GQ Corner
Q. I have a claimant who has not been to the doctor in weeks and does not appear to be scheduled for any follow up appointments. At his last appointment, he was given restrictions the employer could not accommodate. Should I dispute disability and entitlement to TIBs since his treatment has been inconsistent or even possibly abandoned?
A. It depends on several factors, but we would generally not recommend suspension on this basis alone. While disability is a fact question and you are technically always permitted to dispute with a reasonable basis, you leave yourself open to a potential compliance violation if it is later determined that the claimant had disability during the period of dispute. The safest and best practice under these circumstances is typically to request a designated doctor examination on issues of maximum medical improvement, impairment rating, and the ability of the claimant to return to work. However, questions of this nature (concerning possible suspension of TIBs) often simply depend on the carrier’s risk tolerance.
Q. If the claimant did not lose any time from work initially, but has surgery for the compensable injury and begins to lose time on an ongoing basis several years later, would the 104 weeks start from that point?
A. Yes. Texas Labor Code Section 408.082(b) confirms that if disability does not begin at once after the injury occurs or within eight days of the occurrence but does result subsequently, weekly income benefits accrue on the eighth day after the date on which the disability began.
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