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Advisory 92-05

Maximum Medical Improvement/Termination of Benefits

All parties escalate their efforts in resolving disputes over the attainment of maximum medical improvement. If a certification of maximum medical improvement is issued by a carrier selected doctor, it is imperative that the TWCC-69 report from the certifying doctor is sent to the treating doctor asking for agreement or disagreement with the evaluation. Insurance carriers should get involved in this exchange in order to assure this is accomplished. Commission staff will also be committed to facilitating a prompt response from the treating doctor.

Under no circumstances should a carrier completely suspend income benefits before the treating doctor has had an opportunity to respond to the certifying report. If the treating doctor does respond timely, the carrier should not act upon the certification until the certifying doctor reiterates the certification after reviewing the treating doctor's response. If the carrier or certifying doctor does not receive a response within a reasonable time of 17 days, which includes mailing time, the carrier should assume that there is a dispute and request the Commission's assistance in obtaining a response from the treating doctor and arranging for a designated doctor.

When notice is received that the treating doctor or the claimant disagrees with the certification or when notice is received from the carrier that the treating doctor has not responded timely, the Commission shall take immediate action to arrange for a designated doctor. Also, an expedited benefit review conference will be scheduled.

Carriers should continue payments of income benefits until the issue is resolved by using a designated doctor or until the benefit review conference. At the conclusion of the benefit review conference, the carrier may request an Interlocutory Order on the payment of income benefits during the remainder of the disputed period.

Signed this 12 th day of August, 1992.

Todd K. Brown
Acting Executive Director


Austin Carrier Representatives
TWCC Staff
Public Information List
Medical Advisory Committee
County Medical Societies