Objective medical findings are very important in every L&I claim and workers’ compensation claim. The Department of Labor and Industries (L&I) distinguishes between objective and subjective findings. For example, when a work injury claimant describes their symptoms, that falls under subjective findings. However, medical exam results where a treatment provider can see, feel, or measure, are objective.
L&I claim time-loss certification
L&I requires objective findings before they can provide certain benefits. This fact applies to both work injury and industrial disease. One example is time loss compensation benefits. You must certify time-loss before L&I can remit payments. To certify time-loss, a treating provider must complete an activity prescription form (APF). Then, the provider should attach chart notes to document their findings. In fact, the APF contains a mandatory section asking providers to list “measurable objective findings”. Here, examples include things like positive x-rays, swelling, muscle atrophy, and range of motion.
Objective medical findings in an L&I claim
I frequently investigate L&I claims for work injury victims that are not getting time loss payments. Very often, I discover it’s because they didn’t identify objective medical findings. Sometimes, it’s an oversight that anyone can correct easily. Other times, it’s because there are no objective findings.
In reality, some provides have their own definition for “objective”. In more troubling cases, L&I denies x-Ray or MRI exams that would objectify the worker’s complaints. Either way, I think it’s extremely important to identify objective medical findings and communicate them to L&I clearly. In fact, I routinely help my clients ensure that providers submit objective findings to L&I.
Reliance on objective findings
Personally, I find that many work injury claimants struggle to understand the concept of objective medical findings. Many believe that since they are in pain, then it’s enough for them to describe the pain. Unfortunately, pain is a subjective complaint. Therefore, it’s absolutely critical for treatment providers to identify underlying objective medical findings that explain the source of the pain. Furthermore, under the law, if there are objective findings, then medical providers may also consider subjective complaints when deciding things like whether a person can go back to work.
My Dr had requested surgery approval for a Bone osteotomy and tfcc repair which was denied and we sent in more imaging showing the tear getting worse and we have heard back , now the claims manager stopped my time loss payments because of apf form not received . But my doctor had told me to wait to make an appointment till we get a decision from the appeal of the denied surgery recommendation. We have not heard back.