GQ Corner
Q. I have a claimant who fell back and used his arms/elbows to brace himself. He was initially diagnosed with cervical strain/R elbow contusion. He was treated conservatively by WC treating doctor. He released the claimant to full duty and released claimant from care on 5/29/20. The claimant complained that he was still having issues with his R elbow. He followed back up with the WC treating doctor. Again he was treated conservatively. He was released to return to work full duty and released from care as of 6/19/20. The treating doctor’s last DWC-73 mentions elbow bursitis/shoulder pain. The treating doctor’s notes recommend that he follow up with his PCP for his chronic conditions. The claimant has called his employer stating that his PCP told him that his current issues are due to this work related injury. The employer has contacted me wanting to know what we do at this point. We do not have anything from his PCP relating current issues to this injury. What do you recommend that I do at this time? Should I file a PLN-11 limiting comp injury to a cervical strain/contusion & dispute bursitis plus any other ordinary disease of life/pre-existing condition?
A. I think you are absolutely right that the priority in situations like this is to pin down our position on extent of injury and to file a PLN-11 memorializing our dispute of the disputed conditions. This should alleviate any liability for treatment related to those conditions unless and until they are proven to be causally related to the compensable injury. You could consider a peer review addressing extent of injury, though one is not necessarily required. Additionally, if the claimant has been at full duty work but begins losing time exclusively as a result of the disputed conditions, such that the compensable injury is not a producing cause of reduced wages, you should file a PLN-11 disputing disability/entitlement to TIBs on that basis. Finally, you might consider a designated doctor exam on MMI/IR for the accepted conditions to move toward closure of the indemnity aspect of things.
Q. The claimant has a workers’ compensation claim and sustains a compensable injury with Employer A. The claimant leaves Employer A, due to nothing related to workers’ comp claim and goes to Employer B. Will the claimant still be eligible for TIBs benefits from Employer A? And if so, please include rule to support answer.
A. Disability is the inability to obtain and retain employment at preinjury wages due to the compensable injury. It is an economic concept. Thus, if the claimant had returned to work for company A and was on medical restrictions, but was still working at his preinjury wages, then he did not have disability. Thus, no TIBs were owed at that point. If he had returned to work for company A, but he was earning less than his preinjury aww due to the compensable injury, then he had disability and would have been paid partial TIBs. If he had not returned to work for company A due to his work related injury, then he had disability and was entitled to full TIBs. So, it is important to know if you were paying no TIBs or partial TIBs or full TIBs at the time the claimant was working for company A, just before he left that company to go to company B. Secondly, we would need to know if there were any changes in the claimant’s medical restrictions at or after he began working for company B. Third, we need to know what the average weekly wage is at company B compared to company A. Most people leave one job for another because of an increase in pay. The point is that his average weekly wage at company B is probably higher than it was at company A. If so, then no TIBs are owed because TIBs are based on the average weekly wage minus post-injury earnings multiplied by 70 %. If the claimant’s average weekly wage at company B is higher than it was at company A, then the average weekly wage minus the post-injury earnings will be a negative number, meaning that no TIBs are due.
FOLIO
