GQ Corner

Q. Employee missed work from 11/17-12/4/20. He was on restrictions, but did not work due to pain.  He did RTW on 12/5 and is working on restrictions full pay. Can we deny the lost time or is that something we would owe?  No bona fide offer of employment was given either time.

A. If in fact, the claimant lost wages due to his work related injury, then he had disability.  It would be a fact question whether his pain was sufficient to prevent him from working and, thus, constitute disability. The fact that the employer did not make a bona fide offer of employment is a separate issue from the disability issue.  If the claimant had disability, then TIBs would be owed for those periods of 11/17-12/4/20.  The deadline to have made the decision to either dispute disability or to pay TIBs will have run long before his return to work on 12/5/20.   If you are dealing with the initial payment of TIBs, the decision to pay or dispute should have been made no later than 12/1/20.  If you are dealing with periods after the initial pay, then the decision to pay or dispute should have been made by 11/24/20.  This assumes that the carrier had first written notice of the injury at least 15 days before the deadline line date discussed above. 

Q. Can we request an RME (not post DD-RME) to address future medical treatment if there is no designated doctor exam, but only have treating doctor who addressed MMI/IR? 

A. If this is not a network claim, then under § 408.004 you are entitled to an exam by an RME to determine the appropriateness of health care received by the claimant. This need not be after a DD. You are entitled to one of these exams every 180 days. This exam cannot address future medical treatment. It can only address the appropriateness of care that has already been provided. Note, it is a violation of the Act for you to make a statement that denies future medical care on a compensable injury.