GQ Corner
Q. The Claimant has a date of injury of 05/05/20 and returned to work full duty on 05/15/20. I issued payment for 05/06/20-05/12/20 the waiting period. Do I still need to issue the additional 2 days or can I change the prior check to reflect the 2nd week?
A. You do not owe the waiting period until the claimant has at least 14 days of disability. You can pay it if you want to, but since the claimant appears to have had only 9 days of disability, you do not owe it at this point; however, you do owe the initial TIBs period. That period begins with disability day eight. That would cover 5-13 and 5-14. You are required to pay that period based on a week. The deadline is no later than the 15th day following the carrier’s written notice of injury or the 7th day after the 8th day of disability, whichever is later, meaning that both events must occur (the carrier must have 15 days notice of the injury and the claimant must have at least 8 days of disability. I do not know when the carrier first received notice of the injury, but the 7th day after the 8th day of disability is 5-20-20 (based on 5-13 plus 7 days). The calculation of TIBs for that 2 day period of 5-13 and 5-14 will be based on preinjury AWW minus post-injury earnings for the week of 5-13 thru 5-19 multiplied by 70% (but if the claimant was earning less than $10 per hour prior to the injury, then the first 26 weeks are paid at 75% rather than at 70%). How you want to handle it is up to you, but the key is to pay the initial pay period. That means that you owe for 5-13 and 5-14, but keep in mind that payments of TIBs are based on weekly calculations.
Q. The employer pays 100% of the premium for STD benefit. Employer cannot say whether the carrier took credit against TIBs. Am I allowed to take credit? If so, how do I do that retroactively, and do I simply treat it as PIE for calculation purposes, or is there some other method? Claimant had stat MMI rating of 5%. I ran the numbers and noted an overpayment. Due to strict timeframe of issuing the 5%, which was backdated, I had to issue one single check, and I took some credit with that check as best as I could determine. Now, I am trying to rectify the numbers. In light of Rule 126.16, am I barred from taking any credit due to those strict parameters?
A. When an employer pays 100% of a STD premium, the STD payments to the claimant count as PIE. If a claimant was previously receiving STD payments and TIBs concurrently in this scenario, you would have a recoupable overpayment pursuant to Rule 126.16. You would be entitled to follow the very strict recoupment procedures in Rule 126.16. This rule also requires that you notify the employee that you are going to begin reducing his payments by 25% or 10% (depending on attorney representation). The reduction cannot occur before the second week following the notice to the claimant. To the extent that you were able to provide that notice, there would not have been a prohibition.
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