This is form the treating doctor may fill out to make it easy for him or her to report your condition to the Workers Compensation Commission in an easy, concise way. It can filed electronically or by old-fashioned mail. It is not always used, as sometimes doctors prefer their own form, and sometimes, the issues are more specific than those set forth on the form. The key elements each doctor should complete are:
- Identification information for the employee – name, address, date of birth, SSN, phone number and sex
- Initial information – name of the employer, when the accident occurred and the employee’s version of how the accident happened
- Diagnosis and test results – this include any X-Rays or lab studies
- The doctor does indicate whether he/she thinks the diagnosis relates to the incident described by the employee
- The medical treatment suggested
- Whether there was any fracture or amputation
- Whether the employee is disabled
- Whether the employee can return to light work or regular work
- Any permanent disfigurement
- Has the employee reached maximum medical improvement
- Information that identifies the treating physician – name, address and date or the report
Call Virginia Injured Worker’s Lawyer Joe Miller for Workplace Injuries and Occupational Illnesses
Joe Miller knows that the medical review of your case is the key to both getting full medical compensation and all the work loss benefits that Virginia allows. He knows that your entire case really rests on the opinions of your authorized treating physician. He knows many of the injuries and illnesses that workers get. He uses this knowledge and his experience to make sure the doctor addresses all the necessary issues in his report. Call attorney Joe Miller at 888-694-1671 to discuss your medical and wage issues today. You can also email him at jmiller@joemillerinjurylaw.com.
