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Difference between revisions of "Workers' Compensation Claim Benefits (7:XI)"
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Workers' Compensation Claim Benefits (7:XI) (view source)
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A case manager’s decision that a worker can return to their pre-injury job is considered to be a finding of fact and not an appealable decision. In the context of a plateau decision, this RTW finding means that the Board considers that the accepted permanent conditions do not impair or disable the worker from their pre-injury job. | A case manager’s decision that a worker can return to their pre-injury job is considered to be a finding of fact and not an appealable decision. In the context of a plateau decision, this RTW finding means that the Board considers that the accepted permanent conditions do not impair or disable the worker from their pre-injury job. | ||
If this is not the case, this is a very important issue to | If this is not the case, this is a very important issue to challenge. Since an appeal of a plateau decision often involves seeking additional TWL, a new plateau date, additional permanent conditions, etc., the RTW finding of fact can be addressed in the context of these additional issues. | ||
However, if there are no other issues in the plateau decision except this RTW finding, the plateau decision should be appealed on the grounds that the worker cannot to his pre-injury job and is entitled to additional VR benefits. Framing the appeal issue in this way ensures that the RD has an entitlement decision to address. | However, if there are no other issues in the plateau decision except this RTW finding, the plateau decision should be appealed on the grounds that the worker cannot to his pre-injury job and is entitled to additional VR benefits. Framing the appeal issue in this way ensures that the RD has an entitlement decision to address. | ||
=== | === If Not, Referral to Vocational Rehabilitation (VR) === | ||
If the Board finds that the worker cannot return to his pre-injury job, then the case manager will most often refer the case to VR for VR benefits. | If the Board finds that the worker cannot return to his pre-injury job, then the case manager will most often refer the case to VR for VR benefits. | ||
=== | === Did the Worker Suffer an Exceptional Loss of Earnings? === | ||
There is a varied Board practice on whether the plateau letter will contain a decision on a worker’s entitlement to a Loss of Earnings (LOE) | There is a varied Board practice on whether the plateau letter will contain a decision on a worker’s entitlement to a Loss of Earnings (LOE) assessment or whether this decision will be deferred, pending the outcome of VR. However, all plateau letters should be assessed for whether they contain an LOE decision (express or implied) and if so, if this decision should be appealed. | ||
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