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Key Changes From Original TWCC-73 with Explanations

The form TWCC-73 has undergone numerous changes thanks to significant input from employees, employers, health care providers, insurance carriers, and attorneys, who all took time to provide feedback to the Commission on ways to improve the form as a reporting tool.

General Formatting:

1) Lightened checkboxes. One of the respondents suggested that this would help the "checks" stand out more.

2) Used reversed lettering in section titles to set them out better.

Part I General Information:

1) Removed "Number of Pages" from the transmission section. The number of pages should always be one.

2) Changed "General Description of Injury" to "Employee's Description of Injury/Accident." Discussion with doctors indicated that Part I was likely to be filled out in the "front office" and calling it "Employee's Description . . ." will help ensure that the information is gathered during the first visit. This information will help employers and carriers investigating claims (particularly carriers since the TWCC-73 may be the carrier's first notice of the injury in many claims).

3) Revised the doctor information. Removed FEIN and license number and replaced them with address, phone and fax information. A number of people suggested that this information was more useful and, though there are concerns about unnecessary telephone calls, the fact is that the statute charged the Commission with implementing up a program to encourage communication regarding return to work and modified duty. Providing telephone and facsimile numbers seems to fit that mandate.

Part II Work Status Information:

1) Emphasized the need to put estimated expiration dates and, if applicable, a description of why the workers' compensation injury prevents the employee from returning to work.

2) Simplified the language further and tried to highlight the differences between the different types of work status.

Part III Activity Restrictions:

1) Added "if any" to all box titles. If no boxes are checked, then it should be understood that there are no restrictions in that area.

2) Removed the superfluous check boxes for "Employee has posture/motion restrictions as follows:" because if a restriction box is checked, then it should be obvious that this represents such a restriction.

3) Changed the hour restrictions from ranges to maximums in the posture and motion restriction sections. Also, split "1-4 hours" into separate two categories since "1-4 hours" was really a large spread and added a category for "0" hours (to denote an activity the employee can not perform at all).

4) Added a blank line for other time periods in the posture and motion restriction sections. One of the objections received on the earlier form was that it did not work for employees who worked other than 8 hour days. The change will allow the doctor to specify other periods of time than 2, 4, 6, or 8 hours.

5) Added a "Restrictions Specific To (if applicable):" section to allow the doctor to identify if the restrictions are specific to certain body parts. If nothing is checked, then it is assumed that the restrictions apply to the whole body.

6) Added a statement at the bottom of the box that indicates that the restrictions are based upon the doctor's best understanding about the essential job functions of the employee 's job. Also notes that employees should follow the restrictions outside of work as well as while working. If an employee can not or should not do something at work, then the employee should not do it at home either.

7) Reorganized and separated the "Motion Restrictions" and "Posture Restrictions" to emphasize certain functions.

8) Changed "Lifting Restrictions" to "Lift/Carry Restrictions" to cover both activities. Although the activities are similar, there are differences and the change might ensure that it is understood that the restrictions apply to both.

9) Removed "May lift objects without restriction" box because this was a redundant box (i.e. if none of the restriction boxes are checked, then it should be assumed that there are no lifting restrictions as a result of the workers' compensation injury).

10) Changed the "stretching breaks" restriction to include "sit breaks" and to make it easier to specify how long and how often the breaks are to occur.

11) Removed "May perform sedentary work only" restriction since this could have very different meanings to different people and might be more of a source of dispute than a useful piece of information.

12) Changed "No work in water" to "Must keep _______________ : Elevated or Clean & Dry." Often an injury will require elevation of a limb to control swelling. Also, when an employee needs to keep something dry, it will often need to be kept clean as well (e.g. a burn).

13) Eliminated the "Must wear tennis shoes only" and "Must wear sunglasses" restrictions since many doctors indicated that they have rarely, if ever, found reason to place such a restriction on an employee and since the doctor could always do so in the "Other Restrictions" section.

14) Added a separate area to note restrictions due to medications and noted that, if the employee's medications may cause drowsiness, then there may be safety/driving issues.

NEW Part IV: Diagnosis/Follow-Up Appointment Information:

1) Added space for diagnosis information so that the carrier will have a better idea what the condition is.

2) Added a space for follow-up service information to allow doctors to indicate follow-up appointments for a number of different things. For example, the doctor can indicate that the employee is going to have physical therapy for several weeks and then be reevaluated by the treating doctor.

3) Added a way to close a minor injury by adding a box that allows the doctor to indicate that no further treatment is expected at this time. It should be noted that this is not the equivalent of MMI. This will probably be used on sprained ankles and other minor injuries that don't require a lot of treatment ("treat and release" injuries).

4) Added a place for the employee's signature. A number of employers indicated that this would allow them to substitute this form for their own forms and save paperwork. Also, it would not hurt to have the employee's signature on the form to ensure that the employee has received a copy of the form and is aware of his or her current work status and restrictions (if any).

5) Added a box to indicate if the visit is the initial or follow-up visit. This will help carriers flag the claim as possibly being a new injury.

Suggested Changes Not Made to the Form and Explanations

In addition to making changes based upon input from system participants, suggestions were made that did not result in changes to the form. These are summarized below to help clarify why the TWCC-73 took the final form it did.

Part I General Information:

1) Did not bold "Employee's Description of Injury/Accident" because there is no reason to assume that this is more important than the other information on the form.

Part II Work Status Information:

1) Did not remove box 13(c) which restricts employees from all work. Although we don't want to bias the form one way or the other, we also can envision circumstances (especially at the beginning of an injury) where it would be appropriate for the doctor to restrict the employee from all work.

2) Did not eliminate all the checkboxes and turn form into a "free text"-style form because most doctors have indicated that the checkboxes make it easier to file the form and many carriers and employers have indicated that they like having a form with standard restrictions.

3) Did not change language of the expected expiration dates for the restrictions to indicate that the employee is expected to return to work on a specific date. Although this could be useful, we were trying to keep the language in this section cleaner to make it easier to read and reduce confusion. It should be intuitive that, if the employee is expected to be restricted from work until a specific day, then the employee would be able to return to work either with or without restrictions at that time unless the estimate was superseded by a more recent examination.

4) Did not include a "no change in status" checkbox as this might bias the form. If it is easier to simply checkoff that there has been no change in status, then a doctor might be more inclined to check this box rather than reconsider restrictions and evaluate the employee's progress towards being able to return to work.

5) Did not remove the requirement for a doctor to provide an explanation of why the injury prevents the employee to return to work if the doctor believes that the employee is unable to work at all. The form would be biased if it was significantly easier for doctors to indicate that the employee can not return to work than it is to indicate that the employee can return and list the restrictions. Further, although we can envision circumstances (especially at the beginning of an injury) where it would be appropriate for the doctor to restrict the employee from all work, we would like to see doctors identify reasonable restrictions (even if stringent) on an employee's ability to work and let the employer have the opportunity to find work within those restrictions. Nothing is lost if the employer is unable to meet the restrictions and this approach emphasizes return to work from the beginning of the claim.

Part III Activity Restrictions:

1) Did not put definitions from page 1013 of the Dictionary of Occupational Titles on the form since this book is not a required reference in the system and it is not clear that they are needed.

2) Did not include boxes for "no posture" and "no motion" restrictions because they are redundant. The instructions indicate, if there are no boxes checked, then it should be assumed that none of the unchecked boxes apply.

3) Did not separate "Pushing" from "Pulling" in the "Posture Restrictions" section because there was not sufficient room. If the doctor wants to indicate that the employee is only restricted in one of these activities, the doctor can mark out the one that does not apply.

4) Did not put specific restriction associated with uneven or graded surfaces as the doctor can indicate this in the other restrictions box. It will also be relatively obvious in the case of an employee on crutches.

5) Did not create a "no work" box in "Misc. Restrictions". If the doctor indicates in Part II that the employee is unable to return to work, then there is no reason for the doctor to check a box which says the same thing. Further, the "Misc. Restrictions" section is in Part III which is only filled out if the employee is able to return to work.

Part IV Treatment/Follow-Up Appointment Information:

1) Did not put boxes for "permanent disability", "retired status", "will never return to former job", or "requires retraining" because, although useful in some situations, these will be the minority of cases and will likely occur well into the claim. This report can not cover all situations perfectly and remain one page long.

2) Did not put place on report for the treating doctor to indicate agreement or disagreement with a referral or other type of doctor's report because, although useful, there was not enough room.

3) Did not add a place for the doctor to exhaustively list all diagnostic tests performed (if any) or add a bunch of medical terminology. The report is not designed to be a medical status report. As noted in the preamble adopting rule 129.5 in December of 1999 and reaffirmed in the adoption preamble for the June of 2000 amendments, doctors are not expected to perform functional capacity examinations to fill out this report as this would be an unnecessary expense.

4) Did not add a place for the doctor to indicate if requested medical tests or treatments have been denied or delayed. This report is not designed to be a medical dispute resolution request form.

5) Did not remove boxes indicating role of doctor filing the form. Although the form will usually be filed by a treating or referral doctor, RME and designated doctors will sometimes be required to file the form as well.