Disputing a Low Impairment Rating in Texas Workers’ Comp

It can be frustrating to get a low impairment rating when your work injury still impacts your day-to-day life. A Texas workers’ compensation lawyer can assist you in reviewing the rating and how to contest it. Time is critical as a rating can go final even if you feel it does not reflect your condition.

What does an impairment rating measure?

An impairment rating measures permanent damage to your body from a covered work injury. It doesn’t simply measure pain or how difficult your job has become. A doctor generally assigns the rating when you reach maximum medical improvement, or MMI.

MMI can mean further lasting recovery isn’t reasonably expected. It can also occur when a legal time limit is reached, so it doesn’t always mean you’ve finished treatment.

Texas generally uses the fourth edition of the American Medical Association’s Guides to evaluate permanent impairment. The doctor must apply the required standards to your condition rather than choose a percentage based only on your symptoms.

How does the rating affect your benefits?

Your rating helps determine how long you receive impairment income benefits. Eligible workers receive three weeks of these benefits for each percentage point of impairment. A 5% rating means 15 weeks, while a 10% rating means 30 weeks.

A rating of at least 15% is also one requirement for supplemental income benefits. Other eligibility rules apply, so reaching that percentage doesn’t automatically qualify you.

MMI can also end temporary income benefits. That makes checking the MMI date important even when your main concern is the percentage.

How long do you have to dispute a rating?

You generally have 90 days to dispute the first valid MMI certification and impairment rating after written notice is delivered to you by verifiable means. The period begins the next day. Verifiable delivery means there’s evidence that you received the notice. Save the report and proof of when you received it.

Missing that deadline can make the certification and rating final. Limited exceptions exist, but you shouldn’t assume that continuing treatment or asking the insurer to reconsider protects your rights.

How do you start a formal dispute?

The procedures for filing vary depending on whether a designated doctor has been selected to evaluate MMI and impairment. This is a doctor selected by the Texas Division of Workers’ Compensation, or DWC, to decide disputed medical issues.

If no designated doctor has been appointed for those issues, you can request one using DWC Form-032 or request a benefit review conference using DWC Form-045. If one has already been appointed for those issues, request a benefit review conference to dispute the certification.

Identify whether you’re challenging the rating or the MMI date. You may need to dispute both. A Texas workers’ compensation lawyer can help you submit the appropriate request before the deadline.

What evidence can support your challenge?

Start with the rating report and the doctor’s explanation. Compare them with your treatment records and test results. Look for missing findings or errors in how the rating standards were applied.

The rating should address the entire covered injury. If the insurer disputes whether an additional condition belongs in the claim, that disagreement may also need to be resolved. Don’t assume that resolving it later will automatically reopen a final rating.

A designated doctor’s report receives special legal weight. To overcome it, the greater weight of the other medical evidence must support a different conclusion. A medical explanation of the error is more useful than simply saying the percentage feels too low.

What happens if the dispute isn’t resolved?

A benefit review conference is an informal meeting aimed at resolving the disagreement. If no agreement is reached, the dispute may proceed to a contested case hearing before a DWC administrative law judge. Further appeals have their own deadlines.

Keep copies of your filings and attend required appointments. Continue giving accurate information about your limitations so the medical record reflects your condition.

A Texas workers’ compensation lawyer can help you assess the evidence and prepare your challenge. Contact The Law Office of Sandy McCorquodale, P.C. at (833) 712-4472 to discuss your impairment rating and the steps available to protect your benefits.