GQ Corner
Q. Since we currently cannot get DD exams and Required Medical Exams, what can an adjuster do to move the files towards closure?
A. There are several tools at our disposal to move files forward during this challenging time. One proactive step we can take is to pursue a records review conveying an expert medical opinion regarding one or more issues, such as medical necessity of treatment, relatedness of treatment, extent of injury, maximum medical improvement, impairment rating, the ability of the claimant to return to work, disability, and others. Our office can transmit a copy of the relevant records and an analysis letter to the expert (who will typically be a hand-picked specialist in the relevant practice area) in order to ensure that he or she receives a thorough evaluation of the claim and its history, as well as instructions that are tailored to the unique issues involved in your case. If you are interested in pursuing a records review, please contact Walter Beck at wnb@fol.com or (512) 435-2251.
Another proactive measure we can take is to continue to prepare DWC-32 requests for designated doctor examinations and DWC-22 requests for post-designated doctor required medical examinations. Though these examinations remain suspended at this time, early preparation of the request instruments should ensure that your request is closer to the “front of the line” as to minimize delays once the suspension is lifted and the agency begins to process the backlog of requests. Furthermore, if you are filing a DWC-32 in order to dispute the first certification of MMI/IR issued by a treating or referral doctor, it must be filed within the 90-day period. Please continue to send your requests for designated doctor examinations and post-designated doctor required medical examinations to our DDR/RME team at ddr@fol.com so that we may get the ball rolling in pursuit of earlier approval by the Division.
Finally, you might consider a comprehensive review of your file and a legal opinion containing our analysis, strategy recommendations, and so on. We can develop a case-specific plan of action outlining the “next steps” toward developing your defense, mitigating the exposure, and ultimately expediting resolution of pending issues. If this is of interest to you, please send your requests to Sharissa Karol at sdk@fol.com or (512) 435-2224 so that we may set it up and assign it to an attorney for prompt review and response.
Even in the face of the current challenges, we are here to help you advance your claims toward a point of closure, and are always available to talk with you and craft a case-specific plan in order to assist in doing so.
Q. I have a claimant who is repeatedly missing and then moving appointments for personal excuses. He is out of work completely and getting TIBS. I find this ridiculous. Can I suspend TIBS until he attends? I am sure the answer is no, so what recourse do we have as this should not be allowed. His only job right now is to attend appointments and he is no doubt doing it on purpose now that the TIBs valve is open.
A. You have two options. First, if the claimant is not attending ANY appointments and, thus, you do not have updated medical records addressing his work status, you can consider raising a disability dispute based upon the lack of medical evidence addressing his work status. If the claimant is smart enough to at least attend appointments frequently enough to get medical reports keeping him off work, this may not be an option for you. The second option is to request a DD to address MMI/IR, point out what the claimant is doing in an analysis letter, and hope the DD reads the letter and agrees the claimant has reached MMI. Or maybe you get lucky and the claimant misses the DD exam and you can suspend TIBs on that basis. Other than that, your options are limited.
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