GQ Corner
Q: The claimant is currently on work restrictions. The employer has offered light duty but the work is to be performed at a different branch approximately 50 miles away from that at which the claimant worked prior to the claim injury. Can I suspend TIBS based on the availability of modified duty employment?
A: Disability and bona fide offer issues are notoriously fact-intensive and decided on a case-by-case basis considering the totality of the circumstances. This presents a fact question to be analyzed by weighing various factors. For an offer of light duty employment to be considered bona fide and used as a basis to suspend TIBS, it must meet the requirements of Rule 129.6. One of those requirements is that the offered position be “geographically accessible” to the employee. The rule provides that geographic accessibility should be reviewed with consideration of the affect the employee’s physical limitation has on the ability to travel, the distance of the travel, the availability of transportation, and whether the offered work schedule is similar to the pre-injury work schedule.
If the claimant has limits on the ability to drive or sit for extended periods, did not travel or have a lengthy commute prior to the claim injury, or does not have transportation, he has a strong argument that the 50-mile commute renders the offer of modified duty work unreasonable and not geographically accessible to him such that he remains disabled and entitled to full temporary income benefits.
Q: The carrier filed a complaint via the DWC website. How can I check on the status to see if any action has been taken?
A: A representative of the Division should contact you within a reasonable period of time to convey its findings and to inform you of past and future actions. If it fails to do so, you may call the Compliance and Practices department and ask to speak to a customer service representative.
Q: I received a phone call from the claimant’s attorney requesting that I send him and his client all utilization review determinations. Am I required to do so?
A: Yes. Rule 134.600 provides as follows:
(j) The insurance carrier shall send written notification of the approval of the request, adverse determination on the request, or denial of the request under subsection (g) of this section because of an unrelated injury or diagnosis within one working day of the decision to the:
(1) injured employee;
(2) injured employee’s representative; and
(3) requestor, if not previously sent by facsimile or electronic transmission.
FOLIO
