GQ Corner
Q. I received a questionable claim. What is my deadline to dispute the claim?
A. An insurance carrier or self-insured has 60 days from the first date of written notice to investigate the claim and potentially raise a compensability dispute. If you raise your dispute after Day 15, however, you are responsible for all medical and indemnity benefits that accrued through the date of your denial. In other words, if you raise your dispute on Day 32, you are responsible for all benefits that accrued up until that date.
Q. The injured worker sustained a compensable injury to his left foot. I don’t yet know the extent of the injury because communication with the provider has been difficult. I did receive a DWC-73 work status report that indicates the claimant is prevented from using his left foot. When I spoke with the injured worker about the restriction, he stated that he is unable to drive because, unlike most individuals, he drives with his left foot. Am I required to provide transportation to the injured worker for what seems to be a self-imposed driving restriction? If the alleged driving restriction cannot be accommodated, when do I owe Temporary Income Benefits?
A. Ultimately, this is a disability issue, and that means that so long as the injured worker does not work, the clock is ticking for the carrier to either initiate TIBs or to file a PLN-11 disputing disability. The deadline for doing so is the later of two events : (1) the 15th day following the carrier’s first written notice of the claimed injury or (2) the 7th day after the 8th day of disability.
Regarding the injured worker’s allegation that he drives with his left foot, that becomes a fact issue. If you do not find this claim to be credible, then you should file a PLN-11 to dispute disability. If you find this claim to be credible, you are not required to furnish transportation; however, the injured employee’s inability to obtain and retain pre-injury employment earning pre-injury wages will be directly attributable to his work restrictions. This mean you will owe TIBs absent some other defense.
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