GQ Corner
Q. I have a claimant who injured his wrists in a clearly compensable injury. He only treated once and elected to submit that bill to his group carrier. He, however, wanted to file this claim, in case he needed more involved treatment for his wrists in the future. And we have no problem with that; calling in a “notice only” claim is common. That said, though, when would the applicable statute of limitations run? He did not lose any time from work for this injury.
A. The only potential statute of limitations that might apply in the circumstances you have described is the 1-year rule for a claimant to file a DWC-41 (Notice of Claim for Compensation) with the DWC. Otherwise, if the claim has been reported to the employer and carrier, the claimant can choose not to pursue now, and come back weeks, months, or even years later, and choose to pursue. These “notice only” claims can be dangerous because they frequently are not given the necessary attention, and then the claimant shows up months later, after it is too late for the carrier to dispute the claim, and pursues a claim that may have been denied if it had been investigated. If you have notice of a claim now, I would encourage you to fully investigate it, and determine whether the claim is compensable or not. It sounds like you have already made that determination, and if that’s the case, the claimant can resurface whenever he wants, as long as he can show the treatment is reasonable, necessary, and related to the compensable injury.
Q. We have a small dilemma. The claimant in question was referred out to the designated doctor; however prior to the DD appointment taking place the claimant was referred out for MMI/IR by his treating physician. The claimant was seen by Dr. Scott Harrell on 9/26/19 and placed at MMI 7/24/19 w/an 8% impairment rating. Upon receipt we began paying IIBs; the claimant was then seen by the DD on 10/2/19; however was not placed at MMI. The DDR indicates claimant will not reach MMI until 1/2/20 as he just underwent surgery.
Please keep in mind the carrier is only accepting sprain/strains. The claimant has since received surgery to the shoulder in which the carrier is not accepting. The carrier did not approve surgery nor were we aware that surgery had occurred.
During further phone conversation between the RM and the claimant it was found the claimant filed the surgery under his private health insurance since it was not related.
Do we need to file for an expedited BRC to get a DWC-24 signed to state what is being accepted and that MMI has been reached by other doctor selected by treating doctor?
A. If you do not like the 8%, Carrier needs to file a DWC-45 requesting a BRC to dispute the Dr. Harrell’s MMI/IR certification within 90days of receipt of that report. Otherwise, it will be considered final. If extent of injury is at issue, you will also need to list that as one of the issues for the BRC. Make sure that you have file a PLN-11 raising the extent dispute. You could also ask Claimant to agree on the extent, MMI and IR issues and execute a DWC-24.
If you like the 8%, you have the options of waiting to see if that becomes final without a dispute by Claimant. Make sure you send the PLN-3 and report by certified mail or delivery confirmation. After 90 days have passed without Claimant requesting a BRC, you can assert that Dr. Harrell’s certification is final and redesignate TIBS as IIBs pursuant to that certification. In either track you take, you will need to resume TIBs for all periods of undisputed disability when the extent, MMI and IR issues are adjudicated or negotiated.
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