In Texas workers' compensation, a doctor certifies maximum medical improvement (MMI) and assigns any permanent impairment rating on this report. The certifying doctor states whether the employee reached clinical or statutory MMI and gives the rating with the AMA Guides edition used, backed by a narrative. When someone other than the treating doctor certifies, the treating doctor marks agreement or disagreement on the same page.
The certifying doctor completes Parts I to V: a treating doctor, a doctor acting in the treating doctor's place, a DWC designated doctor, or a DWC-approved carrier-selected RME doctor. The treating doctor completes Part VI when another doctor certifies.
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Report of Medical Evaluation
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Only a doctor serving as the treating doctor, a doctor selected by the treating doctor to act in its place, a DWC-selected designated doctor, or a carrier-selected RME doctor approved by DWC after a designated doctor exam, under 28 TAC 130.1. Certification by an unauthorized doctor is invalid.
The form tells employees that a first certification of MMI or impairment rating must be disputed within 90 days after written notice is delivered, by requesting a designated doctor or a benefit review conference through DWC. Otherwise the certification may become final.