Sample documentation for worker comp who has reached visit limit

GREG VANICHKACHORN, MD, MPH, BRAD A. ROY, PhD, RITA LOPEZ, MSN, AND REBECCA STURDEVANT, MSN

Am Fam Physician. 2014;89(1):17-24

Author disclosure: No relevant financial affiliations.

Approximately 3 million work-related injuries were reported by private industries in 2011, and primary care physicians provided care for approximately one out of four injured workers. To appropriately individualize the treatment of an injured worker and expedite the return to work process, primary care physicians need to be familiar with the workers' compensation system and treatment guidelines. Caring for an injured worker begins with a medical history documenting preexisting medical conditions, use of potentially impairing medications and substances, baseline functional status, and psychosocial factors. An understanding of past and current work tasks is critical and can be obtained through patient-completed forms, job analyses, and the patient's employer. Return to work in some capacity is an important part of the recovery process. It should not be unnecessarily delayed and should be an expected outcome communicated to the patient during the initial visit. Certain medications, such as opioids, may delay the return to work process, and their use should be carefully considered. Accurate and legible documentation is critical and should always include the location, date, time, and mechanism of injury.

The evaluation and treatment of the injured worker has become a common challenge in the practice of medicine. In 2011, about 3 million workplace injuries were reported in private industries. 1 More than one-half of these involved an injury severe enough that work restrictions, job transfer, or time off from work was required. 1 The occupations with the most injuries requiring time off were laborers (construction trades), nursing aides/attendants, and janitors/cleaners. 2 Persons 45 to 54 years of age had the highest incidence of injuries, with sprains, strains, and tears the most common diagnoses, accounting for 38% of all injuries requiring time off work. 2 The back (36%), shoulder (12%), and knee (12%) were most often injured. 2 In 2007, the costs for workers' compensation care in the United States was approximately $50 billion, about four times the cost of breast cancer treatment. 3

Occupational medicine is one of the smallest medical specialties, producing about 130 board-eligible physicians annually. 4 With the shortage of occupational medicine specialists, primary care physicians are often tasked with evaluating injured workers. Overall, 25% of patients with work-related conditions are cared for by primary care physicians, providing nearly three times as many visits for injured workers compared with occupational medicine specialists. 5