1. (a) Certifying Doctor. Maximum medical improvement (MMI) shall be determined and certified by a doctor as defined in §401.011 (17) of the Texas Workers' Compensation Act.

2. (b) Certification of Maximum Medical Improvement.

   1. (1) Maximum medical improvement (MMI) is:

      1. (A) the earliest date after which, based on reasonable medical probability, further material recovery from or lasting improvement to an injury can no longer reasonably be anticipated;
      2. (B) the expiration of 104 weeks from the date on which income benefits begin to accrue; or
      3. (C) the date determined as provided by Texas Labor Code §408.104.
   2. (2) MMI must be certified before an impairment rating is assigned.
   3. (3) Certification of MMI is a finding made by a doctor that an injured employee (employee) has reached MMI as defined in subsection (b)(1) of this section.

   4. (4) To certify MMI the certifying doctor shall:

      1. (A) review medical records;
      2. (B) perform a complete medical examination of the employee for the explicit purpose of determining MMI (certifying examination);

      3. (C) assign a specific date at which MMI was reached.

         1. (i) The date of MMI may not be prospective or conditional.
         2. (ii) The date of MMI may be retrospective or the date of the certifying exam; and
      4. (D) complete and submit required reports and documentation.

3. (c) Assignment of Impairment Rating.

   1. (1) An impairment rating is the percentage of permanent impairment of the whole body resulting from the current compensable injury. A zero percent impairment may be a valid rating.

   2. (2) A doctor who certifies that an employee has reached MMI shall assign an impairment rating for the current compensable injury using the rating criteria contained in the appropriate edition of the AMA Guides to the Evaluation of Permanent Impairment, published by the American Medical Association (AMA Guides).

      1. (A) The appropriate edition of the AMA Guides to use for all certifying examinations conducted before October 15, 2001 is the third edition, second printing, dated February, 1989.

      2. (B) The appropriate edition of the AMA Guides to use for certifying examinations conducted on or after October 15, 2001 is:

         1. (i) the fourth edition of the AMA Guides (1st, 2nd, 3rd, or 4th printing, including corrections and changes as issued by the AMA prior to May 16, 2000). If a subsequent printing(s) of the fourth edition of the AMA Guides occurs, and it contains no substantive changes from the previous printing, the Commission by vote at a public meeting may authorize the use of the subsequent printing(s).; or
         2. (ii) the third edition, second printing, dated February, 1989 if, at the time of the certifying examination, there is a certification of MMI by a doctor pursuant to subsection (b) of this section made prior to October 15, 2001 which has not been previously withdrawn through agreement of the parties or previously overturned by a final decision.
      3. (C) This subsection shall be implemented to ensure that in the event of an impairment rating dispute, only ratings using the appropriate edition of the AMA Guides shall be considered.

   3. (3) Assignment of an impairment rating for the current compensable injury must be based on the employee's medical record and the certifying examination. The doctor assigning the impairment rating shall:

      1. (A) identify objective clinical or laboratory findings of permanent impairment for the current compensable injury;
      2. (B) document specific laboratory or clinical findings of an impairment;
      3. (C) analyze specific clinical and laboratory findings of an impairment;

      4. (D) compare the results of the analysis with the impairment criteria and provide the following:

         1. (i) A description and explanation of specific clinical findings related to each impairment, including zero percent (0%) impairment ratings, and
         2. (ii) A description of how the findings relate to and compare with the criteria described in the applicable chapter of the AMA Guides. The doctor's inability to obtain required measurements must be explained.
      5. (E) assign one whole body impairment rating for the current compensable injury.

      6. (F) be responsible for referring the employee to another doctor or health care provider for testing, or evaluation, if additional medical information is required. The certifying doctor is responsible for incorporating all additional information obtained into the report required by this rule:

         1. (i) Additional information must be documented and incorporated into the impairment rating and acknowledged in the required report.
         2. (ii) If the additional information is not consistent with the clinical findings of the certifying doctor, then the documentation must clearly explain why the information is not being used as part of the impairment rating.

4. (d) Reporting.

   1. (1) Certification of MMI and assignment of an impairment rating for the current compensable injury requires completion, signing, and submission of the Report of Medical Evaluation and a narrative report.

      1. (A) The Report of Medical Evaluation must be signed by the certifying doctor. The certifying doctor may use a rubber stamp signature or an electronic facsimile signature of the certifying doctor's personal signature.

      2. (B) The Report of Medical Evaluation includes an attached narrative report. The narrative report must include the following:

         1. (i) date of the certifying examination;
         2. (ii) date of MMI;
         3. (iii) findings of the certifying examination, including both normal and abnormal findings related to the compensable injury and an explanation of the analysis performed to find whether MMI was reached;
         4. (iv) narrative history of the medical condition that outlines the course of the injury and correlates the injury to the medical treatment;
         5. (v) current clinical status;
         6. (vi) diagnosis and clinical findings of permanent impairment as stated in subsection (c)(3); and
         7. (vii) the edition of the AMA Guides that was used in assigning the impairment rating.

   2. (2) A Report of Medical Evaluation under this rule shall be filed with the Commission, employee, employee's representative, and the insurance carrier (carrier) no later than the seventh working day after the later of :

      1. (A) date of the certifying examination; or
      2. (B) the receipt of all of the medical information required by this section.

   3. (3) The report required to be filed under this section shall be filed as follows:

      1. (A) The Report of Medical Evaluation shall be filed with the carrier by facsimile or electronic transmission; and
      2. (B) The Report of Medical Evaluation shall be filed with the Commission, the employee and the employee's representative by facsimile or electronic transmission if the doctor has been provided the recipient's facsimile number or email address; otherwise, the report shall be filed by other verifiable means.

5. (e) Documentation. The certifying doctor shall maintain the original copy of the Report of Medical Evaluation and narrative as well as documentation of:

   1. (1) the date of the examination;
   2. (2) the date any medical records necessary to make the certification of MMI were received, and from whom the medical records were received; and
   3. (3) the date, addressees, and means of delivery that reports required under this section were transmitted or mailed by the certifying doctor.

Source Note:The provisions of this §130.1 adopted to be effective June 7, 2000, 25 TexReg 5352.