GQ Corner

Q. The Claimant was treating conservatively at CareNow.  She was given full duty release and placed at MMI, on 4/27/20-0% IR, by treating doctor.  In June ’20, Claimant requested a DDE, as she was not in agreement with treating. Claimant was terminated from employer in July ’20.  She was evaluated by DD in November and placed not at MMI.   As of January, Claimant resumed treatment with a new provider who placed her at light duty. This is a non-HCN claim.  Claimant did not complete a DWC-53.  Would we owe any disability based on her “new” doctor’s work status? Do we need to file disability dispute indicating current disability is not the result of the compensable injury? If so, would dispute go back to full duty release?

A. No, assuming her condition has not changed, only her treating doctor has changed; as for your last two questions, yes and yes. 

Q. Does the city/employer have to file a DWC-1 with Carrier in the below scenarios or are they able to retain an incident report internally and file if claimant treats or had disability?

1. 1. 1. Employee has a bodily injury, however, chooses to not seek medical treatment and has not had any disability.
      2. Employee reports an occupational disease/illness but has not had medical treatment and has not had any disability.
      3. Employee reports an injury and/or occupational illness/disease in which the employer feels it is an “alleged” incident and the employee has not sought medical treatment and has not had any disability.

A. Rule 120.2(a) states that the employer shall report each injury that results in more than one day’s absence from work and any occupational disease of which the employer receives notice of the injury or has knowledge. So for scenario 1, since there’s been no disability, there has been no absence from work that resulted from the injury, and thus no report is required. However, for scenario 2, since the employer received notice of an occupational disease, it must be reported.

For 3, it’s basically the same—if they have notice of a claim for an occupational disease, it must be reported, but if it’s an injury that has not resulted in any days missed from work whatsoever, no report is needed. However, if the employer believes the report is false or inaccurate, that will certainly be part of your investigation and could be the basis for a denial even if a claim is reported.