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RULE §130.1Certification of Maximum Medical Improvement and Evaluation of Permanent Impairment

  (5) If an impairment rating is assigned in violation of subsection (c)(4), the rating is invalid and the evaluation and report are not reimbursable. A provider that is paid for an evaluation and/or report that is invalid under this subsection shall refund the payment to the insurance carrier.

(d) Reporting.

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

    (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.

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

      (i) date of the certifying examination;

      (ii) date of MMI;

      (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;

      (iv) narrative history of the medical condition that outlines the course of the injury and correlates the injury to the medical treatment;

      (v) current clinical status;

      (vi) diagnosis and clinical findings of permanent impairment as stated in subsection (c)(3);

      (vii) the edition of the AMA Guides that was used in assigning the impairment rating (if the injured employee has permanent impairment); and

      (viii) a copy of the authorization if, after September 1, 2003, the doctor received authorization to assign an impairment rating and certify MMI by exception granted from the division.

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

    (A) date of the certifying examination; or

    (B) the receipt of all of the medical information required by this section.

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

    (A) The Report of Medical Evaluation shall be filed with the insurance carrier by facsimile or electronic transmission; and

    (B) The Report of Medical Evaluation shall be filed with the division, the injured employee and the injured 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.

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

  (1) the date of the examination;

  (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) 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; amended to be effective January 2, 2002, 26 TexReg 10910; amended to be effective March 14, 2004, 29 TexReg 2328; amended to be effective August 25, 2013, 38 TexReg 5263

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