GQ Corner

Q. Shortly after his compensable injury, the claimant presented to a company doctor who released him to return to full duty work. However, the treating doctor subsequently removed him from work entirely and continued to maintain his off duty work status. I would like to obtain a second opinion. What would be the best way to facilitate this?

A. Our recommendation would be to request a designated doctor examination addressing the ability of the claimant to return to work. Generally, it is a good idea to simultaneously request evaluation of MMI and impairment rating. In either case, the opinion of the designated doctor will be entitled to presumptive weight and further enables the carrier to arrange a post-designated doctor required medical examination with a doctor of its choice.

Q. We have been paying the claimant TIBs while withholding 50% for child support. The claimant received a full duty work release, at which time we had incurred an overpayment. However, work restrictions were subsequently imposed again and the claimant was terminated while they remained in effect. Consequently, we intend to reinstate full TIBs. We would like to take a credit for the prior overpayment but want to ensure that we properly calculate the amount owed in TIBs, the amount owed in child support, and the amount we may recoup. The TIBs rate is $500. The claimant is not represented by an attorney. How should we effectuate recoupment under these circumstances?

A. Rule 126.16 sets out the procedures for recouping benefits and contains numerous requirements with which the carrier must comply in order to properly do so. Assuming it properly complies with the notice requirements and other dictates of the Rule, the carrier may withhold up to 25% of the claimant’s benefits if they are not concurrently being reduced to pay approved attorney fees or to recoup an advance approved by the Division. Since the claimant is not represented by an attorney and the TIBs rate is $500 weekly, you may recoup 25% of $500, or $125. You would then divert 50% of the remaining $375, or $187.50, for child support. The remaining $187.50 would go to the claimant.