’s Panel noted that the insurance carrier’s PLN-11 was a dispute of benefit entitlement, not a dispute of compensability or liability of the injury.
APD 221028
The Appeals’ Panel reversed the decision because the administrative law judge failed to make a conclusion of law and decision regarding the average weekly wage issue.
APD 210393
The Appeals Panel reversed the decision because, in determining average weekly wage, the Administrative Law Judge considered only the injured self-employed claimant’s business income and failed to consider the business expenses.
APD 210186
The Appeals Panel reversed the decision because the Administrative Law Judge ruled on a “right knee meniscal tear” instead of a “right knee lateral meniscal tear.” The Appeals Panel noted the parties had agreed during the hearing to add “lateral” to the condition.
APD 201505
The Appeals Panel reversed the decision because, in calculating the average weekly wage, the administrative law judge failed to consider the value of an apartment and utilities that the claimant received from the employer during a portion of the 13-week period.