How are you doing with EDI 3.1? Indiana is one of the first States to implement this reporting format. Our Indiana Worker’s Compensation Board has tried to limit the information requested and some States ask for even more detail. If you have any questions or issues with EDI 3.1, please feel free to contact the Indiana Worker’s Compensation Board (David Babcock or Jake Forte) for assistance. The start date for possible statutory penalties is December 1, 2019.
QUESTIONS AND ANSWERS
Q: I have heard that PPI compensation may be paid weekly, bi-weekly, monthly or in a lump-sum with a 3% reduction. How do I determine which payment method to use?
A: As with the other forms of compensation, PPI compensation is to be paid weekly. But, since the PPI rating is not usually assigned until weeks or months after the date of the accident, one must first calculate the number of weeks of PPI compensation to be paid (PPI value divided by TTD rate) and then determine whether all or part of the PPI value has accrued (weeks from accident date to current date times TTD rate). The PPI compensation which has accrued is to be paid in a lump sum. If there is PPI compensation which has not accrued, then that compensation is to be paid weekly until the full PPI value has been paid. Or, if the employee and the employer agree and the Indiana Worker’s Compensation Board approves, then the PPI compensation which has not accrued may be paid other than weekly or in a lump sum. A lump sum payment of PPI compensation which has not accrued may be reduced to present value pursuant to Indiana Code 22-3-3-25. That reduction is not a 3% reduction of the lump sum payment. It is a calculation of the commutable value of the amount to be paid per week for the compensation which has not accrued at the rate of 3% compounded annually. A table setting out the calculation of commutable value is generally available and is included in the Worker’s Compensation Handbook published by the Indiana Chamber of Commerce.
Q: When the attending physician has prescribed a brand name drug, may a generic equivalent be substituted if the attending physician has not indicated dispense as written (DAW) or do not substitute (DNS)?
A: Assuming that the attending physician was chosen by the employer or that the employer has acquiesced in some other person’s choice of the attending physician, then the prescription should be provided as written. But, the point of the employer being allowed to choose or acquiesce in the attending physician is that the employer can consult with the attending physician as to issues related to cost control. If there is a generic or other lower cost alternative, then the attending physician may be contacted and asked to consider that alternative. When a prescription drug has been dispensed by the attending physician or other medical service provider, IC 22-3-3-4.5 imposes price, frequency and time limitations on such provision of such drug.
Q: Must TTD be paid if the attending physician deemed the injured employee to be temporarily disabled but the employee failed a post-accident drug test or otherwise violated the employer’s drug use policy and the employer therefore suspended or terminated the employee?
A: If the employee’s drug intoxication can be proven to have caused the employee’s injury, then such intoxication would be an affirmative defense to the claim pursuant to Indiana Code 22-3-2-8. But, the violation of the employer’s drug policy and the employment suspension or termination imposed therefor is not a basis for the denial of TTD compensation if the employee is unable work due to the work-related injury.
To find even more information, you can visit the in.gov page on EDI 3.1 here: https://www.in.gov/wcb/2586.htm