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Appeals Panel No. 141650 (Decided 09/29/2014)

Posted: Dec 19, 2014
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Overcoming the Designated Doctor's Impairment Rating

Facts

 

The claimant testified he was injured while lifting cases of 3-liter sodas from a pallet.  The parties stipulated in part that the carrier accepted liability for a lumbar sprain/strain, a lumbar disc herniation at L4-5, and radiculopathy at L4-5.  In addition, the parties stipulated that the claimant reached statutory maximum medical improvement (MMI) as of January 30, 2014.

 

Issue

 

What is the claimant’s impairment rating?

 

Evidence

 

Dr. T., the designated doctor assigned a 0% IR to the claimant.  Dr. R., the treating doctor assigned a 10% IR to the claimant.  Dr. T noted in his narrative report that “[t]he [claimant] indicated he has NOT had surgery for this injury.  The claimant testified at the CCH that he underwent two surgeries for the compensable injury, the first in January 2013, and the second in November 2013. In evidence is an operative report dated January 24, 2013, noting the claimant underwent surgery for lumbar radicular syndrome secondary to foraminal disc herniation at right side L4-5. Also in evidence is an operative report dated November 14, 2013, noting the claimant underwent surgery for lumbar radicular syndrome secondary to herniated disc at right side L4-5.

 

CCH D&O

The hearing officer resolved the disputed issue by deciding that the claimant’s impairment rating (IR) is 0% as certified by the designated doctor, Dr. T.

 

AP Decision

 

The AP reversed and rendered a new decision that the IR is 10% as certified by Dr. R.  The AP explained that that Dr. T’s IR is not valid because Dr. T did not have all the medical records.

 

Lesson

 

If you are trying to beat a DD report, check to make sure the DD reviewed all the medical records.  If the DD did not have all the medical records, his certification is not valid.

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