GQ Corner
Q. The claimant told me that his current complaints he has had prior to the injury are not related to the work event and does not want to continue treatment under work comp. So, I sent him for a designated doctor’s evaluation to address MMI & IR only. The DD did not put him at MMI because he found tears in his compensable knee. So I had a record review done and they opined that the tears are not related like the claimant states. So I requested a post DD/RME and the doctor would not address the tears because we only asked the DDE to address MMI & IR. My opinion is that we can because the DDE is the one that brought up the tears. Our vendor was advised that we needed another DDE to address the tears as extent.Does this make any sense to you? What is the course you think we should take?
A. Unfortunately, the advice is correct – the RME can only address the issues noted on the DWC32 that resulted in the DDE. So, you have two options:
- Get a DDE on the issue of extent of injury, and then get another post-DD RME (recommended).
- Fight the DD’s opinion regarding the tears with the peer review you obtained. Arguably, the DD only holds presumptive weight on the issues of MMI and IR.
Q. Claimant was a police officer and injured his back stepping out of his patrol unit on 03/08/17. Claimant has disc displacement at L4-5.He is no longer employed with the city, and TIBs continue to be paid. His doctors have kept him on light duty status and he is working another job now. We requested a DDE on MMI, IR and return to work.The claimant did not show for the DDE.Can we dispute TIBs at this time?
A. Yes, you can suspend TIBs based on the claimant’s failure to attend a designated doctor evaluation without good cause, as noted in Rule 127.25(a).
FOLIO
