The Claims Management Reality

CASE HISTORY #3

Claimant was injured in March 1992. There was no lost time at that point. However, in June 1992, employee complained of severe back pain and reopened the original claim. The employee was still out on compensation six months later.

The treating physician gave a Return to Light Duty. However, no light duty work was available.

Claimant filed Unemployment claim, since her employer technically did not have an available job for her. Employer was paying both Worker’s Compensation and Unemployment for this employee.

NOTE: NY LAW states that unless patient can be returned to work in full capacity, the employer is responsible for unemployment as well as Worker’s Compensation.

POST SCRIPT: Through investigation, we found that the claimant was given an alternative method of treatment (surgery), which would guarantee her return to a normal function level, and she declined.

The employer now can ask the carrier to submit a C22b form that states to the Worker’s Compensation Board that they want to suspend medical payments and the reason. It is reviewed before a judge and the court determines if payments will terminate.