GQ Corner
Q. Claimant was working limited duty when he decided to resign from the claim employer. The claim employer has advised he resigned because he found new employment; however, we do not have actual evidence that he has a new employer or any current earnings. Claimant resigned from the claim employer effective 11-01-19. Is there any way to dispute disability/TIBs given that the claimant voluntarily resigned? If we cannot dispute TIBs, can we only pay partial TIBs and use what he was earnings (PIE) from the claim employer since the claimant chose to give up the earnings?
A. If the claimant was working, and then left the employer for a new job, I would dispute disability. If the claimant asserts he did not go to work for another employer, or was earning less than his AWW and wants partial TIBS, he can request a BRC.
Q. A 19 year old maintenance employee of two months was injured on 10/21/19. He sustained a hand injury, crushing/contusion and had no lost time. He was then terminated on 11/20/19 for multiple policy violations within probationary 6 months. Until that point all work restrictions had been accommodated. Should I file a PLN-11 on disability or do we need to start TIBs. The DWC-6 showing termination was received today.
A. If the claimant has returned to light duty at the preinjury AWW, and if there is then a termination for misconduct, 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 preinjury AWW, then he is, by definition disabled during the time that he is working. If there is then a termination for misconduct, 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 for cause. 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 misconduct constitutes a de facto rejection of the bona fide offer of employment.
FOLIO
