PJC General Negligence 2024

W ORKERS ’ C OMPENSATION —D ISABILITY , MMI & I MPAIRMENT

PJC 23.7

PJC 23.7

Negating Division’s Finding of Maximum Medical Improvement; Seeking Determination of Not at Maximum Medical Improvement—Question

QUESTION ______ Has Paul Payne not reached maximum medical improvement?

“Maximum medical improvement” means the earliest date after which, based on reasonable medical probability, further material recovery from or last ing improvement to an injury can no longer reasonably be anticipated. Answer “Yes” or “No.” Answer: _______________ COMMENT When to use. PJC 23.7 should be used when a party appeals a decision of the Division of Workers’ Compensation of the Texas Department of Insurance (DWC) that the injured worker is at maximum medical improvement and seeks to persuade the jury that the employee has not yet reached maximum medical improvement. For cases in which a party appeals a decision that the worker has reached maximum medical improvement with a particular impairment rating, and seeks to persuade the jury to adopt a different date of maximum medical improvement and impairment rating, PJC 23.8 or 23.9 should be used. See PJC 23.14 regarding the definition of “maximum medical improvement.” Burden of proof. The party who appeals a decision that the injured worker is not at maximum medical improvement may be either the claimant or the carrier, depend ing on the facts of each individual case. The burden of proof should be placed appro priately in accordance with the decision of the appeals panel. See PJC 15.1. Source of question and instructions. “Maximum medical improvement” is the point when further material recovery or lasting improvement can no longer be reason ably anticipated or two years after income benefits begin to accrue, whichever is sooner. Tex. Lab. Code §401.011(30); Texas Workers’ Compensation Commission v. Garcia , 893 S.W.2d 504, 513 (Tex. 1995). Caveat. While the Code requires that the trial court adopt a specific impairment rating— see Tex. Lab. Code § 410.306—there is no similar requirement with regard to the maximum medical improvement date of a claimant. However, the supreme court has noted that “[a]ny dispute that challenges an impairment rating’s finality necessar ily implicates the date of maximum medical improvement and the amount paid as tem porary income benefits.” Rodriguez v. Service Lloyds Insurance Co. , 997 S.W.2d 248,

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