GQ Corner

Q. The claimant disputed the initial assessment of MMI and impairment. The DD has agreed with the initial assessment. Can a claimant request a post DD RME in this scenario?

A. The claimant can request an alternate certification if he would like to do so, but the carrier is not liable for payment of the alternate MMI/IR exam. The carrier is only liable for an alternate where the first certification is from the DD and the claimant is disputing or disagrees with that certification. 

Q. I have a claim for which the claimant did not report a specific injury or accident. He works along the toll road in Austin and his job varies from day to day. He reported that from getting in and out of his truck and going up and down stairs that his low back and neck hurt. He is a Customer Patrol Maintenance and will help passengers with flats, etc. He will go around in the company truck any given day and his job duties are not the same every day. I don’t see an injury as defined under the Labor Code. His job is not repetitious.

A. I would agree based on the information provided. I do not see sufficient evidence to establish an injury (damage or harm to the physical structure of the body) arising out of and in the course and scope of employment particularly given the fact that there is no clear mechanism of injury. Our case law dictates that the mere onset or recurrence of symptoms in the workplace is not enough by itself to establish a compensable injury. It seems his complaints are consistent with an ordinary disease of life to which the general public is exposed outside of the employment. Moreover, if the employee pursues a repetitive trauma claim, it would most likely not be compensable. The general public is exposed to hazards inherent in walking, standing, sitting and driving. Conditions resulting from such repetition are an attribute of employment generally, and are not compensable. See AP Nos. 92272, 92314 and 941018.