GQ Corner
Q. I have a claimant who we’ve been trying to get scheduled for an MRI since 11/9/16. The MRI was requested by her doctor. The employee keeps delaying in setting the appointment because she says she’s had a cough. Her MRI appointment has been scheduled for 12/14/16. I spoke to her this morning and she stated that she has to get ready for daughter’s graduation on 12/15/16; she’s therefore unsure if she will be able to attend the MRI appointment.
Is there any recourse for non-compliance if she doesn’t attend MRI?
A: Unfortunately, not anything easy. I assume that the MRI was preauthorized. If so, probably the only thing you can do is to request a Designated Doctor and in the analysis point out that the MRI has been requested. The Designated Doctor can order it, if it is necessary and if the claimant fails to attend, that will contemplate non-attendance and you can suspend temporary income benefits.
Q: I have a claim on a car sales person. The DWC-3 shows wages of over $19,000 for a period of 13 weeks from 7-1-16 to 10-1-16. She has a fractured foot/ankle. Since her AWW is $1,537.00, I am paying the max TIBs rate. She was off work until 11-20-16. On 11-21-16, she returned to work for 8 hours day, 6 days a week. She gets paid only if she sells a car and she gets $150 per car. Since 11-21-16, she has sold 4 cars and earned $600.
How do we figure her partial TIBs rate?
A: You take the pre-injury AWW and subtract the weekly post-injury earnings and pay 70% of the difference up to the max rate.
Q: We received a certification from the designated doctor on MMI/IR that we don’t agree with. The designated doctor’s certification is the first certification on the claim.
Do you agree we have 90 days to file our DWC 45 disputing the DDE?
A: If that is the first certification, yes. You have 90 days to dispute the first certification regardless of who the certifying doctor is. I prefer to file the dispute early enough so that you actually get the BRC set before the 90th day. Waiting too long and then having your DWC-45 rejected for some reason is too risky in my opinion.
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