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Thread Title: QIW Question
Created On Wednesday March 08, 2006 8:51 PM


Katalinarose
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Wednesday March 08, 2006 8:51 PM

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If a PTP indicates that an IW is QIW if the employer cannot modify his position, and assume the employer does modify the applicant's job duties and IW works for a few months at this position and then quits and gets another job without the modifications given by the PTP... here is where the question comes in .......Is the carrier responsible to send IW a letter/notice of ineligibility to participate in voc rehab?

Assume that after working for one year at his new job, he quits. Can he request voc rehab again?

My thoughts were to return the IW to the PTP for a recent opinion on QIW status.

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wcadjuster@gmail.com
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Wednesday March 08, 2006 9:43 PM

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Katalina,

QIW may not even be an issue. What is the date of injury?

Assuming that this was pre voucher era. Was an RU-94 done? Was it submitted to the rehab unit in conjunction with the ru 105? If it was, then I don't see where the employer would be liable for services.

A "genuine" mod position was offerred and the injured worker elected to cease employment. Has your case settled? If so, then it really is of no impact to return the injured worker back to the treater.

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Katalinarose
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Wednesday March 08, 2006 11:43 PM

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The DOI is 2001. The case is not settled. The RU-94 indicated that IW was QIW. The IW returned to work with same employer and recently quit to work elsewhere. I'm concerned that because nothing was filed with the RB Unit that IW may come back later on and say he wants vr services based on PTP determination of QIW status. I must add that the DQME also said that IW was QIW, however, this did not become an issue because IW was provided modified job duties and performed these duties up until the time he left his employment. At this point I'm wondering if I should request closure via RU-101. I'm pretty sure that along with that I have to send the IW a notice of denial of VR services based on the fact that he has RTW. I'm lost

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stewshe@comcast.net
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Thursday March 09, 2006 6:13 AM

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Katalinarose,

You might file an RU-105, request for Termination. The RU-101 is used for change of address or of a party. It is seldom used now since the same info is in the heading of the RU-105 or RU-103 if there is a dispute.

Yes, the EE could request more services, but on the facts you have submitted would probably not be awarded any.

Things which might tip the scales in the EE's favor might be if the mod/alt work offered was not physically appropriate, or if it initially was and then was changed, e.g., to require more repetative lifting, bending, stooping, etc. Other possibilities might be a reduction in working hours so wages were no longer within 85%, or if the job site was changed so work was only being offered at a much longer commute from the EE's home.

Basically, it will boil down to whether or not suitable gainful employment was really being offered and did the EE leave for more attractive employment, or was the EE in effect forced to leave? Many times CAs are unaware of what the ER is doing, and, believe it or not, some ERs try to get the EE to exceed the work restrictions so they can somehow prove they shouldn't exist.

I have never understood the thought process. From the fact a doctor says someone SHOULD not do something, it simply does not follow that if the person is ordered to do it and they do and they do not get hurt that one time, the restriction should somehow be lifted or reduced. Often new injuries occur in these cases.

Good luck!

P.S. You might try a C&R and include as one of the things released, prospective VR, or do a separate RU-122 for a relatively nominal amount...if you are sure of the facts of the job the EE left.


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Katalinarose
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Thursday March 09, 2006 6:32 AM

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Thank you for your thoughts

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Bravo
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Sunday March 12, 2006 12:34 PM

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Just regarding the Notice and not additional action-
A Notice of Potential Eligibility is not a notice of payment of benefits, you could send a NOPE denial. If a person is not able to return to U&C, they are QIW by definition in the report despite a doctors conclusion in the report that they may not be in the face of mod duty. You should send a notice within the 10 days of report receipt to avoid a PAR violation and keeping injured properly noticed. Sending it can help your PAR audit ratios on files where the notice is missed. Just say yes to the notice.

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FORUMS > VOCATIONAL REHABILITATION [ REFRESH ]

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