GQ Corner

Q. The claimant was presented with a bona fide offer of employment, which he rejected. The offer was for the full pre-injury wages. Which PLN do I need to file in this situation?

A. You would need to file a PLN-11, disputing disability, as well as your own PLN that contains language sufficient to notify the claimant that he has been extended a bona fide offer of employment for full, pre-injury wages. A PLN-11 cannot be used to assert the defense of a bona fide offer of employment, which is why you would need the extra PLN. Your PLN would need to inform the claimant that he has been offered a light duty position for his full, pre-injury wages. It would also need to reasonably inform him that, because he has chosen to reject the offer, the carrier will treat the offered wages as post-injury wages.

Your PLN-11 will assert a disability defense, since the APD has previously held that when a claimant does not avail himself to a reasonable offer of employment, he has not established disability. See APD 012646.

Q. I received a certification of MMI and IR on 3/1/2017, which certified that the claimant reached MMI as of 1/1/2017 with a 10%. I had been paying the claimant maximum TIBs ($913.00), and now max IIBs are due ($639.00). How do I account for my overpayment for the two month period between 1/1/2017 and 3/1/2017 where I was paying max. TIBs, but max. IIBs were actually due?

A. In this situation, we recommend that you convert TIBs to IIBs for the approximate 8-week period that you were overpaying, and then begin the recoupment procedures found in Rule 126.16. This means that as of 3/2/2017, you would send to the claimant a letter indicating that you will be recouping the overpayment. You must then wait until the second IIBs payment before recouping either 25% (if unrepresented) or 10%(if represented) from the IIBs payments, until the overpayment has been fully recuperated.