An injured worker in West Virginia uses this application to ask that a claim be reopened for a new permanent partial disability rating. It reaches the clinician after the worker completes Section I, citing either aggravation or progression of the compensable condition or factors the OIC did not consider before. The physician's findings and rating then go, with any supporting evidence, to the carrier, self-insured employer or TPA administering the claim.
The claimant completes Section I (grounds for reopening, later injuries or claims, unemployment or wage replacement benefits, current employment and retirement) and gives the form to the doctor. The treating physician, or a new treating physician, completes Section II in detail and attaches a narrative report if needed.
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Claim Re-Opening Application for Permanent Partial Disability
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The claimant checks one of two grounds in Section I: aggravation or progression of the condition or disability from the compensable injury or occupational disease, or facts about the disability that the OIC did not consider in earlier findings. The physician's Section II then documents the physical findings behind any aggravation or progression in a short narrative.
Yes. Section II asks whether you were the treating physician for the claim or are a new treating physician, and the date of the examination your findings are based on. The physician also states whether the worker can return to the regular job or light duty, would benefit from rehabilitation, and has reached maximum medical improvement.
Question 10 asks for the Range-of-Motion model, with the tables and charts used to reach the whole person percentage, applying Title 85, Rule 20 to the exam. Question 11 then asks for any prior percentages given for the same body part and whether they should be subtracted from the new rating.