Exercise Your Right to Designate Your Permanent and Stationary Reports
by Kai Tiltmann, DC, QME
The complexity of California's Workers' Compensation (WC) system cannot be overstated. However, there are some laws that actually make it easier for the primary treating physician (PTP) to work within the system. Labor code (LC) 4061.5 and Regulation 9785(c) state: "The treating physician primarily responsible for managing the care of the injured worker or the physician designated by that treating physician shall, …render opinions on all medical issues necessary to determine eligibility for compensation." (Italics added). So that's what the law says, but what does it mean? You, the PTP are obligated by law, to render opinion on all issues related to the injury to determine eligibility for compensation (benefits). This is best done in a narrative report format. Ultimately, the report carries tremendous responsibility, with far reaching consequences for the PTP, the patient's attorney (if represented), the WC carrier, and especially the patient.
It is essential to have a clear understanding of the importance and the benefits associated with designating Permanent and Stationary (P&S) reports and when to write such a report.
The injured worker becomes P&S when they have been treated for a work related injury, have reached maximum medical improvement (MMI), but are not pre-injury status. By definition, they have sustained some level of disability, either subjective and/or objective, and may therefore be entitled to compensation. A patient is considered to be P&S if their condition does not significantly improve or deteriorate over a 2-3 month period. At this point the PTP should write a P&S report. You have 3 choices: You can choose to use the PR-3 form, you can write your own narrative report, or you can designate someone else to write a narrative report.
There are doctors who prefer to use the PR-3 form (Reg. 9785.3) instead of writing a narrative report, presumably because it is simpler. However, attorneys and judges dislike the PR-3 form because it rarely addresses all the issues in sufficient detail. In my experience, all WC attorneys prefer the narrative report to the PR-3.
There are distinct benefits for the patient, the doctor, and the applicant attorney when you designate your P&S report writing responsibilities. The patient is more likely to receive fair compensation for their disability if the P&S report is written by a doctor specializing in such reports. For the PTP, the benefits include spending more time with patients and less time with paperwork, continuing to treat under future medical provision, and reducing the odds of the report being disputed by the carrier (which may result in the need for a QME report). In addition, the PTP is compensated for adopting the report. The attorney benefits via receipt of a ratable report, and still has the option of requesting an applicant QME.
Designating a doctor to write your P&S report takes three simple steps:
Step 1: Inform the carrier of the referral. Include a reference to LC 4061.5, as not all adjusters are familiar with this law. You are not requesting authorization; you are informing the carrier of your right to designate the report.
Step 2: Have the patient complete a history form and schedule an exam with the designated doctor. (The doctor who writes the report must examine the patient.)
Step 3: Review, comment, and adopt the report, then submit it to the carrier and bill them for reviewing the report. The report must be adopted in writing by the PTP.
These simple steps are all that is needed to designate another doctor to write your P&S reports.
A good narrative P&S report should have the quality of a QME report. Regulation 10606 requires at least 15 items that the doctor must comment on, or the report may not be considered as credible evidence by the judge. The 15 items are:
· Date of the exam
· History of the injury
· Patient's complaints
· List of medical records reviewed
· Patient's medical history
· Findings on examination
· A diagnosis
· Opinion as to the nature, extent, and duration of disability and
work limitations
· Cause of the disability
· Treatment indicated
· Opinion as to the permanent and stationary status
· Apportionment of disability, if any
· Determination of the percentage of total causation if the injury
is psychiatric
· Reason for the opinion
· Signature of the physician
By including the above elements and more, I have had tremendous success with report adoption.
As a PTP, you should be aware that there are times when it is no longer an option to designate another doctor for a P&S report. These times include previous submission of a PR-3 report or when you are no longer the PTP.
Now that you know how to designate your P&S reports, to whom do you designate them? You may designate your P&S report writing to any doctor licensed in California. However, I recommend working with only those doctors who have experience and are specialized in the process.
Good luck with your workers' compensation cases and don't forget to exercise
your right to designate.