GQ Corner
Q: I’m confused as to what exactly a DWC 31 is and how this will benefit the beneficiary in a death case. Can you provide a quick synopsis on what a DWC 31 does?
A: If a DWC 31 is approved by the Division, the death benefits are payable monthly as opposed to weekly as is typically required. The arrangement alleviates the carrier’s weekly obligation, which impacts compliance concerns, and the claimant beneficiary can request that payments return to weekly if they decide they are not in agreement with the monthly payments. The benefit is mutual, with fewer checks transactions and a larger sum deposit for the beneficiary. Division Rule 132.16 specifically governs the annuity.
Q: If we receive a decision and order (D&O) that requires us to pay TIBs or IIBs based on the decision, what is our time frame to do so? Are we still bound to the 5 day rule or do we have the 20 days that we have to appeal as well?
A: Your deadline to pay is different depending upon whether you appeal or not. If you appeal, you must issue payment within 5 days of the date of appeal. If you do not appeal, then the decision becomes final on the 16th business day after receipt and you then must pay within 20 days of that date.
Q: Claimant was still in his probationary period when he sustained an injury. Claimant was released to return to work limited duty; however, the employer does not have a limited duty position available. The claimant was subsequently terminated on the basis that he was not progressing fast enough within his job. He should have been able to turn a wrench the correct way, should have been able to repair smaller leaks without direction, and should have been able to read the city map and navigate around the system. Claimant was not at that level and therefore was terminated.
In this scenario, we must pay TIBS given that the employer does not have limited duty available? If the city did have limited duty available, would there have been a chance of disputing entitlement to TIBs based on the claimant’s termination basis or would we still have owed TIBs regardless?
A: If the claimant has returned to light duty at the pre-injury AWW, and if there is then a termination, then there is no disability and the claimant is not entitled to TIBS in the absence of a changed condition.
If the claimant has returned to light duty at lower than the pre-injury AWW, then he is, by definition disabled during the time that he is working. If there is then a termination, then disability continues in the absence of a changed condition, and the claimant is entitled to TIBS. The amount of TIBS depends upon whether there is a written bona fide offer of employment. If there is no written bona fide offer of employment, then the claimant is entitled to full TIBS, regardless of the fact that he was terminated. However, if there is a written bona fide offer of employment, then the claimant is entitled to partial TIBS, based upon the terms of the bona fide offer of employment. The notion is that the claimant’s termination constitutes a de facto rejection of the bona fide offer of employment.
FOLIO
