GQ Corner
Q: The designated doctor assigned the injured employee a 14% impairment, and we just paid the last week of IIBs under this impairment rating. We have a CCH coming up in two weeks to address impairment rating since the referral doctor gave 20%. Should I stop paying IIBs since the first rating has been paid?
A: You are not obligated to pay pursuant to the referral doctor’s report. Rather, as provided in Section 408.0041, you are required to pay pursuant to the report of the Designated Doctor, who assigned the 14% IR. As a result, you are not only safe in suspending IIBs, you are required to do so by law.
Q: I cannot find in the rules that there is a time limit to request monies from the SIF other than the wording in Rule 116.11(h) that says “An insurance carrier seeking reimbursement from the SIF shall timely provide…” The “timely provide” language is subjective so any ideas what they’re considering timely? For some reason I thought the deadline was one year from the Decision & Order or Appeal’s Panel notice.
A: No, there is not a time limit to file a SIF request in most cases. The section you quoted regarding timeliness applies when the SIF request is filed and then SIF officer asks for additional documentation that was not initially provided. However, subsections (e) regarding requests that involve multiple employment and subsection (g) regarding requests for reimbursement based on initial pharmaceutical coverage when a claim is later found to be not compensable have time deadlines. For multiple employment, the request must be submitted on an annual basis for payments made during the same or previous fiscal year, and requests submitted outside that timeframe will not be reviewed. For pharmaceutical coverage, the request must be submitted in the same or following fiscal year after a determination that the injury is not compensable.
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