Introduction:
The WKC-16-B form used in the Worker's Compensation program is entitled: "Practitioner's Report on Accident or Industrial Disease in Lieu of Testimony." Doctors may be asked to complete it by an insurance company, employer, attorney or employe. After the form has been completed and returned, the doctor may not be required to testify at a subsequent worker's compensation hearing.
The form was devised to provide competent medical testimony without the necessity of having doctors take time off from their schedules to appear at hearings. In this guide we will attempt to explain the approach to some of the more troublesome questions.
The completed WKC-16-B form is a document which will be made a part of the record at a worker's compensation hearing. Decisions involving medical problems are generally predicated upon these forms. Therefore, while many of the questions asked are difficult to answer, the form of the question in these documents is required by state law and court decisions.
The questions on the WKC-16-B concerning causation and disability are to be answered to a "reasonable medical probability." The Worker's Compensation Law does not require 100 percent certitude. The standard is "reasonable medical probability," which is somewhat less that absolute certainty. On the basis of the information available to doctors, they should decide whether it is more likely than not that an event or series of events caused the injury and whether the injury caused the disability. "More likely than not" is an accepted definition of "probability." Probability is not a certitude, but, it is also not a possibility. Probability is a considerably higher standard than a mere possibility.
Questions 1-3
The first three questions on the form should present no difficulties. In answering Question 3, the doctor should enter the date of accident according to the history provided by the injured employe. If you are treating a work-related disease or illness, enter the date on which the disease first caused the employe to miss time from work.
Question 4
In answering Question 4, the doctor should describe accidents (traumatic incidents) or work exposure (in case of disease) to which patients attribute their medical conditions. A legible copy of the history or notes will suffice if they contain this information. Those notes can be copied, attached to the WKC-16-B form and referred to in Item 4. For example, "See attached history and notes."
Question 5
Question 5 requires the doctor to include the subjective complaints and objective findings. If it is possible at the time the report is completed, the doctor should provide the diagnosis or a description of the physical, mental or emotional conditions from which the employe is suffering. Again, a legible copy of the history or notes, if they contain this information, can be attached and referred to.
Questions 6-7
The answers to Questions 6 and 7 are self-evident and only require a review of the doctor's notes.
Questions 8-10
However, Questions 8, 9 and 10 present more complex problems. These questions are directed to the issue of temporary disability. An accurate description of temporary disability is "the healing period." Following injuries, workers must be given time to recover. They may be hospitalized, at home resting, or receiving therapy and medication. When treatment is completed, the healing period is ended and is followed by recovery or stabilization. Sometimes stabilization is referred to as "the plateau of healing."
Whether recovery or stabilization has occurred is strictly a medical question. The fact that some treatment is still necessary, such as physical therapy or pain medication, does not rule out the fact that the healing period may have ended. This type of treatment is referred to as "maintenance."
The answer to Question 8 provides the Worker's Compensation Division with the beginning of the healing period. A definite date is necessary. In Question 9, the Division recognizes that although patients are in healing periods, they may be able to do limited work within medical restrictions imposed by the doctor. Question 9 provides that information, that is: Patients are still in their healing periods but are capable of doing some work.
The information as to the end of the healing period (stabilization) is provided in the answer to Question 10. Again, please provide definite dates.
Questions 11-13
Questions 11, 12 and 13 are directed to the issues of medical causation and should be answered to a reasonable degree of probability, the definition of which was discussed earlier. After the healing period has ended and workers' conditions have stabilized, they may have permanent residual disability as a result of injury. This, of course, is a different type of disability than temporary disability. This is the type of disability that employes will have to deal with for the rest of their lives.
Questions 14-16
Permanent disability has been placed in two different categories by the Worker's Compensation Law. The first category is known as "scheduled injuries." These injuries include permanent injuries to the arms, hands, thumbs and fingers. Also included are injuries to the legs, feet and toes. Loss of vision and hearing also are scheduled injuries. Disability to these scheduled injuries is rated by comparing the permanently injured member or organ with a member or organ which is functioning at a 100 percent level.
The Legislature has decided that permanent injuries to the back, head, respiratory system, bodily organs (except for eyes and ears) and mental illness are not amenable to a schedule. Therefore, concerning this type of permanent injury, the doctor must compare, on a physical basis, this disability with a 100 percent disability to the entire body. This is strictly a physical or functional rating by the doctor.
The elements which constitute the disability should be described. For example, in dealing with back injuries, doctors could state that employee are limited to lifting 25 pounds or that they cannot do repetitive bending. This is a physical evaluation. The problem of how this affects the injured person's ability to perform in the available labor market must be addressed by the WC Division-not the doctor.
Doctors completing this form should "leave the disabilities where they find them." In other words, if the pain and limitation of motion is at the wrist, rate the disability at the wrist. Do not rate it as a disability of the entire arm. Question 15 is directed to the rating. Question 16 is directed to elements which constitute the disability.
Questions 17-18
Questions 17 and 18 are used by the Division to determine whether the particular claim should be kept open. If you believe there may be an increase in disability or that further treatment is required, and this includes maintenance, you should so state. This is very valuable information.
If you have information relative to a preexisting permanent disability, please answer Question 19.
This form is to be certified, which means that the form need only be signed. It does not have to be notarized.
Other W.C. Forms and Publications
WKC-16-A: This is a special form used only in cases involving permanent impairment of VISION. Since the information needed to calculate permanent disability compensation for loss of vision is so different from any other type of permanent injury, the Worker's Compensation Division suggests that only this form be used to report permanent vision loss. The form is available on request from the Division.
WKC-16: This general form is the one most commonly used to report injuries or occupational illness. It is available from the WC Division or from an insurance carrier. It is to be completed when there is clearly permanent disability, as in the case of an amputation, or when the temporary disability extends beyond three weeks. The report on this form should be based on an examination after the healing period has ended.
A publication is available to help guide doctors in their evaluation of extent of disability. It is quite specific and detailed, called: "How to Evaluate Permanent Disability," (WKC-7761). Included are explanations and definitions relating to scheduled and nonscheduled injuries and language of pertinent state administrative rules.
This can be ordered from the WC Division at 608-266-1340.
Remember, if all parties involved with a claim cooperate, the likelihood of litigation can be avoided, the total cost of the claim can be reduced, and the injured employe will be able to return to the work force sooner.
For additional information about worker's compensation, contact:
Worker's Compensation Division
Department of Workforce Development
Division's Main Office
Room 161
201 East Washington Ave.
P.O. Box 7901
Madison, WI 53707
(608) 266-1340
Milwaukee Area Office:
3rd Floor
Milwaukee State Office Building
819 North Sixth Street
Milwaukee, WI 53203
(414) 224-4382
Appleton Area Office:
1500 North Casaloma Drive
Suite 310
Appleton, WI 549ll
(920) 832-5450
WKC7760 (R.5/96)