Once a railroad employee is receiving sickness benefits, the Railroad Retirement Board mails this form to the treating provider to confirm the disability is continuing. It asks for the last exam date, diagnosis, current objective findings, complications, response to treatment, surgery, maternity dates, an estimated return-to-work date and whether maximum medical recovery has been reached.
The health care provider treating the employee completes items 1 through 7 and signs with degree or title and National Provider Identifier. The patient's name and Social Security number appear at the top.
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Supplemental Health Care Provider's Statement
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The Railroad Retirement Board needs additional medical evidence before it pays further sickness benefits under the Railroad Unemployment Insurance Act. It usually mails the SI-7 to the treating provider when benefits continue, with an envelope for returning it. No more benefits are paid until it comes back.
Item 5 asks whether the patient can now work without restriction in their last occupation. If yes, give the date they became able to work. If no, give an estimated return-to-work date and explain how the medical evidence shows the patient is still disabled.