Paperwork for occupational medicine

A note before you read

I practice internal medicine, and I have treated injured workers too, but I’m not an occupational medicine specialist. What I can help with is my knowledge of how to complete the paperwork we both are asked to do. The findings, the restrictions and their dates come from you, as the clinician who saw the patient.

Workers’ compensation work status reports

The workers’ compensation form you will probably see most is the work status report, which tells the employer and the insurance carrier whether the worker can work, with what limits, and until when. Most states publish their own version, and the details vary, so I would check your state’s workers’ compensation agency. As examples, Texas has the DWC073, Florida the DWC-25, Ohio the MEDCO-14 and Washington the Activity Prescription Form. Federal employees bring the Department of Labor’s CA-17 duty status report and CA-20 attending physician’s report.

Many workers’ compensation forms state their own deadline, and each state sets its own, so I would read the instructions before filling out the first one. The CA-17 asks you to complete your side, sign it and return it to the employing agency within two days, to prevent interruption of the employee’s income. California’s Doctor’s First Report (Form 5021) is due within five days of the first examination, and the form warns that a late report may bring a civil penalty. From a treating doctor, Texas’s DWC073 goes to the worker at the time of the examination and to the carrier and the employer within two working days. When the employer or the carrier sends a set of descriptions of the modified duty jobs it has, with their physical and time demands, a new DWC073 is due within seven days. Designated doctors and required medical examiners have their own deadlines on the same chart.

On the form itself, I would keep the expected end of each restriction separate from the date of the next visit. If a restriction is permanent, I would use the form’s permanent option rather than invent an end date.

Some reports ask more than function. The CA-20 asks whether the work caused or aggravated the condition, and Washington’s form asks whether there is any permanent partial impairment. Workers’ compensation reports also ask for the diagnosis, and HIPAA allows you to give what workers’ compensation law authorizes, to the extent needed to comply with that law. The walkthroughs go box by box through the Texas DWC-073, the Florida DWC-25, the Ohio MEDCO-14, the Washington Activity Prescription Form and the federal CA-17 and CA-20.

Light duty when the workers’ compensation absence is also FMLA leave

When a work injury is also a serious health condition, the employer may run the workers’ compensation absence and FMLA leave at the same time, with proper notice to the employee. The FMLA regulations then say something worth knowing before you release a worker to light duty. If you clear the worker for light duty but not yet for the old job, and the employer offers a light duty job, the worker may take it but is not required to. A worker who turns it down may lose workers’ compensation payments, but can stay on unpaid FMLA leave until able to go back to the same or an equivalent job, or until the FMLA leave runs out. That choice belongs to the worker and the employer, so I would describe the limits accurately and leave the decision to them.

The same overlap can change who may call you. If the state’s workers’ compensation law lets the employer or its representative contact you directly as the workers’ compensation provider, the FMLA does not stop that, and the employer may use what it learns in deciding the FMLA leave.

The rule: 29 C.F.R. § 825.702(d)(2) and § 825.306(c).

Fitness for duty and return-to-work notes

After FMLA leave for the worker’s own condition, an employer with a uniformly applied policy may ask for a fitness-for-duty certification. It may ask only about the condition the leave was for. To require that it address the job’s essential functions, the employer has to say so in the designation notice, its written notice that the leave counts as FMLA leave, and give the employee a list of those functions no later than that notice, so I would ask to see the list. The employer may contact you to clarify or authenticate what you wrote, but it may not hold up the return while it does. It may not ask for a second opinion on it, and the worker pays for it. For intermittent leave it can ask only when there is a reasonable safety concern, and then no more than once every 30 days.

The rule: 29 C.F.R. § 825.312.

Outside workers’ compensation and FMLA, the request is usually a plain return-to-work note or a work restriction letter. A routine one says when the worker can go back, whether that is full duty or with limits, and how long the limits last, and it does not need the diagnosis. If the employer asks for documentation for an Americans with Disabilities Act (ADA) accommodation instead, the letter describes the limits, how long they are expected to last and why a suggested change would help, and the worker and the employer work out the accommodation together. FMLA paperwork for doctors covers the leave forms themselves.

Where PatientPapers fits

I built PatientPapers to make this paperwork easier to complete. PatientPapers walks you through the forms occupational medicine clinicians are asked to complete, such as workers’ compensation forms, FMLA forms and return-to-work, work restriction and accommodation letters, so you can fill them out more quickly and more confidently. It does not calculate an impairment rating. You set up your information once on each computer you use. Then you answer one question at a time, and nothing goes on the form until you confirm it. Before you sign, it flags some problems, such as a missing state license. Then you review the completed form, and if everything looks correct, you sign it and you’re done.

Your patients’ information is encrypted on your own device with a passcode only you know, and none of it is sent to us or anyone else. Because we never receive it, there is no business associate agreement to sign with us. We cannot reset your passcode, so setup asks you to save a recovery code, and if you forget the passcode that code lets you set a new one. HIPAA still applies to how your office handles that computer, any copies you export, and the forms you print and sign. If you want to see whether it helps with your own paperwork, try the free trial, and I think you will find it saves you time and makes the forms more intuitive to complete.

Questions the office asks

What should a work status report say?

Whether the worker can work, and if so with what limits, in terms the employer can act on, such as a lifting limit in pounds and how often, and when the limits end or will be reviewed. Many state forms also state a deadline for sending the report, so I would read the instructions first.

Does a worker have to accept a light duty job?

Not under the Family and Medical Leave Act (FMLA), when the workers’ compensation absence also counts as FMLA leave. The worker may decline it and stay on unpaid FMLA leave until able to return to the same or an equivalent job, or until the FMLA leave runs out, though they may lose workers’ compensation payments. The rule is 29 C.F.R. § 825.702(d)(2).

Can an employer require a fitness-for-duty note after FMLA leave?

Yes, for leave for the employee’s own condition, if it has a uniformly applied policy and said in the designation notice that it would ask, and only about that condition. To require that the note address the job’s essential functions, the employer must also have given the employee a list of them no later than the designation notice.

Can my nurse or medical assistant fill in the form for me?

Yes. A provider can add staff such as a nurse or medical assistant, at no extra charge, and each one gets their own passcode. They can fill in the whole form and mark it ready for you, but only the certifying provider can sign it, so I would read what they entered before signing. Everything stays on one computer, so a simple setup is one laptop or tablet kept just for forms that staff and clinicians share. How staff help with forms is the practice’s to arrange and supervise.