The second element for a certification to become final is that it must be a valid certification. The validity concept itself is comprised of multiple elements. The certification must be on a form DWC-69. This is the form prescribed by the DWC for certifying impairment. The requirement that the form be accompanied by a narrative report is not essential for finality per Appeals Panel precedent (Appeal No. 132383).
It must contain an MMI date that is not prospective (the date of MMI not be future in reference to the examination date) or conditional (e.g. I the doctor determine the injured employee reached MMI July 1, 2020, but only if she does not have the surgery to repair her rotator cuff tear) (cf. Rule 130.1(b)(4)(C)(i)).
Conditionality is a neglected element, in that it is not unusual for a doctor to indicate that the certification is being rendered in reference to a dispute over extent of injury. A doctor may outline an opinion regarding the extent of injury in the certification, and inform the reader that the certification is based on the dispute by the carrier of the extent of the injury. Although there is no extent of injury exception to finality, as discussed at length below, certain reports may contain an implicit conditionality that arises out of uncertainty as to extent of injury.
Reports should be reviewed carefully for facts which would support this argument. An example would be a doctor stating: “Based on the MRI of June 15, 2020, I have diagnosed the claimant with a herniated disc at L5-S1 causing lumbar radiculopathy, which will require surgical intervention. However, because the insurance adjuster has informed me that the carrier is disputing this diagnosis, I am certifying the claimant to be at maximum medical improvement on June 15, 2020, with a 0% impairment rating. As of that date, the diagnosis of lumbar herniated disc at L5-S1 became the controlling diagnosis and no further treatment would have been rendered for the accepted condition of lumbar strain, and any muscle guarding, loss of reflexes, and atrophy would be relative to the L5-S1 herniated disc and not the muscular strain.”
Such a report could well be read as creating a certification conditional on the dispute and resolution thereof regarding the extent of injury to the L5-S1 herniated disc. Such conditionality could render the certification invalid and not subject to finality.
Per Rule 130.1(b)(2), another element of validity is that the impairment rating must be based on the injured employee’s condition on the MMI date:
An impairment rating is invalid if it is based on the injured employee's condition on a date that is not the MMI date.
This element is often considered carefully in judging the adoptability or ultimate weight of a certification, but rarely viewed through the lens of finality. If the certification is based on the injured employee’s condition on another date, then it is invalid.
The certification must arrive at an impairment rating percentage or certify that no permanent impairment exists (Rule 130.1(c)(1)).
The certification must use the correct edition of the AMA Guides to the Evaluation of Permanent Impairment, currently the fourth edition (Rule 130.1(c)(2)(C).
The certifying doctor must sign the DWC-69 (Rule 130.1(d)(1) and (d)(1)(A). The doctor may authorize the signature by stamp, or it may be affixed electronically, but it must be the physician’s signature (as opposed to, for example, the signature of an employee or mid-level provider).
The doctor must be authorized to certify the impairment rating (either a treating doctor, designated doctor or required medical examination doctor ordered to do so, or a referral from the treating doctor specifically authorized to certify MMI/IR) (Rule 130.1(a)). The treating doctor may only certify MMI/IR if authorized by the DWC (Rule 130.1(a)(1)(B)(i). The treating doctor may certify MMI with no impairment if not so authorized (Rule 130.1(a)(1)(B)(ii).
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