GQ Corner
Q. The injured employee sustained a compensable injury and was seen at the emergency room. The IE has informed me that he was diagnosed with a fracture, but I do not have any medical records to substantiate that allegation. I initiated TIBs when the IE informed me he had a fracture and was unable to work, but I have been unable to reach the claimant, and I still have no medical records on this case. Can I dispute disability and suspend TIBs?
A. I think the correct answer on the disability question is “more investigation is needed” and that contact with the employer and health care provide needs to be attempted first. Those cases are fact specific and we should not imply that mere failure to produce medical records justifies a dispute.
Q. The employee was using the restroom and twisted his knee as he stood up from the toilet. Can I deny this alleged work-related injury?
A. While you have an argument that the employee’s injury was not sustained within the course and scope of employment, the Appeals Panel has held that, generally, using the toilet facilities is an act that would be covered by workers’ compensation. However, these cases are incredibly fact-dependent. In APD 962020, the AP determined that, “the claimant was in the restroom on the premises of the employer. As she was getting up from the toilet, she twisted her left knee. She did not strike the knee on any instrumentality of the employer.” The AP reversed the decision of the hearing officer and determined that the claimant did not sustain an injury in the course and scope of her employment.
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