GQ Corner

Q: Is there a time frame to challenge a change in treating physicians approved by the TDI? I have a file that the approval was issued on 06/21/16 and I’d like to challenge the change.

A: Rule 126.9(g) states that the Carrier has 10 days from receipt of the order to dispute. To file a dispute, you need to file a request for an expedited CCH or a request for a BRC.

Q: We received a request on one of our workers’ compensation claims from the State of Colorado.  He is no longer receiving TIBS but may be entitled to an impairment rating.  Are we to withhold payment per the lien of 50% per the notification from the State?  Do we have to notify the claimant?

A: I’m assuming this is a child support order. If so and if the claimant gets additional benefits, the benefits would be reduced by the terms of the order up to 50% of the payment. You don’t have to give any notice to the claimant of receipt of the lien. You would only need to show the reduction on your PLN when you initiate IIBS.

Q: Claimant did not attend a designated doctor appointment on 7/7/16. He has provided multiple excuses, which include bad weather, loaning his vehicle out to a friend, and not receiving notice of the exam.  The notice was sent by DWC, our defense firm, and the designated doctor’s office sent a notice and called. Claimant still failed to attend.

If and when claimant reschedules and attends the designated doctor exam, are we required to reinstate TIBS from the original TIBS suspension date or only reinstate them from the date of attendance and forward?

A: You would need to reinstate TIBs as of the date the claimant attended the examination if the claimant still has disability otherwise and then abide by the resultant DD report. You get a holiday from paying TIBs between the date the claimant missed the DD exam without good cause and the day before he attends the DD exam.  They are to be reinstated the day of the DD exam if he attends and still has evidence of disability that entitles him to TIBs.

If the claimant was released to full duty in between the missed and the rescheduled DD appointment, you do not reinstate TIBs upon attendance and do not reinstate back TIBs, but abide by the DD’s opinion on MMI and IR according to your normal deadlines.