GQ Corner

Q: I have a no lost time claim on which I have not paid any indemnity benefits to date. However, the designated doctor recently certified MMI as of a year ago with a 5% impairment rating. Do I owe interest on the 15 weeks of impairment income benefits (IIBs) owed?

A. No, you would not be liable for interest on the IIBS assuming you issue such payment timely, which is five days after receiving the designated doctor report. See Rule 130.8. 

Q. The claimant tested positive for narcotics shortly after the claim injury. Several witnesses have indicated that he did not appear to have the normal use of his faculties at that time. My investigation indicates that he previously had a prescription from his doctor for the drugs, but that the prescription lapsed quite some time ago. Do I have a reasonable basis to deny the claim in its entirety by way of the intoxication defense?

A. Yes. Texas Labor Code Section 401.015 provides that “intoxication” does not include the loss of normal use of mental or physical faculties resulting from the introduction into the body of a substance taken under and in accordance with a prescription written for the employee by his or her treating doctor. However, where the prescription has lapsed and is thus effectively inactive at the time of the claimed injury, you may assert that the carrier is not liable for compensation under Section 406.032(1)(A) because the claimed injury occurred while the claimant was in a state of intoxication.

Q. Will an impairment rating review and a post-designated doctor required medical examination effectively dispute a certification of maximum medical improvement (MMI) and impairment rating issued by the designated doctor?

A. No. The only way to effectively dispute a certification of MMI and impairment rating issued by the designated doctor is to file a DWC-45 requesting a Benefit Review Conference on those issues. Note that a party must successfully complete this filing within 90 days of receiving delivery of written notice of the certification by verifiable means or else it may be deemed to have become final under Texas Labor Code Section 408.123 and Rule 130.12.