FOLIO

GQ Corner

Sep 30, 2021 | by FOL

Q. When a designated doctor comes back and states not at MMI until 11/07/21, do we need to do the whole DD process again or can we just send the claimant back for a “follow up”?  If an insured brings back a claimant as Team Member versus a General Manager, which would be less than pre-injury wages, when she reaches MMI and are we still responsible for the difference in pay? 

A. Yes, you will need to file another DWC-32 and start the process over as soon as 60 days since the prior exam unless there is good cause to get the exam quicker. Once the claimant reaches MMI, you will no longer need to pay the claimant TIBs and, thus, will not be responsible for the pay differential; however, you will owe IIBs if the claimant is assigned an impairment rating.

Q. We have an injured worker that was placed on modified duty on 09/16/2021.  He was scheduled off on 09/17-19/2021, to return to work on 09/20/2021.  On 09/20/2021, he called in stating he had to take his son to the doctor.  On 09/21/2021, he called in stating he was having family issues that needed attention.  On 09/22/2021, he called in stating he had to stay home to take care of his son.  On 09/23/2021, he came in to work and signed a BFOE. When he was placed on modified duty on 09/16/2021, he was advised to come to work on Monday, 09/20/2021 as he would be accommodated based on his restrictions, but the BFOE was not given to him until today when he actually showed up.  Are we responsible for partial TIBs for September 20^th, 21^st, and 22^nd?  If we do owe him TIBs, do we pay a full 8-hour day or take credit for an 8-hour day?

A. You can only pay partial TIBs when a BFOE is in place or the claimant has actual post injury earnings for which you can take credit. As a result, for the dates in question you will either pay full TIBs or no TIBs at all. Given that the claimant has returned to work, but is not earning his full pre-injury wages, it would be difficult to assert he was not disabled for those three days. I, therefore, recommend you issue full TIBs for 9/20 – 9/22.