GQ Corner

Q:Claimant reported an injury occurred on 10/22/15,  but did not actually report the injury until 10/26/15. He advised that the drug screen may be positive due to taking wife’s pain medication.
The results of the testing are still pending. Do we still have a defense of denial if the test results are positive?

A: You need to take a recorded statement from claimant before the test results come back as to what the medication was, the dosage, and when he took the pain medication. You will get more reliable answers if you ask now. Otherwise, he may attempt to couch his answers to fit the test.

Once you have the test results, you should obtain a toxicology peer review with the information from the recorded statement considered. The peer reviewer will need to address whether the results match with the employee’s explanation of usage and whether this testing shows he did not have the normal use of his mental and physical faculties at the time of the injury.

The 4-day gap between the injury date and the drug test is problematic. You only have an intoxication defense if you can present credible evidence of intoxication at the time of  the injury.  You may be faced with an explanation that between the injury date and the test date, he took the pain medication and had not taken any prior to the injury. The credibility of that assertion can be evaluated by the test results and peer review.

Q: Compensable injury is contusion to bilateral knees. Degenerative arthritis was disputed via PLN 11. Claimant is off work because she was terminated for cause after her injury. She is on light duty so TIBs are being paid. Peer review indicates the compensable injury, ie the bilateral knee contusions, have resolved and claimant is now treating for her degenerative conditions.

Can I stop TIBs based on peer?

A: Just as a claimant can establish disability through his or her testimony alone, the handling adjuster is permitted to evaluate the same evidence to determine if it does not support a claim for disability. If you believe that the evidence does, in fact, support the contention that the compensable injury was limited to contusions to the bilateral knees and that they have resolved, then you can file a PLN-11 indicating that the compensable injury has resolved and, therefore, it is not a producing cause of any continued inability to obtain and retain employment at the preinjury wage.