When an employer is disputing a request for temporary total disability benefits in a workers’ compensation claim, it is always important to make sure that the independent medical examination (IME) specifically addresses the period of disability requested. For instance, even though the doctor may be examining the claimant on July 1, the law allows the specialist to render an opinion on the extent of disability of the claimant going back to May 1. As long as the claimant is not currently receiving benefits, the hearing officer may go back in time and rely upon the physician’s opinion to decide if the claimant is at maximum medical improvement or could have returned to work on a date prior to the date of the hearing. This point was illustrated by the holding of the Tenth District Court of Appeals in State ex rel. Medina v. Indus. Comm., et al, 2016-Ohio-173 (Jan 19, 2016).
In the Medina case, the claimant sought temporary total disability benefits after changing her physician of record. The employer disputed the requested period of temporary total disability benefits and had the claimant examined by its own physician. The period of disability at issue began in February of 2014, but the claimant was not examined by the employer’s specialist until July of 2014. The physician indicated that the claimant was capable of returning to her former position of employment and was also at maximum medical improvement. It was the doctor’s opinion that there was no reason, based upon the conditions allowed in the claim, for her to remain off work. Unfortunately, the doctor did not specifically state that he was referring to the requested period of disability beginning in February of 2014. However, it was his opinion that “no” temporary total disability benefits should be paid. The Commission relied upon the doctor’s report to deny the benefits. Thereafter, the claimant filed a mandamus action in court arguing that the Commission should not have relied on the physician’s report.
The court agreed with the claimant and overruled the Commission’s order. The court ruled that the specialist can render an opinion on disability prior to the date of his or her examination, but that the doctor must specifically state the dates or period of disability at issue. Otherwise, the report cannot be relied upon to dispute a period of disability prior to the date of examination.
While the claimant was successful in this case in having her benefits awarded, this decision also confirms that employers can rely upon a doctor’s opinion about the injured worker’s disability prior to the date of the examination. Employers must be careful, however, to ensure that their doctors are specifically addressing the disability period in question.