GQ Corner

Q. The claimant was certified at MMI on 9/30/20 with a 5% rating by the designated doctor, who also addressed extent of injury. The carrier accepted the DD opinion on extent and paid the IIBs. The claimant’s treating doctor then certified MMI for 12/24/20 with 0%. The claimant contacted OIEC, who sent a letter to the treating doctor requesting an alternative certification of MMI. He referred her out for another rating.  Can they do this?  Is the treating doctor’s rating not the alternative certification? Also, she is now trying to get bilateral carpal tunnel included in our claim (she has never been diagnosed with carpal tunnel by ANY doctor that has seen her for the compensable injury).  She has requested another designated doctor to address this.  Can they do that?

A. They can obtain as many alternative certifications as they want, but you should deny the bill when you are charged for it.  §408.0041 (f-2) provides a claimant may request an MMI/IR exam from the treating doctor or from another doctor to whom the claimant is referred by the treating doctor if: (1) the DD’s opinion is the claimant’s first evaluation of MMI/IR; and (2) the claimant is not satisfied with the DD’s opinion. The carrier shall pay for an exam under (f-2). The carrier’s liability is limited to one alternate opinion on MMI/IR and this assumes the facts are that the DD under (f-2)  has provided the first evaluation of MMI/IR.

Q. Once SIBs are completely paid out, do we remain responsible for reasonable and related medical for the rest of the claimant’s life? 

A. Regardless of where the claimant is with regard to indemnity being paid, the Carrier continues to be responsible for reasonable and necessary medical treatment that is related to the compensable injury.  So, conceivably years from now the claimant can still seek treatment under the claim if he meets those two requirements.  As a practical matter, though, that becomes more and more difficult as the years pass.