GQ Corner
Q. I have an injured employee who voluntarily returned to work full duty on 12/1/2016, but his most recent DWC-73 states that he is to be off of work completely through 1/1/2017. Do I still owe him Temporary Income Benefits for this period based upon the DWC-73?
A. You would not owe the injured employee TIBs in this instance. TIBs are only owed when an injured employee is not earning his pre-injury wages as a result of the compensable injury. In this instance, even though the DWC-73 has placed the injured employee in an off-of-work status, he has returned to work full duty, earning his pre-injury wages.
Q. The injured employee attended a designated doctor’s examination on extent of injury, maximum medical improvement, and impairment rating. For the accepted injury, the designated doctor place the injured employee at MMI with a 0% impairment rating. However, the DD found additional diagnoses to be related to the compensable injury, and for those diagnoses, the designated doctor opined that the injured employee was not at MMI. Which certification do I follow?
A. In this instance, you must follow the certification that declares the injured employee not at MMI. Because a designated doctor’s report is given presumptive weight, and because it is the designated doctor’s opinion in this case that the injured employee is not at MMI for the conditions the designated doctor believes to be related, you must adhere to that opinion.
Q. If the Division denies the first quarter of Supplemental Income Benefits (SIBs), when do I need to send the injured employee the second quarter application for SIBs?
A. If the Division’s initial determination is that the injured employee is not entitled to the first quarter of SIBs, it is the Division’s duty to send the injured employee the DWC 52 for the second quarter. See Rule 130.103(c)(4). Under those circumstances, the carrier does not have a duty to send the injured employee the second quarter SIBs application. And under those circumstances, the carrier does not have a duty to send the injured employee a DWC 52 until the injured employee has filed a DWC 52 with the carrier. Essentially, the carrier’s duty is that if it receives a DWC 52 from the injured employee, it is to send the injured employee a DWC 52 for the next quarter when either the carrier pays the first month of the prior quarter or disputes the prior quarter. For example, if the Division issues a non-entitlement notice and then the carrier receives nothing from the injured employee for months, the carrier is not required to send the injured employee a DWC 52 until the carrier receives one from the injured employee. See rule 130.104(b).
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