GQ Corner
Q. The Division appointed a designated doctor to evaluate MMI and impairment rating only. The designated doctor opined that the claimant had not yet reached MMI but did so based upon consideration of disputed injuries, and in fact suggested that such injuries are related to the claim injury. Is the carrier liable for medical benefits related to the disputed injuries per the report?
A. No. While the carrier must indeed comply with and issue benefits pursuant to the opinions of the designated doctor with respect to all issues he or she was appointed to address, it is not bound by a gratuitous opinion as to an issue he or she was not appointed to address. Effectively, the comments of the designated doctor as to extent constitutes an expert medical opinion on the matter but one without presumptive weight under the statute. Here, you are bound by the “not at MMI” opinion but may maintain the extent dispute at this time. In these scenarios, you can often anticipate that the claimant will request a new designated doctor examination specifically on the issue of extent of injury, and it is generally wise to pursue a post-designated doctor required medical examination if you disagree with the conclusions expressed.
Q. What is the carrier’s deadline to pay or dispute death benefits, and where may I find the authority for this?
A. Rule 132.17(a) provides that upon receiving notice of a death resulting from an injury, the carrier shall have 60 days from the later of notification of the death or written notice of the injury resulting in the death to conduct its investigation concerning compensability and liability. Rule 132.17(f) specifies that the carrier shall begin payment of death benefits if it believes the claimant is eligible to receive them or shall otherwise file a PLN-1 notice of dispute not later than the 15th day after the latest of receiving the claim for death benefits, final adjudication of the carrier’s denial of compensability or liability under Rule 124.2 and Rule 132.17(b), or the expiration of the carrier’s right to deny compensability or liability under Rule 132.17(a).
FOLIO
