Easy as “1, 2, 3” to Use the PMT(b)
By: Sara Phillips
What is the recourse for an employer/insurer paying indemnity benefits when a claimant is not complying with medical treatment? Your most efficient option for resolution is through a WC-PMT(b), or Petition for Medical Treatment, which is frequently utilized to seek authorization of various types of medical treatment recommended by an authorized treating physician (ATP). However, the WC-PMT(b) is also an available resource employers/insurers may use to petition the Board for a phone conference with an Administrative Law Judge (ALJ), during which the clamant must show cause why an order should not be issued directing the claimant to attend an appointment with an ATP.
Notice to the claimant of the appointment is one item employers/insurers need to ensure is in place prior to filing the WC-PMT(b) and requesting the telephone conference. Pursuant to State Board Rule 205(c)(2), the employer/insurer must show proof the claimant was provided with at least five business days’ notice of the missed appointment. Accordingly, if noncompliance has become an issue or you suspect it will be, it is good practice to make sure the claimant is being regularly notified of upcoming treatment in writing via email and U.S. Mail, if practicable. Reaching the claimant by phone is another great method of ensuring awareness of the appointment. A recommended best practice is to document details of the call and whether or not a voicemail was left. If you are using the services of a nurse case manager to set appointments, confirm with them the above best practices are used.
In response to the WC-PMT(b), the claimant is able to submit a response, agreeing to attend the at-issue appointment in order to negate the need for a telephone conference with the ALJ. However, should the employee not attend the appointment after agreeing to do so, or following a Board order directing attendance, employers/insurers may then submit an additional WC-PMT(b), completing Section D, seeking the suspension of income benefits. Another conference will then be scheduled with an ALJ, requiring the claimant to show cause as to why income benefits should not be suspended.
Prior to the creation of the WC-PMT(b), employers/insurers were required to file a Motion, seeking either an order compelling the claimant’s compliance with medical treatment or suspension of the claimant’s income benefits. In the latter scenario, once a Motion was filed, the claimant would have 15 days to prepare and file an Objection to the Motion. Thereafter, the parties would need to wait for an order to be issued by the ALJ. While the WC-PMT(b) provides the claimant with an opportunity to correct their behavior and comply with medical treatment to avoid the possible suspension of their indemnity benefits, it is altogether a more efficient and streamlined process when compared to filing a Motion.
Attorney Contact Info
Sara Phillips
sara.phillips@swiftcurrie.com
404.888.6134