Especially since the onset of COVID, we have to deal with a number of different scenarios where a personal or unrelated condition interfered with treatment for the WC injury or light duty. A few examples and solutions:
- Claimant unable to continue working LD because of unrelated personal health condition- you can suspend TPD as the accident is not the major contributing cause of the loss of earnings. BUT, LD must otherwise remain available for every week you deny TPD.
- The Employer was unable to accommodate LD before the personal condition- you must continue TPD. Dilemma comes when that changes while the claimant is out on personal condition. If LD is formally offered when it does become available, in writing, you can suspend TPD if the claimant does not return to work.
- Claimant unable to continue the authorized WC treatment plan- if it’s a short window, we may just have to accept it. If they miss 2 or more scheduled appointments, without a valid reason, arguably you can suspend indemnity for medical non-compliance. However a serious unrelated medical condition may be viewed as a valid reason.
If it is going to be a prolonged delay in WC treatment, a possible path is to have your defense attorney (in our firm because you are smart) or an NCM conference with the treater. If the claimant never returns to treatment or cannot treat for a long time, they have plateaued, and therefore should be put at “temporary MMI” unless or until they return. If that is explained to a doctor, they will often agree.
As always, let me know if you have any questions.