Case Update: If The Insurance Carrier Shuts Off My Lost Wage Benefits – Can I Get Penalties?
MacDougal v. ICAO, Bridgestone Retail Tire Operations
The Court of Appeals put out an (unpublished) opinion affirming the denial of penalties against an adjuster for failing to reinstate lost wage benefits (TTD). On February 6, 2015, a Physician’s Assistant (PA) – not the actual Authorized Treating Physician – placed the injured worker at maximum medical improvement (MMI) and removed all restrictions – effectively clearing the worker for regular duty. However the section for permanent impairment was left blank..
The Insurance Carrier filed a Final Admission admitting to zero impairment that day. However eleven days later, on advice of counsel, the adjuster filed a General Admission of Liability (GAL). The GAL did not reinstate TTD benefits – relying on the PA’s release to regular duty.
On February 23, 2015 the Authorized Treating Physician (ATP) wrote a letter raising concerns about the PA’s medical note and noted that the injured worker would need permanent restrictions and an impairment rating. Because the ATP did not rescind the PA’s release to regular duty – the carrier did not reinstate TTD Benefits. When the ATP saw the injured worker in April, he placed the injured worker at MMI and impairment. (It’s unclear if the ATP provided permanent restrictions.)
The injured worker sought penalties against the carrier’s refusal to reinstate TTD benefits. The Administrative Law Judge determined that while the Final Admission was invalid because there was ambiguity of what, if any, impairment the injured worker had – the release to regular duty was not vague. Further, the ATP’s letter of concern did not expressly impose restrictions or retract the release to regular duty.
Given that confusion, the Court of Appeals agreed that claimant had failed to show that the adjuster acted unreasonably.
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Case: MacDougal v. ICAO, Bridgestone Retail Tire Operations, 16CA0705 (Colo. App. 2016)