GQ Corner
Q. I was just informed of a fatality. It is unknown at this time what actually occurred and the incident is still be investigated by the Texas Highway Patrol. What I do know is that the claimant is employed as a driver and for some unknown reason he exited the lane travel and veered into the northbound lane of traffic striking another motorist. He was transported to the emergency room where he later died.
If a medical condition such as a stroke caused the MVA would the claim be compensable? What do I need to do during my course of investigation? Are there any forms that I need to provide to any possible beneficiaries? Is there any timeframe that I need to be aware of for filing forms?
A. If a medical condition (i.e. heart attack, stroke, etc.) caused the accident, you would not be responsible for the underlying condition(s), but you would be responsible for the injuries sustained in the crash. If the death resulted from the injuries sustained in the crash, you would be responsible for the death. If the medical evidence suggests, for example, the claimant had a massive heart attack and was dead before the collision occurred, you may have a basis for disputing the death.
You certainly need all the medical records from the date of injury/death. You need the autopsy report and you need to get the results of any toxicology tests that were performed. If the claimant was intoxicated at the time of the incident, that would serve as a basis for denial.
You need to contact the family to try to find out who the claimant’s family doctor was and request records from that provider.
You have an obligation to attempt to identify any potential beneficiaries and send any potential beneficiaries a PLN-12.
You have 60 days to investigate the claim.
Q. The injured employee has been released to return to work with restrictions, and the employer has extended a Bona Fide Offer of Employment (BFOE) that otherwise complied with Rule 129.6. The employee called the employer to inform the employer that, unless the offered working hours could be switched from day shift to night shift, he would be unable to accept the position. He normally works day shift, which makes this an odd request. Is the employer required to accommodate?
A. The legal answer is no, as long as the offer otherwise complied with the rule. However, it would be best practice to attempt to accommodate if the employer is able. Returning an employee back to work in any capacity has other benefits beyond suspending or reducing Temporary Income Benefits. Speak with the employer to see if they can accommodate. I also suggest speaking with the employee to determine why he wants to now work night shift. There may be other extenuating circumstances at play.
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