GQ Corner
Q. We have an injured worker who has a torn rotator cuff, but cannot proceed with the surgery because when he did the stress test, the doctor found he needed a cardiac catheter. The need for the catheter is not related to workers’ comp and is not going to be paid under the claim. My question is, since he cannot move forward with the surgery to repair the work injury, is he not at a plateau in his care? And if so, would he not be at MMI based on the plateau?
A. Here are your options.
You could find out if the claimant is going to have the catheter put in since it may be in his own benefit to have that done. If he does it on his own or on his group health insurance, you could move on with the RCT surgery.
You could pay for the catheter (even though it’s not directly for the compensable injury) and then proceed with the RCT surgery. Something tells me this may be expensive so it may not be a viable option. If it’s not too expensive it might be an option.
You could take the position that he has plateaued and see if you could get an MMI from the treating doctor or request a DDR and provide a good analysis so the DDR knows specifically why he can’t have the surgery and hope that the DDR MMIs him.
Q. We were paying the claimant TPB, he was working l/d with the insured, they have a policy they can only do l/d for 13 weeks. Now the claimant is going to STD. Do we start his benefits back up? If we do, can we/should we take credit for that amount of STD and pay TPB?
A. You should initiate TIBs once light duty ends. As to whether you can take credit for STD benefits, Rule 129.2(d)(5) explains that STD is NOT considered post-injury earnings (PIE) if the benefits are paid under a policy paid for by the employee separate from WC. So you should check with the insured about who paid for the STD policy.
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