Austin, TX – The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) reminds all workers’ compensation system participants that the Texas Labor Code and TDI-DWC rules impose certain requirements for a doctor to become authorized to certify maximum medical improvement (MMI) and assign impairment ratings for claims in the Texas workers’ compensation system.
TDI-DWC Authorization Required
Texas Labor Code §408.023(o)(2) requires doctors who intend to provide certification of MMI or assign impairment ratings to comply with the TDI-DWC impairment rating training and testing requirements.
In accordance with 28 Texas Administrative Code (TAC) §130.1, only a doctor authorized by the TDI-DWC may certify an injured employee’s MMI date and assign an impairment rating if there is permanent impairment. This requirement applies to treating doctors, referral doctors, designated doctors and required medical examination doctors, including doctors that contract with a workers’ compensation health care network certified under Insurance Code Chapter 1305.
28 TAC §180.23 requires a doctor to successfully complete the TDI-DWC prescribed training, or approved similar training, and pass a test to receive TDI-DWC authorization to certify MMI and assign impairment ratings. The TDI-DWC may grant a doctor permission by exception to assign impairment ratings and certify MMI on a specific claim-by-claim basis (generally reserved for certain out-of-state claims only).
Doctors who are not authorized by the TDI-DWC may only determine whether an injured employee has permanent impairment, and in the event that the injured employee has no impairment, certify the injured employee’s MMI date. If a doctor determines that an injured employee has permanent impairment, but is not authorized to certify MMI and assign an impairment rating, the doctor should refer the employee to a doctor who is authorized by the TDI-DWC.
Pursuant to Texas Labor Code §408.023(p), doctors who do not comply with the TDI-DWC MMI and impairment rating training and testing requirements commit an administrative violation. Further, §408.023(q) provides that an insurance carrier may not use, for the purpose of suspending temporary income benefits or computing impairment income benefits, a certification of MMI or an impairment rating assigned by a doctor who fails to comply with TDI-DWC MMI and impairment rating training and testing authorization requirements.
28 TAC §130.1 also specifies that a certification of MMI, finding of permanent impairment, and/or an impairment rating assigned by an unauthorized doctor are invalid and the doctor shall not be reimbursed for the examination, certification, or report.
Verifying Doctors’ Authorization to Certify MMI and Assign Impairment Ratings
System participants are responsible for ensuring that the doctors they use to certify MMI or assign impairment ratings on workers’ compensation claims are properly authorized by the TDI-DWC. To locate TDI-DWC authorized doctors or verify the authorization of a specific doctor, visit the TDI website at http://www.tdi.texas.gov/wc/txcomp.html and click on “Healthcare Provider System” under “Select TXCOMP Healthcare Provider System.”
For additional information regarding a doctor’s authorization to certify MMI and assign impairment ratings, contact the TDI-DWC by calling Comp Connection For Health Care Providers at 1-800-372-7713 and select option 3 or e-mailing firstname.lastname@example.org