GQ Corner

Q: I have a claim where the SIBs rate is $2155.11. Commission ordered attorneys’ fees for the first attorney is $721.23. Ordered attorneys’ fees for the current attorney are $515.00. How do I calculate the amount to be paid to each party?

A: You need to review whether either order is for fees incurred to obtain SIBS where Carrier disputed the DWC’s determination of entitlement or are associated with some other aspect of claim. If these fees were ordered based on Carriers’ SIBS dispute, you would not reduce the income benefits, but would need to pay the fee order in full in addition to SIBS. The orders should state whether they are to be paid from benefits or in addition to benefits. On the other hand, if the fees were ordered for the lawyer’s work on some other aspect of the claim such as an MMI/IR or extent dispute, then you do take the fees out of the claimant’s SIBs check in the order that the fee orders were issued. The fee orders that are to be paid by a benefit reduction are to be paid in order of issuance. If the first attorney obtained the first fee order first, that attorney gets paid fully before you begin paying the second fee order.

Q: The claimant is employed at a pizza restaurant. She works in-store. She was outside on the premises taking a smoke break when she suffered a seizure and fell. She thinks she hit her head and landed on the cement.  She had bruising and redness to the right side of her face, and she has a history of seizures. Would you recommend a complete denial of the claim since she was on break when it occurred? Or should I file a PLN-11 and deny the seizures, but accept the facial abrasions?

A: The claimant was on a break, so she was paid for the short smoke break. The personal comfort and convenience doctrine would most likely cover the fall and the injuries that resulted from her impact with the ground since she was on the employer’s premises with no evidence that she’d abandoned her employment. However, the underlying seizure is not compensable and I therefore agree with your plan of action to file a PLN-11 and dispute the compensable injury includes a seizure disorder.