Physicians use this three-page West Virginia report to give their opinion on whether a worker has occupational pneumoconiosis, how long the disease has been present and whether it impairs capacity for work. It belongs to an occupational pneumoconiosis claim alongside the employee's OIC-WC-1OP and the employer's OIC-WC-2OP, and includes a NIOSH chest radiograph classification form. The carrier, self-insured employer or TPA may then refer the claim to the Occupational Pneumoconiosis Board.
The examining or treating physician completes the whole report, covering history, complaints, sputum testing, X-ray and pulmonary function studies and physical findings, then signs it. The attached chest radiograph interpretation is completed by the film reader, who classifies film quality and parenchymal and pleural abnormalities.
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Physician's Report of Occupational Pneumoconiosis
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Yes. The OIC lists the report as including the ILO form, and the PDF carries the CDC/NIOSH Roentgenographic Interpretation sheet. The film reader records film quality, parenchymal abnormalities consistent with pneumoconiosis by shape, size, zone and profusion, pleural findings, other abnormalities, and whether the worker should see a personal physician.
Page one asks whether, in your opinion, the claimant has contracted occupational pneumoconiosis, how long they have had it, and whether it has impaired their capacity for work and to what extent. Page two records physical findings: appearance, height, weight now and a year ago, breath sounds, heart sounds, pulse and blood pressure.
The carrier, self-insured employer or TPA administers the claim and may refer it to the Occupational Pneumoconiosis Board. The Board conducts examinations on questions of exposure and the degree of pulmonary function impairment, while the OIC's Claims Services schedules the Board's docket, tracks exam requests and checks that required information is included.