The Claimant Filed a WC-RICATEE Requesting a Catastrophic Designation. What Should I Do Next?

The Claimant filed a WC-RICATEE requesting a catastrophic designation. What should I do next?

First and foremost, an objection/response should be prepared and filed with the State Board. Under the current law, once a claimant has filed a request for a catastrophic designation, the Employer/Insurer has twenty (20) days to file a response, or else the claimant’s injury is presumed to be catastrophic. So again-make sure a response gets filed objecting to the request within the time prescribed by law!

As for things to focus on in the response, I’ll use an example from a recent catastrophic request we handled for a shoulder/neck injury. In that claim, in addition to the RICATEE form, the claimant only submitted his recently-received award of social security disability benefits. There was no mention of the health conditions which warranted the SSDI award; it was merely the letter from the Social Security Administration indicating that benefits were awarded. Moreover, the claimant failed to attach even a single medical record to the RICATEE form. Notably, the Form WC-RICATEE expressly requires the claimant to “Attach this form to the statement from the Employee’s Authorized Treating Physician(s) opinion of the claimant’s work ability. This statement must be dated no more than one year prior to the certified mailing date of this form. This must be submitted even if the claimant is receiving Social Security Disability (SSDI) or Supplemental Security Income (SSI) Benefits.”

Given that the claimant’s injury was not classified as a “per se” catastrophic injury (such as an amputation or severe burn, etc.), the law states that he has the burden of proving that he is entitled to a catastrophic designation. Without providing any documentation or evidence supporting the claim, we argued to the judge that the claimant had fallen far short of sustaining his burden, and the judge agreed. The request was denied.

In addition to attacking the evidence provided by the claimant (or lack thereof), there are other helpful methods for defending a catastrophic claim request, such as labor market surveys (to show that there are jobs available in the economy for a particular claimant), surveillance (to possibly catch the claimant engaging in activities that undermine his disability claim) and discovery depositions (to dig into work, military, and education history, and who knows-maybe you’ll find out that the claimant has certain valuable skills acquired from an ongoing hobby) just to name a few. Also, while a claimant may use an SSDI award as evidence in his or her favor, you should definitely find out the specific medical conditions which were taken into account by the Social Security Administration when issuing the award. The inclusion of non-work related medical conditions in an SSDI award can greatly diminish its value in a workers’ compensation setting.

Lastly, one particularly helpful piece of case law in defending a catastrophic request is Caswell, Inc. v. Spencer, 280 Ga. App. 141 (2006), in which the Georgia Court of Appeals agreed with the ruling of an administrative law judge that a 62 year-old man was capable of learning new skills and could adapt to new light duty work. This case is obviously helpful to demonstrate that even an “older” claimant is not shut off from a wide range of jobs in the national economy. The more work you can show that is available to a claimant seeking a catastrophic designation, the stronger your defense will be.

But again-the very first step to take in defending a catastrophic request is to get the objection filed on time!