GQ Corner

Q. I have a new claim where claimant admits she dislocated her knee while dancing at work because she was happy about finishing her work. Would this be compensable?

A. You could deny on the basis that the claimant was not in the course and scope of employment at the time of the accident and engaged in horseplay. Whether the activity constitutes “horseplay” is going to be a fact question for an ALJ to resolve.

Q. We have been handling a claim where a 51-year-old employee was injured while driving his car in the course and scope of his employment and was struck in the rear by a large truck. Although he had multiple injuries, we learned he fell at home yesterday, went to the ER for a broken nose and passed away last evening.

1) As we begin our investigation into his death, please confirm our handling as to his on-going TTD?
2) We require a new claim filed for the date of death, allowing for investigation?
3) We file a PLN 11 on the current, existing claim?

A. TIBs stop at death. You should file a PLN-11 on your existing claim. You have 60 days investigate the death. A new claim needs to be filed. Read rule 132.17. You have to notify potential beneficiaries using a PLN-12 within 7 days of the date that you identify them.

If you determine the death is not compensable, you file a PLN 1 on the new death claim.

Q. Are inguinal hernia’s considered compensable in TX? If compensable, does there have to be a specific incident? Claimant is reporting injury from raising landing gear on a tractor trailer. Medical notes do not reflect a specific incident but indicates he has noticed swelling and discomfort for the past 2-3 weeks.

A. Yes, they are compensable in Texas. But there does not necessarily have to be evidence that the hernia was caused by a specific incident. (There did have to be that evidence under the “Old Law.” What the claimant has to do is have medical opinion explaining how the job caused the injury.