If you’re in workers’ compensation in California, then you probably know that an RFA (“Request for Authorization”) is a standardized form distributed by the Department of Industrial Relations. Click here to view the official RFA form on the DIR website.
Medical providers need to complete an RFA for every treatment they order for the patient. The Utilization Review department of the insurance carrier must then review the RFA, and either approve or deny the request.
Each RFA includes the following:
Basic information about the patient and the claim
Diagnostic codes of the patient’s condition(s)
The actual service that is being requested—such as medication, therapy, referrals, equipment, etc.
Failure to include any of this information may result in the insurance carrier sending the RFA back to the provider.
The good news is that medical providers and office workers can create and manage RFAs for work-related injuries using RateFast. For free.
Click here to learn more about how RateFast users can automatically fill out RFAs while writing reports.
To get a more in depth description of how to get your RFAs approved by insurance carriers, click here.
This article is intended for RateFast users who have questions about the Whole Person Impairment ratings that come with each PR-4 Permanent & Stationary work injury report.
This FAQ contains answers to a few common questions that we’ve received regarding RateFast impairment ratings.
We pride ourselves in the accuracy of our impairment ratings, and would be happy to explain how they are being calculated. If your question isn’t answered here, then please contact us with questions about your PR-4 report.
Apportionment is one of the top three decisions which can delay a WorkComp claim from closing. This is understandable, as it’s a tricky subject. Nearly all medical providers have a different idea about how apportionment should be arrived at. Insurance companies want to pay the injured worker the right price, the injured worker needs to be adequately compensated… And the employer only wants to be responsible for the part of the injury which was caused at work.
Bottom Line: There are no clear rules with apportionment. Although the law defines that only “permanent disability” is to be apportioned, there are no instructions on how the medical provider is to actually do it. Is it functional disability (eg. could lift 20 pounds before the injury and now lifts only 10 pounds)? Is it “permanent disability” from a permanent disability rating (PDR) that results from an impairment measurement (eg. %Whole person impairment, which may or may not result in true permanent functional disability). Or, is it a change in treatment burden such as medications, therapy, and or other measurable medical support that is now needed, new, or increased from a pre-injury condition to maintain the new level of function? Which one is a correct method? They can all be used clinically with equal defensibility when correctly explained and supported.
There are a few things which can be referenced when deciding apportionment, in order to keep consistent, objective impairment reports.
Let’s start with some definitions.
Apportionment is one of the subsets of the PR-4 report.
It’s a section where the medical provider is asked to make a determination if the permanent disability that results from the work injury may be attributed medically to any other conditions.
Now time for a real-world example.
A gentleman who is 25 y/o is lifting a box at work. He injures his back and receives treatment. At the conclusion of the report the doctor is going throught the case history and it turns out that the worker had a pre-existing injury to his back. This placed him on a restriction from listing more than 20 pounds. After this new injury he can only lift 10 pounds.
Is apportionment present and if so, what %?
The answer is yes. He is 50 % apportioned to his permanent disability from the old, unrelated event when he hurt his back.
In this case we’re lucky enough to have a clear a baseline of pre-existing disability, we know the worker is at MMI, and now there’s a new level of permanent disability. This makes the apportionment determination much simpler, and helps with the timely closure of the claim. Remember apportionment is no walk in the park, so if you’re looking for any advice feel free to Submit a PR-4 report for review today!
This article is intended for medical providers who need to write a history of a work-related injury.
The quality of a patient’s injury history can make or break the accuracy of an impairment rating. Read our eight rules on conducting a complete patient interview, including how to let silence be your friend, and the one comment that every good medical history should include.
In occupational medicine the terms aggravation and exacerbation are often mixed up. This article explains the technical definitions for aggravation and exacerbation, and why the difference matters.
Telemedicine is the delivery of medical care, including an actual discussion of medical history and a physical exam.
Just like an office visit, in a telemedicine visit the doctor interviews the patient, gets a complete history, and then performs an exam. Recent advances in technology now allow providers to remotely measure blood pressure, oxygen saturation, cardiac and lung auscultation. They can even look at the tympanic membranes of the inner ear drum or take high resolution pictures of the skin without actually being in the same room as the patient.
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