GQ Corner
Q: The claimant returned to work in a modified duty position after signing a bona fide offer. He then scheduled vacation. Is the vacation considered post injury earnings? If so, should we treat it the same as if he was working modified duty? Since he has various restrictions, should he get a medical release for vacation since he may be doing things contrary to the restrictions?
A: The BOE creates a deemed PIE whether the claimant returns to work or not. You may deem the offered wages as paid to the claimant during the period of vacation and calculate whether TIBS are owed based on that amount. In other words, assume that the claimant earned the offered wages even though he may not have because of his vacation.
As far as the medical release is concerned, you cannot require that the claimant to get a release that meets with his vacation activities. He may or may not violate his restrictions during the vacation. It may be helpful to know what he plans to do on his vacation so that you have information that might explain a flair up when he returns from vacation or may tend to demonstrate a greater ability to function that in the work release.
Q: Are we responsible for the replacement of glasses (lenses and frames) if they were damaged during a fall? I have always been told that they are considered personal property and not covered under comp unless the claimant sustained an eye injury and his vision was affected. Is this still correct?
A: If the claimant damaged his glasses only, then the answer would be no, carrier is not responsible for replacement. However, if the claimant sustained an eye injury, the carrier is liable for medical treatment and medical equipment that is reasonable and necessary. If his eyes were damaged such that he needed another prescription, then the answer is yes, carrier is responsible.
Q: Claimant sustained an injury then returned to work with restrictions. The insured was accommodating the restrictions. The insured provided claimant was a bona fide offer and the claimant accepted a light duty position. The claimant is now resigning for personal reasons. Should I continued to pay partial TIBs taking credits for post injury earnings that she could have earned but for her decision to resign? Should I file a PLN-11 and dispute the payment of full TIBs based on the bona fide offer?
A: If the bona fide offer was for wages equal to the pre-injury AWW, you can dispute that TIBs are owed. If there are lost wages based on offered wages, you still need to pay partial TIBs until the medical status or other circumstance support a complete dispute of disability.
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