GQ Corner
Q. I recently spoke with a DD about getting some clarity of his recent report. He mentioned sending him an LOC. What is this and how do I get that done?
A. You need to be aware that you are not allowed to contact the DDR. DWC is the only one that is allowed. Sometimes you can contact the DDR’s office to find out if the exam took place, etc. But no one is to contact the Designated Dr. himself. When there is a problem or concern with a DDR’s report, you “request” a Letter of Clarification (LOC) from DWC. DWC will review and either deny the request or send out their LOC. LOCs only come from DWC.
Q. I have a claimant who has missed several appointments off and on during the course of this claim. In May 2019, the Orthopedic Doctor placed him a full duty, as he was being non-compliant with his physical therapy and overall treatment. He called me once I suspended TIBs to find out why. He became upset and stated he was not able to work. He went back to the clinic on 6-6-19 and was placed back on restrictions. As he has been terminated, I reinstated his TIBs. The claimant told the his doctor that he needed a letter stating he is still unable to perform work duties out of fear of being fired from work. He also recently attended a DDE. We are currently awaiting the DD’s DWC-69 and report. With this information, if he misses any additional doctors or physical therapy appointments would I be right to suspend TIBs for non-compliance for failure to follow up with conservative treatment at the direction of his treating physicians.
A. Failure to comply with a treatment plan or non-compliance with his doctor’s recommendations is not a valid reason to terminate TIBs. Under these facts, you can only stop paying if the claimant has reached MMI or is no longer disabled. I would therefore wait and see what the DD has to say before taking additional steps.
FOLIO
