GQ Corner
Q. We have received and continue to handle many COVID claims for first responders that reported their claims last year. We still have several off work on TIBS and have completed peer reviews on many of their files. Their claims were deemed compensable last year; however as a result of the peer reviews, we have filed PLN-11’s disputing extent of injury diagnoses. Over the weekend, we have received 3 emails from claimants with compensable COVID claims and they are now requesting that we reprocess their claims due to the new rule under SB22 and they have each filed PLN 15’s. I anticipate we will receive many more of these same types of requests in the coming days and weeks. If the claims were deemed compensable since they were received, is the carrier still obligated to “reprocess” them if they are already compensable?
A. Under Chapter 10(c) of SB 22, reprocessing does not apply unless the claim was disputed originally. The PLN-15 should not be filed by the injured worker. That is the carrier form to respond to the reprocessing request. The Claimant’s request can be in any format. The request forms on the DWC site are merely suggested for use. You should not file a PLN-15 in response to a reprocessing request on an accepted COVID claim. Rather, you should send a written notice (letter format) to the injured worker informing them that the claim was not disputed, so reprocessing is not necessary, and that the Carrier will continue to pay income and medical benefits as appropriate under the claim.
Q. If a drug test comes back positive for a prohibited narcotic medication and the claimant fails to present a prescription….would that constitute as a positive drug test, which means a denial?
A. If the positive test was timely, is for a controlled substance, and the employee does not have a prescription, then you have evidence to invoke the intoxication presumption and dispute the claim.
FOLIO
