GQ Corner
Q. I have claimant whose date of injury is 1/15/16. He has only accrued 96 days of TIBs since the date of injury but has now reached stat MMI as of 1/20/18. It’s my understanding we can cut off TIBs even though he has not had an IR assigned and he is still off work. Can you confirm if we can stop TIBs?
A: Once an individual has reached maximum medical improvement by operation of law, you are not only permitted to suspend temporary income benefits, you must do so. You have no obligation to do anything else. You are permitted to make a reasonable assessment of impairment rating, request a designated doctor, do both, or do nothing at all.
Q: We did not have a workers’ compensation policy in place for an employer on the date an employee was injured. Do I need to dispute coverage and if so, what wording should I use?
A: Anytime you have a case in which you think that there is no coverage for a particular employer, you probably not only want to deny coverage but also compensability. As for coverage dispute, the language would be something like the following : (the carrier – identify the carrier) denies that it had coverage for (identify the alleged employer) for the claimed injury. (The carrier) does not have workers’ compensation coverage for the employer in question.
You might want to add more depending upon the facts you have such as if there had been coverage either before the DOI or after the DOI, in which case, you would include comments as to the dates of coverage.
FOLIO
