What is the Workers’ Compensation Medical Status Questionnaire?

StethoscopeWhat 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.

What Is A Form 24 In A North Carolina Workers’ Compensation Case?

Workers' Compensation Doctor Looking at X-RayWhen you receive your workers’ compensation benefits, you have been evaluated by a doctor as to what limitations you may have when you go back to work.  Let’s say that you have hurt your arm, and the doctor limits you to “light duty” work, and perhaps sets a limit to the weight that you can carry or the movements that you can make, but you are able to work under certain circumstances.  You go into work and decide that you can’t and/or do not want to work and you stop showing up. Your refusal to do your legally obligated job under the workers’ compensation law can prompt your employer to try to terminate or suspend your workers’ compensation payment.

When your employer does not feel like they should still have to continue to pay your workers’ compensation benefits they can file a Form 24 which is an Application to Terminate or Suspend Payment of Compensation (G.S 97-18.1).  Your employer will fill this out which explains why they feel your workers’ compensation payments should be suspended or terminated. At this point, the date that they mail it, you have 17 days to fill out your response and send it back. Typically there will be an informal hearing in which the Deputy Commissioner will hear both sides of the story (normally by a telephone conference) and will make a ruling based upon their findings and the consideration of the doctor’s opinion.

You have the right to appeal the decision to the full commission if you do not agree with the Deputy Commissioners decision, although in most cases, once the decision has been made it is not likely to be overturned. They key is, however, is to ensure that you follow the steps laid out by your doctor. If you do not agree with the restrictions or with something set out as part of your restrictions you should discuss that with your workers’ compensation attorney instead of just not following the doctor’s orders.

Should I Give A Recorded Statement to the Insurance Company or Employer?

The answer is maybe!  When an employer, or especially their workers’ compensation insurance company, wants to take a recorded statement from you, they are not trying to help you.  They will probably try to use the statement against you in the future.  Most of the time they are gathering ammunition to use against you in the recorded statement.

Recorded Statement to Insurance Company?

When taking a recorded statement from you, the insurance company representative may state questions in a way that weakens your case for workers compensation benefits. For example, you have injured your knee at work. The adjuster may ask you if you help coach any of your children’s sports teams. You explain that you help coach your son or daughter’s soccer team. The adjuster may try to twist your answer in such a way that it appears your current injury is an injury you had outside of work and they could deny your workers compensation benefits based upon the way you answer this question. Be extra careful how you answer the question.  Remember the insurance adjuster is not your friend, even though they may seem like a nice person.  They have a job to do!

We suggest you not give a recorded statement to the insurance company unless you are in the presence of your attorney.

In the alternative, you may agree to state what happened to you in writing. Ask the insurance adjuster to send you their questions in writing and you can then answer them in writing.

However, be aware if you do not cooperate with the insurance company they may deny your claim.  If you decide to give the insurance adjuster a statement, at least contact an attorney to discuss your options before you give the statement. The insurance adjuster’s job is to find a technicality so they can avoid covering your workers’ compensation claim. It is a business for the insurance company and they generally lose money if they have to pay your claim. A workers’ compensation attorney can help you ensure that protect your rights.

Are Travel Expenses Covered Under Workers Compensation?

Travel Expenses for Workers' Compensation | Form 25TGenerally speaking, mileage to go to and from treatment is covered under workers’ compensation if the client travels 20 miles or more roundtrip.  The current mileage reimbursement rate is $.565 per mile, but it is subject to change in accordance to the Internal Revenue Service guidelines.  If the Internal Revenue Service alters the mileage rates, whether they increase or decrease, the Industrial Commission will act in accordance to their updated rates.

What form should I fill out?

Clients are going to fill out a Form 25T which can be accessed on the NC Industrial Commission website. The form itself is simple to complete but it’s important to stay on top of documenting your mileage to and from treatment.  You may consider keeping a journal close by so you can document the date, where you are traveling, arrival and departure time, and mileage reading before and after appointment.  It’s a good idea to have it documented on both the Form 25T and your journal, since you will be submitting the form to the insurance carrier.  You may also consider making a copy of the Form 25T for your records.

How do I turn in my Form 25T?

The form will be submitted to the insurance carrier so it typically depends on what form of communication is already in place.  When you fill out your form for the first time and are ready to submit, it’s probably a good idea to send it to your workers’ compensation attorney first.  Your attorney can review the form and make sure everything is filled out before sending it to the insurance carrier.  While your attorney is reviewing the form, touch base with him or her and let them know you would like to verify how to submit it to the insurance carrier.  After the first couple of times, you should be able to complete the form and send it to the insurance carrier on your own.

When do I receive my reimbursement check?

Most clients will receive a reimbursement check from the insurance carrier within a couple of weeks.  It is essential clients are staying on top of filling out their forms on a weekly basis and submitting them in a timely manner.  If you have questions about mileage reimbursement for treatment, Form 25T, etc. you should consult with your workers compensation attorney.

Is Gross or Net Income Used To Determine the Average Weekly Wage in Workers’ Comp Cases?

If you have been injured by an accident at work, you will find it is in your best interest to meet with an attorney as soon as possible to be sure your rights are being protected. When you meet with an attorney, you will likely find that one of the first questions they ask you as they begin working on your file is “how much were you making at your job?”

Workers' Compensation Questions

Your income at your job prior to the accident is important to your workers’ compensation case because it allows your attorney to determine your “average weekly wage.” Your average weekly wage is the calculation used to determine your “comp rate,” which equals 66% of your average weekly wage.After your attorney determines your average weekly wage using your gross income, your comp rate (which is the amount you will be paid until you either return to work or a settlement is reached) will be determined by calculating 66% of your average weekly wage.

As you can see, your average weekly wage is the number that ultimately determines the amount of money you will be entitled to receive while you wait for a settlement in your case or wait to appear in front of the Industrial Commission. Your attorney will use an average of your gross income prior to your injury to determine the average weekly wage for your case.