Results
Petition to Terminate Ongoing Receipt of TPD Benefits Granted on Basis that Claimant Voluntarily Removed Himself from the Workforce
The Industrial Accident Board (IAB) granted our petition to terminate the ongoing receipt of temporary partial disability (TPD) benefits on the basis that the claimant had voluntarily removed himself from the workforce. The claimant was a correction officer who suffered head injuries in an altercation with an inmate. He was out of work for a time and eventually released to return to work on modified duty. His restrictions were permanent and, because they could not be accommodated by his employer, he was placed on TPD. After more than a year with no indication of an attempt to return to the workforce, we challenged his ongoing entitlement to receive TPD. We worked with the employer to obtain documentation regarding the claimant’s job search (or lack thereof), other sources of income (pension, Social Security) and recreational/social activities since he had been separated from employment. In addition, we put forward both medical and vocational expert testimony at the hearing. As a result, the IAB reasoned that the claimant was able to work in a medium-duty job, that jobs were available within his restrictions, the he had conducted a minimal job search since his work release more than a year and a half earlier, and that his description of his daily activities was consistent with a person content with a retirement lifestyle rather than someone who intended to continue to work. Accordingly, he was no longer entitled to wage replacement benefits.
Petition to Terminate Temporary Partial Disability Benefits Granted
We were successful in having our petition to terminate the ongoing receipt of temporary partial disability benefits granted on the basis that the claimant had voluntarily removed himself from the workforce. The Industrial Accident Board reasoned that the claimant was able to work in a medium-duty job, that jobs were available within his restrictions, the he had conducted a minimal job search since his work release more than a year and a half earlier, and that his description of his daily activities was consistent with a person content with a retirement lifestyle rather than someone who intended to continue to work. Accordingly, he was no longer entitled to wage replacement benefits.
DELAWARE SUPREME COURT AFFIRMS THE DECISIONS OF THE IAB AND SUPERIOR COURT, HOLDING THAT AN EMPLOYER CORRECTLY PAID FOR KETAMINE INFUSION TREATMENT IN ACCORDANCE WITH THE DELAWARE FEE SCHEDULE
The claimant injured her right wrist in 2016 while working as a teacher for the State. Her injury eventually developed into complex regional pain syndrome (CRPS) involving multiple extremities. From 2017 to 2021, the State paid for 23 ketamine infusion treatments to treat the claimant’s CRPS. The treatment was rendered by an out-of-state provider. In 2019, the State contracted with a new bill-review company that paid substantially lower amounts than was previously paid for the same treatment. The claimant filed a petition that alleged these lower payments were insufficient and inconsistent with Delaware law. The Industrial Accident Board determined that the payments made by the State were correct under the Delaware Workers’ Compensation Act’s health care payment system and Fee Schedule. The Superior Court affirmed the decision. The claimant appealed to the Delaware Supreme Court, arguing that the Board failed to correctly apply the Act and Fee Schedule regulations, as interpreted in the Superior Court opinion Delaware Veterans Home v. Dixon. Specifically, the claimant alleged that the Board failed to assess the adequacy of medical billing codes by referring to resources from the American Medical Association or the National Correct Coding Institute. The Supreme Court rejected this argument. The claimant bore the burden of proving whether the billing codes used by the provider for the ketamine infusion treatments were insufficient or inaccurate. The resources cited by the claimant were, indeed, referenced in the Fee Schedule administrative regulations, but no evidence was presented by the claimant at the Board hearing. It was neither the employer’s nor the Board’s responsibility to present that evidence. Therefore, there was no legal error. The court further advised that the Act’s Oversight Panel is the proper forum to determine whether specific billing codes provide reasonable compensation for particular treatment, which was a secondary argument advanced by the claimant. The decisions were affirmed.
Industrial Accident Board grants motion for reimbursement.
We succeeded in having the Industrial Accident Board grant reimbursement of an amount of total disability benefits tendered that were offset by contemporaneous short-term disability payments. The Board denied the claimant’s motion to compel production of paystubs that he claimed were required to determine the appropriate offset amount, if any. The Board reasoned that the information provided was sufficient to calculate the overpayment amount and that the Fair Labor Standards Act did not require the pay records be kept in any particular form.
Defense prevails before the Industrial Accident Board.
The claimant alleged several injuries. The Board denied the claimant’s petition for additional compensation due on all counts, and granted the employer’s petition for review to terminate total disability benefits. Specifically, the Board concluded that (1) a proposed left ankle reconstruction surgery was not reasonable and necessary, (2) there was insufficient evidence to prove a compensable left knee injury, (3) there was insufficient evidence to prove a compensable lumbar spine injury and (4) the claimant was capable of unrestricted return to work.
Successful defense of workers’ compensation case before the Delaware Supreme Court.
In its order, the Supreme Court affirmed a decision of the Superior Court that had affirmed a Board decision regarding the compensability of travel expenses for trips to and from medical appointments. The claimant had petitioned for parking and toll expenses incurred during her trips to visit a doctor at University of Pennsylvania from her residence in Dover, Delaware. Although the amounts in question were low, the case is significant as it potentially applies to every Delaware workers’ compensation case. Specifically, the court agreed with the employer’s arguments that the plain language of the applicable Delaware statute provides that mileage expenses are to be reimbursed by the employer for travel to and from compensable medical appointments.
