Workers’ Compensation

• Injury details (Date of injury, exact location injury occurred, names of witnesses, to whom did you report the injury?)

• Employer’s name, address, and contact information

• Claim number (if you have it)

• Adjuster or insurance contact information (name, phone, fax/email)

• Any forms provided by your employer or insurance (FROI, CA-16 for federal cases)

• A list of any prior injuries or medical conditions to the same body part(s)

• Photo ID and insurance card (if you have other coverage)

• The provider will review how the injury occurred and your current symptoms.

• A physical exam will be done, including measurements (range of motion, strength, etc.).

• Imaging or lab tests may be ordered if needed; advanced imaging and/or specialist consults may be requested pending work comp carrier authorization.

• The provider will give a diagnosis and explain whether it is related to your work injury.

• You will receive a Work Status Note explaining whether you can return to work, with or without restrictions.

• A treatment plan will be created, which may include medication, therapy, or referral to a specialist.

• Your Work Status Note from the last visit (if given to your employer)

• Updates from your employer or adjuster (if they requested information)

• Any therapy or imaging reports since your last visit

• A list of your current symptoms and any changes since last visit

• Medication list and whether you are taking them as prescribed

• The provider will ask about your progress, pain, and ability to work.

• A physical exam will be performed to track your recovery.

• Any test results or therapy reports will be reviewed.

• Work restrictions will be updated (full duty, modified duty, or off work).

• The treatment plan will be adjusted as needed.

• Another Work Status Note will be given to you for your employer and adjuster.

Helpful Tips

• Always bring your claim number and adjuster’s contact information.

• Keep copies of all forms and Work Status Notes for your records.

• Attend all scheduled therapy and follow-up visits to avoid delays in care or benefits.

• Tell your provider right away if your symptoms worsen or new symptoms appear.

Remember: Complete information helps us help you. Our goal is to get you healthy and back to work safely.