GQ Corner

Q. We’ve been paying weekly death benefits on a claim since 1991. It’s recently come to our attention that the widow may have re-married in 1995; indicating a substantial overpayment of benefits. We have notified our SIU. I also have surveillance currently on the house and cars as we continue to gather evidence.

What would you recommend as our next step with regard to notifying TDI-Fraud and/or requesting a hearing? The widow has “no-showed” three times to scheduled meetings with our investigator.

A. If this is a ceremonial marriage then you may have a fraud case. Common law marriages are harder to prove and win than ceremonial marriages. You should search the marriage records of the counties in and nearby where the widow was living in 1995 and later. A safe bet would also be to schedule a BRC and see if she shows. You can present your evidence and send to a CCH is necessary. If you win the CCH then you can review your evidence to evaluate the strength of a possible fraud case.

Q. We have a claimant who reached statutory MMI on 12/25/18. She had back surgery on 11/8/18 (approximately). We gave a reasonable assessment for MMI and IR and requested a DD. Her doctor is saying that she can’t participate in a DD appointment for 3-6 months post-surgery. The DD appointment was scheduled for 2/9/19. Can we notify the DWC that the surgeon doesn’t feel she can have a DD appointment and get it postponed, or does the claimant need to do that? We don’t want to do anything to further her injuries or risk the surgery outcome but don’t we have to have the DD extent her statutory MMI?

A. If you submit a request to cancel the DD appointment, the DWC will probably contact the claimant to see if she’ll agree to the cancellation. It sounds like she would. As for the extension, the DD does not address that. The claimant needs to submit a request for an extension of statutory MMI. She has until the expiration of 110 weeks from the date the income benefits begin to accrue to file the request.