GQ Corner
Q. We have a claim where the employee was a pizza delivery driver that was involved in a MVA where he rear-ended another vehicle. He reported that he fell asleep. He sought ER treatment on the date of injury and was released. No follow up care was sought and he returned to work. Date of injury 7/31/21. We received notice of the claim on 8/12/21. We had requested the medical records, but did not get the ER records until 9/14/21. The ER records noted that the claimant admitted to taking meth the morning of the accident. The doctor’s note indicated claimant was counselled on drug use and drug cessation. We are still within our 60 days. Can I file a PLN-1 based on the ER notes? As it is more than 14 days so I would still need to pay the ER bill and any benefits up to the denial, correct?
A. Yes you can still file a PLN-1 within 60 days of your first written notice. And yes, you owe all benefits (income and medical) through the date of your denial.
Q. I have a 45-year-old EMS billing supervisor, who sits and types all day. During mid-morning, he began to have symptoms of numbness in his hands. He thought it would go away. Later that afternoon he said he felt like he had gloves on his hands. They were completely numb. He stood up and felt tingling and shooting pains on left leg up to his shoulders. Diagnosis: bilateral carpal tunnel syndrome, numbness of right foot, strain of shoulders, ankles and low back. He did not have an injury. He was just sitting there typing when all of the symptoms arose. I would like to deny the claim as no injury.
A. First of all, CTS does not manifest as numbness of the hands with gloves, so I question the diagnosis. It manifests very particularly in distribution of the median nerve, which does not involve the little finger. Second, it is not caused by typing. The fact that the foot seems to be involved as well suggests some sort of general neuropathy, which is a health condition and would not be associated with a risk of exposure from the employment. You have a reasonable basis to deny the claim. Most likely the claimant will pursue an occupational disease in the form of repetitive physical trauma. With those types of claims, timely notice of injury is often a secondary defense.
FOLIO
