GQ Corner
Q: Claimant was previously seen by two DDEs and was never placed at MMI. Carrier paid 105 weeks of TIBs then assessed a 5% impairment rating at the statutory date of 7/22/15. Once the assessment was made, the carrier requested another DDE. The third DDE and assessed a 7% impairment rating with a MMI date of 11/17/13. The carrier has now overpaid indemnity in the amount of $20,000.00.
Can the carrier request reimbursement from the Subsequent Injury Fund?
A: There is an unrecoupable overpayment due to the earlier DD’s opinions. However, as the case currently stands, the SIF would deny reimbursement. Generally we request reimbursement from the SIF after a D&O adopts a certification that overturns a designated doctor’s opinion. It remains unclear whether a carrier might be eligible for reimbursement based on an agreement on MMI/IR.
Obtaining a D&O on MMI and IR is the fastest way to get to a SIF reimbursement requests. You can start the process by requesting a BRC on MMI and IR to get the issues to a D&O.
Q: I have a claimant that sustained a compensable injury. While returning to work from a follow up appointment for the work related injury she was involved in a MVA and sustained additional injuries.
Wouldn’t this be considered an extension to the original injury?
A: No. The Appeals Panel has held in Decision Number 010105 that an injury in an accident while traveling to or from medical treatment is not within the course and scope of the employment and does not extend the injury.
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