GQ Corner
Q. I have a question on disability on this file. The claimant slipped and fell on 9/9/20. She did not seek any medical treatment for the incident. She stated she was not injured. She was terminated on 10/14/20 due to attendance issues. She then sought medical treatment on 11/9/20 for a left knee strain and lumbar contusion. She was placed at light duty. Obviously the employer cannot accommodate because she is terminated. Am I able to dispute the off work benefits from that employer? She has a second employer as well that are not accommodating her restrictions, so I am assuming she would at least be due TIBs for that second employer.
A. You may want to file a dispute of the entire claim as no compensable injury and raising a 30-day defense. There are certainly reasons – The claimant’s initial statement that she was not injured, the delay in treatment and the circumstances that would raise questions as to the credibility of the claim. You also have facts that would support the affirmative defense for no report of injury within 30 days of the incident under Section 409.002. You also have a basis dispute disability.
Q. Once we have a MMI declaration, can we suspend TIBs? There is no PPD rating, just an MMI declaration from the treater.
A. No. You need both a certification date and an impairment rating. Since you have been paying TIBs, I assume that the claimant has disability. TIBs are owed only so long as the claimant has disability and has not reached MMI. There are several things you might want to do. First, contact the treating doctor and see if he will issue a DWC-69 and a narrative report. Second, see if the treating doctor will release the claimant to return to work without restrictions (in which case, you would file a PLN-11 disputing disability). Third, request a DD on the issues of MMI/IR.
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