GQ Corner
Q. The injured employee works and lives in a state other than Texas, but sustained an injury while on a business trip to Texas. She does not want to pursue Texas workers’ compensation benefits, but would instead like to receive benefits under her home state’s system. How do I go about transferring the claim from Texas jurisdiction to the other state’s system?
A. If this dispute is being made within the first 60 days, then you must file a PLN-1 denying the claim under Texas jurisdiction. If you are outside of the 60-day time limit, then the only way to accomplish this is to sign a DWC-24 indicating that the injured employee elects coverage in a jurisdiction other than Texas.
Q. The designated doctor examined the injured employee for maximum medical improvement, impairment rating, disability and return to work capability. The DD was not appointed on extent of injury. It is clear from reading the report, that the DD considered diagnoses beyond the accepted diagnosis when determining that the injured employee was not at MMI, was disabled for the entire time period, and could not return to work in any capacity for the entire time period. Do I have to pay pursuant to this report, and will a letter of clarification be useful to remind the designated doctor of the accepted injury in hopes that the designated doctor will amend the report and hopefully certify that the injured employee has reached MMI?
A. Because this is a designated doctor’s opinion, you must pay pursuant to that report regardless of an overrating or underrating of the compensable injury. A letter of clarification will unlikely change the designated doctor’s opinion since designated doctors are permitted to define the compensable injury even though not appointed on extent of injury. While this opinion does not expose you to the medical costs associated with the additional diagnoses (because the DD was not appointed on extent of injury), the report does expose you to the benefits associated with the MMI, IR, disability, and return to work opinions.