GQ Corner
Q. I am hearing the PLN-14 can be used for law enforcement employees to allow carriers to complete their initial investigation. Is this true?
A. The form is available for three types of governmental employees: Firefighters, EMTs and Peace Officers. You can use the form to extend the time for your investigation if the claimant suffers from a disease or illness for which they are entitled to claim a presumption under Chapter 607 of the Government Code. The injuries or illnesses that may be entitled to a presumption are: acute myocardial infarctions or strokes, smallpox as a result of a preventative immunization, tuberculosis or other respiratory illnesses, and certain types of cancer. Peace Officers cannot successfully claim a presumption for any type of cancer. The PLN-14 must be completed properly and timely filed (on or before the 15th day) with the Division. A copy must be delivered to the claimant at the time it is filed with the Division. The changes in this area were created as a result of legislative amendments from the 2019 legislative session. They are very technical changes. The Division regulatory oversight in this area is intense. If you have any question about the use of the PLN-14, the investigation of a presumption claim or the language the must be used in the denial of a presumption claim, please let us know.
Q. The claimant is employed as an AC Technician. On the Employers First Report of Injury dated 8/17/20, it states “unsure of the cause”. For two to three weeks, he claims he has felt nauseous and dizzy. The claimant reportedly notified the employer that he thought he was having symptoms of heat exhaustion, and the employer recommended that he seek evaluation. The claimant presented to the hospital and suggested to personnel that he thought he may have COVID-19 but that it was not work-related. The hospital personnel did seem to be under the impression that he had COVID-19 and sent him to another facility, where testing was negative. The employer has the negative COVID test results. The claimant has been off work since. The employer spoke with the claimant, who requested the following Monday off work for personal reasons; more recently, he spoke to the employer and confirmed that he is feeling fine. Should I file a denial? If so, what should the wording be?
A. There appears to be a reasonable basis to dispute, based on the information provided. Suggested language may include as follows: The carrier denies the employee has sustained an injury or illness in the course and scope of his employment. The employee reports that he has been nauseous and dizzy for two to three weeks. He has been tested for COVID-19 and that test is reported to be negative. The complaints do not appear to have originated in a hazard of the employment and the illness did not occur while the employee was furthering the business of the employer. The claimant appears to be suffering from an ordinary disease of life. Because there is not compensable injury, there is no disability.