GQ Corner
Q: Claimant was working light duty earning partial wages, so I was paying her partial TIBs. Claimant then resigned. Should I stop her indemnity benefits because she electively chose to disengage from employment where light duty was being accommodated?
A: If there was a written bona fide offer, you can continue to consider the offered wages to be post-injury earnings. Absent an written bona fide offer, there will be a fact issue as to whether the subsequent loss of income is due to her compensable injury. You have a defensible argument that only partial TIBs at the pre-resignation rate are owed. If Claimant continues to have credible evidence of work restrictions resulting from the compensable injury, Carrier does not have a good basis on which to stop TIBS. If the medical records suggest a plateau in recovery, then you should request a designated doctor on MMI and IR.
Q: The claimant moved to another state before I could request a designated doctor appointment. The accepted diagnosis was heat exhaustion/dehydration. The date of injury is 07/14/16. Prior to his move out of state, the treating doctor released him to restricted duty; however, there is a peer that states the compensable injury has resolved. I have also disputed that the include includes anxiety/confusion, elevated temperature, elevated respiration rate, and/or observed flushing/sweating. I have notified the claimant that it is imperative for him to find a new doctor to address disability, if any. If he has not sought treatment and presented me with a work status by 01/06/2017, can I dispute disability?
A: Yes. If the Claimant does not present credible evidence of ongoing disability, and if the nature of the injury when compared to expected return to work periods would not suggest likely ongoing disability, you can raise that dispute.
FOLIO
