Claim closure is a major event in your patient’s work injury claim. What is your role in closing a worker’s compensation case?
As the attending physician, you are the most important participant in the closing of a worker’s compensation claim. The attending physician is given extraordinary responsibilities in the closing and many of these responsibilities cannot be fulfilled by any other physician.
As an injured worker progresses towards medically stationary status, it is beneficial for the injured worker to return to modified work or regular work if capable. The attending physician is the only doctor who can release the injured worker.
A release greatly affects the worker. A release to regular work terminates the injured, worker’s right to time loss benefits. It also eliminates any opportunity for vocational assistance. So, as the attending physician, you must understand what the injured worker’s regular work was. The worker’s regular work is the work which he was doing at the time of injury.
When a worker returns to modified work and has been doing that job for quite some time, the physician may confuse the modified work with the worker’s regular work, when the release is issued. Given the above-mentioned severe legal consequences which accompany a release to regular work, it is critical – for your patient’s sake -that your release be specific and accurate. So when you issue a release, be sure to specify if your patient can return to the work he/she was doing when injured, or only to work modified to accommodate limitations caused by the injury.
If the injured worker is not able to return to regular work and has a substantial handicap, he/she may be eligible for vocational assistance. The sooner the insurance company is notified that vocational assistance is appropriate, the sooner the injured worker will start receiving the assistance and be returned to productive status.
When the claimant becomes medically stationary, the claim will he closed. The closure will result in a document which 1) terminates the claimant’s right to temporary disability; and 2) determines what, if any, “Permanent Partial Disability” award the claimant is entitled to.
Claim Closure is an appropriate time for you, as the attending physician, to set out the dates the injured worker was not able to do regular work as a result of his/her injury. This will allow the employer to calculate accurate time loss payments.
As attending physician, you also need to rate the injured worker’s impairment(s) in order for the employer to determine what permanent disability award(s) would be appropriate. Impairments most commonly involve reduced ranges of motion, reduced sensation and weakness. Under the Workers’ Compensation laws only the attending physician may rate impairment.
Therefore, you either have to rate the impairment yourself or concur with another medical provider’s rating. If you, as attending physician, choose not to rate the impairment but send the patient out for a PCE (or if the insurance company hires a doctor to do a PCE), it is important for you to know that your concurrence with the PCE or ratings from another physician are legally interpreted to mean that you agree with every single word and every specific finding in the report.
Requests for concurrence are often designed to make it easier for you to agree with the report than to disagree. For example, “If you agree, just check the box: if you disagree, please write a report.” As attending physician, you are not required to write a report if you disagree, You may simply say you disagree. You, of course, may choose to agree generally and disagree on some specific points.
In any event, as the attending physician, You have the final word.
In the next issue, we will provide you with guidelines on assigning impairment ratings, based on the State’s regulations (OAR 436-35).
This article was prepared by Robert F. Webber.