GQ Corner

Q: The treating doctor provided a full duty release and we stopped TIBs. The DD says not at MMI but anticipates in another month or so. The DD was not appointed on return to work and therefore did not issue a DWC-73, but he stated in his report claimant could not do heavy work. The insured could accommodate light duty, but no restrictions have been given . Do we continue not to pay TIBs?

A: The DD’s opinion alone will not require you to initiate benefits. You are required, however, to evaluate the totality of the evidence in the case, including opinions issued by any doctor, the nature of the compensable injury, and the appropriate Return to Work Guidelines as adopted by the Division (or the Network, if this is a network claim). In the absence of the appointment of a Designated Doctor on the issue of ability to work, no doctor’s opinion is entitled to any more weight than any others and, depending upon the nature of the injury, the claimant’s own testimony may be sufficient to require the initiation of benefits. Each case is fact-specific and there is no single answer applicable to all claims.

Q: I have a claim where the claimant is treating with a chiropractor for his lumbar. Our nurse was asking the chiropractor’s office assistant to address our employer’s modified duty options and the office assistant said that “the doctor put him on the bending table and he got hurt really bad.” They want an MRI/EMG/FCE due to the aggravation he received during treatment.  Are we liable for this since it occurred during treatment? Is there anything we can do to try to get him to stop treating with this chiropractor?

A: Yes. Injuries that occur during treatment for the compensable injury are compensable. Of course there may be subrogation in the event there is a malpractice claim pursued against the chiropractor.

Q: I have a bona fide offer of employment in which the supervisor notes on it that the employee refused to accept or decline the position. The employee refused to sign the document. There was also a witness to the employee being offered employment and not signing the offer. This claimant is represented by an attorney who is telling the claimant to not speak directly with his employer at all. Can I stop TIBs in this scenario?
Is there a time frame that I must wait (7 days?)? If yes, do I have to continue payments to the attorney?

A: For the purposes of this answer, I will assume that you have reviewed the offer of employment and that you have confirmed that it is in strict compliance with Rule 129.6. Pursuant to that rule, specifically subsection (g), a carrier may deem the offered wages to be PIE on the earlier of the date the offer is rejected or the seventh day after receipt of the offer. At that time, you may assume the offered wages are PIE and make your TIBs calculation accordingly. If there are any benefits due, the attorney fee order provides that there is lien on them of up to 25% of the benefits payable to the claimant.