What is the Workers’ Compensation Medical Status Questionnaire?

What if you are injured at work and your employer or their insurance provider want to know from the doctor the status of your injury? One of the ways they can do this is by simply requesting the treating physician to fill out a Medical Status Questionnaire to the physician. This is a form that allows them to ask specific questions regarding your diagnosis and/or prognosis. The employer/insurance provider will also need to attach a description of your position with them, as that may be necessary for the physician to consult for the answers to some of the items. They can also request from the physician that they include the answers on the form itself, in medical notes or in a letter to the employer or their insurance provider. Of course, if the physician does not have enough information to have an opinion on any of the items, they are not required to answer them. The medical status questionnaire can be found on the North Carolina Industrial Commission’s website.

Most of the items that are included in the questionnaire pertain to when the employee will be able to return to work and what, if any, limitations the employee will need when they return as a result of the injury. The diagnosis is one of the first pieces of information requested. The next set of questions are very important to your workers’ compensation claim. They ask the doctor if it is their belief that the job duties at work either caused or aggravated your injury.

The next few items inquire about any additional medical conditions that the employee may already have that are affected or worsened by the new injury, what the treatment plan for the work place injury is and whether any medications prescribed for the injury may affect judgment or ability to perform certain jobs. If the employee is able to return to work doing the same job as before the injury occurred, the next two items on the questionnaire are not necessary and the physician is instructed to skip to the last question. If the employee is not able to return to work at the same job description, the physician must provide the restrictions that will be needed when the employee returns to work and how long the restrictions will be necessary.

The questions that are included in the medical status questionnaire are the only items that are allowed to be asked by the employer or insurance provider directly to the physician. The employer or their insurance providers are not required to ask all of the questions that are included on the form. There is a place for them to check which items they need to be addressed, which may or may not be all questions on the form. They also do not have to have permission from you (as the employee) to have the physician fill out this form, as stated in North Carolina General Statute Section 97-25.6 (c)(2). Once the form is filled out, the physician must provide the responses to the employer or their insurance provider and the employee and his or her attorney or other representative.