GQ Corner

Q. I am handling a claim for a 45-year-old Code Enforcement Officer who sustained a left thumb strain, left elbow strain and left forearm strain on 2/8/2019 while stuffing letters into envelopes. In her statement, she detailed that the producing cause was limited to stuffing letters into envelopes on the date of injury and that she had no problems prior to the date of injury. We accepted the claim for the above mentioned strains. As treatment continued, we obtained a peer review that determined the injury was limited to the above mentioned strains and did not include left lateral epicondylitis, left thumb sprain, left carpal tunnel syndrome or De Quervain’s. We filed a PLN-11 and exchanged it with the provider and the claimant. The injured worker was referred by her treating doctor for a MMI/IR exam in June 2019, where she was determined not to have reached MMI. However, the provider administering the exam stated that she was not at MMI because her De Quervain’s in her thumb had not been treated. We requested a DD exam to address MMI/IR and ability to return to work. The DD mentions our accepted injuries twice in the report, but also includes diagnosis code M65.4 (Radial styloid tenosynovitis [De Quervain]) on the DWC-69. The DD determined the claimant has not reached MMI due to need to obtain treatment for De Quervain’s tenosynovitis. 

What is your opinion on the next steps we should take? We have considered an LOC to see if the DD would complete a DWC-69 for accepted injuries only, or perhaps a Post-DD RME. In the meantime, are we liable for treatment related to the DD’s position on the added diagnosis on the DWC-69 even though we did not ask for extent to be addressed? If we were to owe for the diagnosis and a future DD determined we did not owe for the diagnosis, would we be able to request reimbursement from the subsequent injury fund for payment related to that treatment?

A. Even though not appointed on extent, the DWC permits DDs to define the compensable injury like the DD did in this case. However, unlike when a DD is appointed on extent, the self-insured is not bound by the DD’s opinion regarding the additional diagnosis; you are only bound by the not-at-MMI opinion. A LOC will be rejected by the DWC based upon the fact that the DD was free to include the additional diagnosis. I recommend a post-DD RME. The RME doctor will certainly only rate the accepted conditions, but we have the added benefit of asking the RME doctor to issue a second certification including the disputed De Quervain’s. 

Q.  Does the employer have any obligation to pay an employee when they go for medical appointments?   I take the position that a medical appointment is not disability and should be scheduled according to the work schedule as best as possible, but there are always those who do PT in the middle of a work day and do not come back and it is creating a problem.  

A. If the employer does not pay them and they actually have reduced pay for appointments and it is reasonable that they cannot go outside of work hours, then you probably owe them TIBs.  I agree these appointments should be scheduled around work hours, but I know there are those who work full days and have kids and cannot go before or after work.  If people are not full time, then I have a hard time believing they cannot go to appointments outside of work. But full time employees are harder to make that argument about. You can probably successfully dispute disability for the part time EE who tries to go during work, but it depends on the overall facts.