GQ Corner
Q. If the claimant failed to attend a designated doctor examination but contacted the designated doctor’s office beforehand to reschedule, should I suspend payment of temporary income benefits?
A. No. You should continue to pay temporary income benefits (assuming the claimant has not yet reached MMI and the evidence supports disability) given that the claimant timely attempted to reschedule the examination on or before the date it was scheduled to occur. Note that Section 408.0041(j) does permit the carrier to suspend payment of temporary income benefits when the claimant fails to submit to an examination and fails to reschedule same without good cause.
Q. The claimant was working at modified duty status and earning partial wages when she sustained an intervening injury (unrelated to the claim injury at issue) that caused her to stop working entirely, and therefore to cease earning any wages. Do I still owe temporary income benefits?
A. Yes, because the claimant was already disabled and entitled to temporary income benefits prior to and contemporaneously with the intervening injury. Even if the intervening injury was indeed unrelated to the claim injury at issue and caused the reduction or elimination of wages, the claimant’s disability status before and at the time of the intervening injury presumably persists, and dictates essentially that she would have remained disabled whether or not it occurred. Given the prevailing disability status, the statute and rules simply call for mathematic calculation of the benefit rate, generally as 70% of the difference between the average weekly wage and post-injury earnings. However, there is support for the position that the post-injury earnings received prior to and contemporaneously with the intervening injury may be imputed as such to the period of time following it such that the claimant receives only partial temporary income benefits.
Q. The Division appointed a designated doctor to address extent of injury, maximum medical improvement (MMI) and impairment rating. The designated doctor opined that the compensable injury extends to some of the disputed conditions but not others. He provided multiple assessments concerning MMI and impairment rating. Specifically, he certified clinical MMI with a 0% impairment rating for the accepted conditions, clinical MMI with a 10% impairment rating for the accepted conditions and those disputed conditions he opined to be compensable, and opined that the claimant had not yet reached MMI for the accepted and all disputed conditions. Which certification or opinion must I comply with?
A. You are bound to comply with and issue benefits pursuant to the certification or opinion that corresponds with or “matches” the assessment concerning extent of injury. In this case, this would be the certification of clinical MMI with a 10% impairment rating for the accepted conditions and those disputed conditions he opined to be compensable.
FOLIO
