Effective August 17, 2012, the Bureau of Workers’ Compensation will be implementing the use of two “new” forms for the purposes of temporary total disability benefits.
The injured worker’s portion of the disability form will remain known as the Bureau C-84, Request for Temporary Total Compensation, form. While the form will keep its same name, the new form will require a lot more information from the injured worker. On the new version of the Bureau C-84 form, an injured worker is required to indicate whether the requested compensation is for a new period of time or an extension of ongoing benefits and is required to provide a list of all current treating providers (physicians, chiropractors, psychologist, etc.). In addition, the new Bureau C-84 form requires the injured worker to provide employment information, i.e. whether the injured worker has a position to return to, is currently working, and/or whether the injured worker is interested in vocational rehabilitation. As did the old form the new form also requests information regarding other benefits being collected by the injured worker.
As with the old Bureau C-84 form, the new form will be available online, for injured workers to be able to complete the form electronically. However, it will not be available online until mid-September, 2012. In addition, the Bureau of Workers’ Compensation is working on having a Spanish version of the new Bureau C-84 form.
The new Bureau C-84 form is one-sided, unlike the old form and is only for injured workers to complete. Effective August 17, 2012, physicians will be required to complete a new version of the Bureau MEDCO-14, Physician’s Report of Work Ability, form. This will replace the old portion of the Bureau C-84 form that physicians completed in the past.
The new Bureau MEDCO-14 form also requires quite a bit more information from physicians, and is actually two pages. On the new form, physicians are required to inform the Bureau as to how the injured worker is progressing. The physician is also required to indicate whether they have an understanding of the injured workers’ job duties at the time of injury and whether the injured worker is capable of returning to work, with or without restrictions. If the physician feels the injured worker is capable of returning to work with restrictions, there is an entire section of the form dedicated to allowing the physician to outline the restrictions, including restrictions as a result of a psychological condition. The new Bureau MEDCO-14 form also requires the physician to provide a list of conditions being treated and allows the physician to indicate which conditions are causing the injured worker’s disability. Lastly, as did the old Bureau C-84 form, the new Bureau MEDCO-14 form allows for physicians to provide an opinion as to whether an injured worker has reached maximum medical improvement and whether the injured worker is a candidate for vocational rehabilitation.
At first glance, the new forms can seem overwhelming. The good news is that the Bureau appears to be open to suggestions as to how to make the forms more manageable. If you or someone you know has questions or concerns regarding the new disability forms, please contact Gallon, Takacs, Boissoneault & Schaffer Co., L.P.A. for a free consultation.