GQ Corner
Q. The claimant is a 34 year old police officer. On 04/10/16, he was on a motorcycle driving in a training pattern when his right foot got caught between the motor and ground. He sustained an injury to his Achilles tendon requiring surgery. The claimant was certified at MMI on 11/14/16 with a 0% impairment by his treating doctor.
The claimant was in disagreement and requested the carrier change the impairment rating. The carrier declined to. The claimant requested a DD who certified MMI on 11/27/18 with a 0% impairment rating. The claimant’s treating doctor signed in agreement with the report. The claimant is in disagreement with his DD stating that the DD did not include some measurement she stated in her report within the percentage rating.
After reviewing the report, the DD indicates the following in the range of motion section of the report: dorsiflexion at 25 degrees, plantar flexion 16 degrees, inversion 25 degrees, and eversion 20 degrees. However in her summary of MMI and IR she transposes the degrees stating ” the right ankle has plantar flexion 25 degrees and dorsiflexion 16 degrees…” and in the section where she summarizes the right ankle, she leaves out plantar flexion altogether (I have attached this DD report for your reference.)
The claimant is requesting the carrier issue a 3% impairment which would be what The 4th Edition AMA Guides appears to provide.
The carrier did not request this DD, the claimant did. Is it not the claimant’s responsibility to obtain a letter of clarification from the DD and/or request a BRC? Should the carrier request a letter of clarification from the DD? Should the carrier request a post-DD RME? Because there appears to be a mistake in the DD’s report, does this make it invalid? What, if anything, should the carrier do at this point?
A. Technically speaking, you’re correct that it’s up to the claimant to request an LOC to correct the DD’s error. However, I would recommend that you go ahead and request the letter yourself. It’s obvious the DD made an error and frankly it needs to be fixed. It’ll be easier for everyone down the line if the DD report is corrected.
If you’re dissatisfied with the DD opinion after the LOC correction, go ahead and request a post-DD RME. I would also keep an eye on your 90 day clock if you’re interested in disputing this report.
Q. I have a claimant who sustained multiple injuries on 11/24/2018. The investigation revealed some potential prior related care. I had created a prefilled HIPAA-compliant authorization and sent it to the injured worker and his attorney. I have not received the signed authorization in return. The treating physician is now recommending surgery.
- How can I push to get the HIPAA signed?
- Do I have any options for disputing the extent of injury and need for surgery without the prior medicals?
A. You cannot compel the claimant to sign the HIPAA-compliant authorization at this point, but you can request a pre-hearing subpoena if there’s medical out there that you want and you cannot get because the claimant has refused to sign the HIPAA-compliant authorization.
If your investigation has revealed prior related care, depending on what you have found as a result of your investigation, you can file a PLN-11 raising an extent dispute, and make the claimant prove that the current condition is related to the compensable injury and not the pre-existing condition.
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