Insurer Report

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Best practice waiting

Often when a worker is sent for an independent medical examination, the independent examiner will make an educated assessment that the workers' condition should resolve at a date in the future (ie - "this workers' injury should resolve in 8 weeks").

 

There is a common trend that once this time has elapsed, the claim is ceased without consideration of any additional contemporaneous medical evidence.

 

Q-COMP's approach to these matters is that, whilst the educated estimation may be considered as a guide to when the work-related injury may resolve, current medical information is required to confirm the workers' incapacity for work and requirement for further medical treatment as at the date of cessation. 

 

Cessations based on an estimate only, without current medical information (from either a treating or independent practitioner), may result in Q-COMP setting aside the decision of the Insurer and either continuing benefits or requesting that further information be obtained.

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