GQ Corner

Q. Claimant reported right hand pain in April of this year to her supervisor, but acknowledges that she has been experiencing pain and tingling in that hand, wrist and elbow since last October. She had a similar claim in 2018, but denies treating at all from 2019 to 2022.

She has been doing this same job for over a year. A variety of job activities cause her pain, but she denies a specific injury event. She agrees she does not know what is causing her problems, but is convinced it is a “work injury”. She is diabetic.

I believe this is not a compensable claim, and that there is a late reporting issue, and I am contemplating filing a PLN-1. What language would you recommend?

A. Suggested PLN-1 wording as follows, to raise compensability, date of injury and timely reporting issues. Feel free to add/modify with claim-specific info as appropriate. 

“Carrier denies this claim in its entirety. Carrier specifically disputes that the claimant sustained a compensable injury or occupational disease arising out of and in the course and scope of employment. Claimant reported an onset or recurrence of right hand pain to her supervisor on April ___, 2023. However, there was no clear mechanism of injury or work event, either specifically or generally, believed to have caused said symptoms. Moreover, Carrier’s investigation reveals that Claimant has a past medical history significant for upper extremity symptoms and diabetes. She had a similar prior claim in 2018 and has acknowledged experiencing an onset or recurrence of pain and tingling in the hand, wrist, and elbow areas since at least October, 2022. The medical records and other evidence do not establish that the employment or any reported work event is a producing cause of any complaints, symptoms, diagnoses, or conditions—including right upper extremity symptoms or otherwise—alleged by the claimant. These are believed to represent at most an ordinary disease of life to which the general public is exposed outside of the employment. The mere occurrence of symptoms within the workplace does not alone yield a compensable injury. In addition, Carrier disputes the reported date of injury, and maintains that the date of any claimed injury for this alleged occupational disease (the earliest date on which Claimant knew or should have known the disease may be related to her employment) long predates the date reported by Claimant. Finally, Carrier is relieved of liability under Texas Labor Code Section 409.002 because Claimant without good case failed to timely report the claimed injury to Employer within 30 days under Section 409.001. Carrier further disputes any compensable disability, as claim is denied.”