GQ Corner

Q: The designated doctor issued two DWC 69s. We accepted a lumbar sprain only so the first certification says MMI on October 2, 2017 with a 5%. The second DWC 69 takes into account conditions we disputed via PLN 11 and the designated doctor opines that for the accepted condition plus those conditions, claimant is not yet at MMI. He also opines that he believes the disputed conditions are related to the compensable injury. Can we pay the 5%?

A: No. The designated doctor’s opinion is binding unless and until it is overturned by an ALJ at a hearing. If the DD believes the conditions are related, you have to pay under the certification that matches that opinion, which is not at MMI. If the DD was appointed on extent, you will also have to pay for medical treatment related to the conditions he says are part of the compensable injury. If the DD was not appointed on extent, you can continue to deny medical bills for those conditions based on the PLN 11 you previously filed.

Q: I received an email from a claimant where he states that effective immediately, he will no longer require weekly benefits from workers’ compensation. He also submitted a resignation letter to his employer. Can I terminate TIBs based on the email and the resignation?

A: No, there is nothing in the rules or statute that allow you to stop benefits just because the claimant says he doesn’t want them anymore. It sounds like the claimant got a new job so if you can determine how much he’s earning now, you can maybe decrease the amount of TIBs you’re paying or eliminate them completely. I would also recommend that you attempt to obtain an impairment rating from his treating doctor and/or request a DD.