Requirement for separate medical exams cuts receipt of benefits

In Wyoming, a worker is required to undergo separate medical examinations for each application for TTD benefits.

Case name: Talbot v. State of Wyoming ex rel. Wyoming Workers' Safety and Compensation Division, No. S-12-0016 (Wyo. 10/18/12).

Ruling: The Wyoming Supreme Court held that a worker was not entitled to temporary total disability benefits because he did not have a separate medical examination for each period of disability.

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What it means: In Wyoming, a worker is required to undergo separate medical examinations for each application for TTD benefits.

Summary: A worker slipped on ice and injured his back in a work-related accident. He received temporary total disability benefits until he was incarcerated. Following his parole, he sought to have his benefits reinstated. Following a contested case hearing, he was awarded benefits. The worker applied for one period of retroactive benefits for the period when his disability determination was contested and two periods of prospective benefits. All three claims cited the same date for the last doctor's examination. The Wyoming Supreme Court held that the worker was not entitled to TTD benefits.

The court explained that a health care provider must examine a worker for TTD benefits before certifying him disabled. The worker then must file his claim within 60 days of the first day of the certified period of TTD. The court declined to deny the worker's claims for failing to comply with these requirements. The court explained that the worker applied for retroactive benefits for the period during which his TTD status was contested. He did not meet the 60-day filing deadline because he was waiting for the outcome of the contested case proceedings before applying for retroactive benefits.

The court found that the worker did not meet the statute's requirement for a separate medical examination for each certification of disability. The court rejected the worker's argument that the examinations were repetitive. The court said that its interpretation that there must be an examination every time a worker reapplies for benefits was logical because the legislature would want to ensure that a worker seeking ongoing TTD benefits still needed those benefits. The worker only had one examination before his three periods of disability. The examination was the basis for his receipt of benefits for one period, so it could not also serve as the examination for a later period of disability.

Read more at the WorkersComp Forum homepage.

January 28, 2013

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