GQ Corner

Q:  The claimant filed a DWC-52 application for supplemental income benefits (SIBS) after the filing deadline for the relevant quarter. Specifically, he filed the application during the second week of the quarter itself. Given that the application is untimely, is the claimant precluded from receiving SIBS for the entirety of the quarter?
 
A: No. A late application only relieves the Carrier from liability for the portion of the quarter preceding the date the application was filed. If the claimant establishes entitlement to SIBS for the quarter by meeting the Rule 130.102 criteria, the carrier retains liability for SIBS beginning on the date the application was filed and spanning through the end of the quarter.

Q: The designated doctor recently issued the first certification of MMI and impairment rating on a claim. The claimant is now seeking an alternate certification from his treating doctor. Must the carrier pay for this examination?

A: Yes. Pursuant to Labor Code Section 408.0041(f-2) and Rule  126.17, the carrier is obligated to pay for the examination because the designated doctor provided the first certification of MMI and impairment rating on the claim and the claimant is disputing that certification. Please note that the carrier would not be liable for the examination if the treating doctor or a post-designated doctor required medical examiner had already issued a certification prior to that issued by the designated doctor.