GQ Corner
Q. When filing a PLN 1 on a death claim, do you address the PLN 1 to the claimant directly, or do you address it directly to the beneficiaries of the claimant?
A. Assuming there are beneficiaries, there are always two claims in a death claim. That of the employee for the injury, and that of the beneficiaries for death benefits. The dispute of the compensability of the injury claim should be directed to the employee and the dispute of any death benefit claim would be directed to the beneficiary or beneficiaries filing the claim for death benefits. I think it best to always file separate disputes when disputing the compensability of an injury leading to death. The potential trap is created when death follows an injury and does not appear to be related to the injury. Sometimes this may happen years following a work-injury. The rule to remember is that you should always file a dispute contending death is not related to a compensable injury when you learn of the death of a Claimant for reasons appearing to be unrelated to the injury.
Q. Please clarify the steps on disputing MMI/I.R. assessments. I am getting confused on the deadlines for disputing and when to file for a BRC.
A. Only the initial, valid certification can become final absent a dispute within 90 days of receipt of that certification report by verifiable means. If a DD has been appointed prior to the carrier’s receipt of the initial certification report, the only way to dispute the certification is through a BRC request. In other words, if a DD is appointed and finds Claimant has not reached MMI and then the treating doctor certifies MMI, the only way to dispute the treating doctor’s certification is through the filing of a BRC request. A DD request alone will not work. If a DD has not been appointed at the time of an initial certification, the certification can be disputed through the filing of a DWC-32.
If you want to be safe, always request a BRC and a DD when disputing a certification from the treating doctor.
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