Texas Department of Insurance, Division of Worker’s Compensation Reverses Part of Determination

FILED APRIL 7, 2014

A contested case hearing, the hearing officer determined that the compensable injury extended to herniated/protruding discs in the lumbar spine at levels L4-5, L5-S1, L2-3, L3-4, lumbar spine stenosis, lumbar spine radiculopathy, and lumbar spine claudication.

The carrier appealed the hearing officer’s determination, contending that the hearing officer’s extent-of-injury determination was so against the great weight and preponderance of the evidence as to be clearly wrong and manifestly unjust. The claimant responded, urging affirmance of the hearing officer’s determination.

The claimant testified he injured his low back when he was stretched out in an awkward position for several hours while using a torch to cut sections out of a large metal plate.  The Appeals Panel reviewed the medical records and the “Letter of Causation/Letter of Clarification” submitted by the claimant’s physician.

 The Appeals Panel affirmed the hearing officer’s determination that the compensable injury extended to herniated/protruding discs in the lumbar spine at levels L4-5, L5-S1, and L3-4, lumbar spine stenosis, and lumbar spine claudication.  However, the Appeals Panel determined that none of the medical records causally linked a herniated/protruding disc in the lumbar spine at level L2-3 and lumbar spine radiculopathy to the compensable injury.

The hearing officer’s determination was reversed on the compensable injury extending to a herniated/protruding disc in the lumbar spine at level L2-3 and lumbar spine radiculopathy, and the Appeals Panel rendered a new decision that the compensable injury does not extend to a herniated/protruding disc in the lumbar spine at level L2-3 and lumbar spine radiculopathy.

Source: 140266

Texas Department of Insurance, Division of Workers’ Compensation, Appeals Panel Rules Claimant Entitled to Second Designated Doctor Examination

During a contested case hearing (CCH), it was determined that the claimant’s injury and subsequent return to light duty did not warrant a second designated doctor examination.

The hearing officer resolved the disputed issue by deciding that pursuant to Section 408.0041 and Texas Department of Insurance, Division of Workers’ Compensation (Division) rules, a second designated doctor examination of the claimant by the doctor should not have been scheduled.

Section 408.0041(b) provides, in part, that an examination under Section 408.0041 may not be conducted more frequently than every 60 days, unless good cause for more frequent examinations exists, as defined by commissioner rules.

The claimant had made a request for a second designated doctor exam within 60 days of his first request.  Because the evidence established the second designated doctor examination was not within 60 days of the first designated doctor examination, the claimant was not required to show good cause for scheduling the second designated doctor examination under Rule 127.1(c). Accordingly, the appeals panel reversed the hearing officer’s determination, and a new determination was rendered that pursuant to Section 408.0041 and Division rules, a second designated doctor examination of the claimant should have been scheduled.

Appeal 160697