BWC relies on the MEDCO-14 to decide temporary total compensation and to manage return to work in lost-time claims. The treating physician reports work status, which allowed conditions prevent full duty, physical abilities and restrictions, recovery barriers and maximum medical improvement. It is due at each visit while the worker is off work or restricted, and the injured worker separately files the C-84 request.
The treating physician completes and signs all six sections. Physician assistants and nurse practitioners may complete it but can certify temporary disability only for the first six weeks after injury, after which the treating physician must co-sign; the injured worker completes the separate C-84.
Enter the injured worker's name, claim number and date of injury, plus the dates of the last, current and next appointment. Then choose Initial MEDCO-14 (go to Section 2), Subsequent MEDCO-14 with no changes (skip to Section 6), or Subsequent with changes, which requires marking each later section as reporting changes from the last evaluation or no changes.
Say whether you reviewed the job description and who supplied it: the injured worker, the employer or the MCO/BWC. Indicate whether restrictions related to the allowed conditions exist on the exam date and whether they are permanent or temporary. With no restrictions, check the full-duty release and go to Section 6; if restrictions prevent the full-duty job, give the date they began and the estimated full-duty return date.
For every work-related allowed condition being treated, give a narrative description, site or location if applicable, the ICD code, and whether the condition prevents full-duty release to the job held on the date of injury. Then list all other conditions that affect treatment of those conditions, such as comorbidities or conditions not yet allowed in the claim.
Note any prescribed medication for allowed conditions that may be a safety hazard, and the dominant hand. Circle limitations only, using the frequency scale from never to constant, strength levels by lift height, and left, right or both for reaching and hand tasks, then give hours per day and week. Add psychological restrictions, objective findings, barriers, the treatment plan with durations, health and behavioral assessment answers and vocational rehabilitation readiness.
Answer whether the work-related injury or occupational disease has reached MMI, which the form defines as a treatment plateau where no fundamental functional or physiological change is expected within reasonable medical probability despite continuing treatment. Give the MMI date if yes. The form notes that supportive treatment may still be requested and provided after MMI.
The treating physician prints their name and signs, then adds the address with nine-digit ZIP code, BWC provider (PEACH) number, date, and telephone and fax numbers. The signature is mandatory and certifies the information under a felony fraud warning. A physician assistant or nurse practitioner's certification of disability beyond six weeks after injury needs this co-signature.
Download the current version from the source each time; forms change without notice.
Physician's Report of Work Ability
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
Sources for this guide
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Each time the treating physician sees the injured worker while the worker is off work or under restrictions, and when releasing a previously restricted worker to full duty. It is not required once permanent total disability is awarded, if the worker returned to unrestricted work within seven days of injury, or after release to the full-duty job.
Yes. Physician assistants and nurse practitioners may complete the form, but they can certify temporary disability only for the first six weeks after the date of injury. Later periods of temporary disability need the treating physician's co-signature. The signature block asks for the physician's name, BWC provider (PEACH) number and date.
Yes. BWC prefers the MEDCO-14 but accepts an equivalent physician-generated document, such as office notes or a treatment plan, if it contains at least all of the required data elements. If equivalent information was already sent, the form lets you reference that report by name and date instead of repeating it.
The C-84 is the injured worker's own request for temporary total compensation, covering work status, disability dates, employer, light-duty availability and other benefits, and compensation is not paid without it. Physicians no longer certify disability on the C-84; they use the MEDCO-14, and BWC encourages them to remind workers to file the C-84.