GQ Corner
Q: How long do we have to reprocess medical bills upon receipt of a Decision and Order?
A: If the carrier has denied the claim and the claimant prevails at CCH, then the carrier will need to reprocess those bills that were filed prior to the decision that denied the services for lack of entitlement. The same applies if the carrier has denied extent of injury and then loses on that issue at the CCH. The carrier will need to reprocess those bills if they were previously denied solely on extent of injury. Rule 142.16 is not clear on when those bills must be reprocessed, but per DWC, the safe thing to do is to reprocess the bills within the same timeframes as income benefits.
Q: When you overpay one week in partial TIBs, can you take credit on the next week? Or can this only be taken from IIBs? When can you have a TIBs overpayment is there ever a situation where you can take credit from the next TIBs check issued?
A: Rule 126.16 outlines how to go about recouping TIBs. You have to provide written notice of the intent to execute the reduction—either 25% or 10% depending on whether attorney’s fees are being paid. The notice does not go on a PLN, just send a letter. You can begin the reduction with the second income benefit payment after you have provided that notice. The claimant does not have to agree to the reduction. Once you begin and end the reduction, you will send the appropriate PLNs.
Q: My claimant was paid mileage for a period before the injury and then was given a company truck. Those payments would be nonpecuinary wages, correct? Would we have to include this in AWW calculation?
A: These are only considered wages if the mileage and truck usage was intended to be actual remuneration for his work. If the mileage was paid simply to reimburse the employee for the use of his own truck and gasoline, it is not part of the AWW. The provision of a company vehicle is a non-pecuniary wage that is part of the AWW.
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