Part 1: Discontinuing Workers’ Comp Temporary Total Disability Benefits

Part of reducing workers’ compensation program costs is being aware of and developing defenses for Temporary Total Disability (TTD) benefits. There are numerous defenses to paying this type of indemnity benefit. Evaluating where you are in a claim constantly can help ensure you and your claim team are paying only those benefits the employee is entitled to and best position a settlement claim. Now is the time to take a look at your file load.

This two-part series will explore defenses when taking steps to discontinue TTD benefits. The first part will explore more common attacks on the payment of TTD benefits. The second part will explore some less frequently used defenses that still have value when considering whether payments should continue.

Proving Up Maximum Medical Improvement

An employee reaching maximum medical improvement (MMI) is one of the more common defenses to paying ongoing TTD benefits. While the definition of MMI (or end of healing period) varies in each jurisdiction, the concept is the same –the point where the employee’s healing has plateaued, and additional medical is no longer required. Tips for the trade in obtaining this defense can include:

• Using an independent medical examination (IME) to obtain a finding of MMI;

• Sending a health care provider report or other state-generated report to the treating doctor when the employee has stopped receiving medical care on a consistent or irregular frequency or

• There is evidence of malingering or pain magnification.

The claim handler should be aware of any service and filing requirements that must take place at this point. Never ignore the demands of what a statute or administrative rule requires.

Get a Job!

Crafting and sending a written job offer is another option defense stakeholders can take to move a claim along and terminate TTD benefits. The requirements in each jurisdiction vary, so it is crucial to pay attention to statutory or rule requirements. Common items to consider when seeking to make a job offer include:

• Ensure that the job parameters are clearly stated in the written offer. Common elements to include are the start/stop times of a job, fundamental requirements of the position, and applicable physical limitations based on restrictions;

• Other accommodations that might be necessary. Objections to job offers typically include days of the week and start/stop times the employee may be required to work. Not taking these factors into account can prevent a successful defense, and

• Failure to make the job offer meaningful. Employees will often object if their job offer includes work in a different area of work. Make every attempt to avoid issuing a job offer requiring monotonous clerical jobs, including only “folding paper and stuffing envelopes.”

Initiative-taking stakeholders can also consider making a job offer through a work on loan partner, or the Ticket to Work program.

Removal from Labor Market

Another possible defense to consider is whether the injured employee has removed him or herself from the labor market. This can come in a manner of fact-specific patterns that may require investigation to develop the factual background:

• Inquiry into the circumstances of an employee quitting their job. This can be due to various factors, such as leaving work to care for a loved one or the need to provide child care for a dependent or dependent of a child.

• Move from one community with a better labor market to another with lower-paying jobs. This is often found in situations where the spouse of the employee retires, and the remaining partner is the injured employee or

• Other situations are associated with retirement before eligibility for Social Security Retirement or Social Security Disability benefits.

A defense of this nature requires a detailed investigation and possible cooperation of a representative from the employer. A recorded statement or deposition testimony can also be used to uncover the specifics that support the position.

Non-Cooperation and Malingering

Many workers’ compensation statutes require the employee to cooperate with vocational rehabilitation. There are grounds to terminate TTD when the evidence supports the conclusion that the employee is not making good faith efforts to complete a vocational rehabilitation program prepared by a vocational counselor. In these instances, wage loss and other indemnity benefits are subject to suspension but will be reinstated once the employee complies with the plan.

Conclusions

Members of the claim management team should be on the lookout for instances where they can terminate TTD benefits. Any effort should be made in good faith and supported by evidence. Never discontinue benefits to harass an employee. When taking steps to discontinue these benefits for one of the above reasons, having a complete set of facts is critical. The appropriate steps can reduce workers’ compensation costs and ensure program efficiency.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: mstack@reduceyourworkerscomp.com.

Workers’ Comp Roundup Blog: http://blog.reduceyourworkerscomp.com/

Injury Management Results (IMR) Software: https://imrsoftware.com/

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.