Paperwork parameters

With the Health Partnership Program (HPP), BWC puts emphasis on issues and actions involved in the claim rather than on forms. Forms, however, are still necessary as we work together to provide injured workers with the services they need. Forms you will most likely use include:

• First Report of Injury, Occupational Disease or Death (FROI) — The managed care organization (MCO) may require you to use this form to report the injury;
• Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) — The physician of record or treating physician uses this form to submit a treatment request or recommendation for additional condition to the MCO before initiating any non-emergency treatment;
• Physician's Report of WORK ABILITY (MEDCO-14), — Physicians use this form for work restrictions;
• Notice to Change Physician of Record (C-23) — The injured worker must sign this form and indicate the physician to which he or she desires to change and the reason. Send the C-23 to the MCO;
• Request for Temporary Total Compensation (C-84) — The physician of record must complete specific sections of this form and sign it to indicate the injured worker is unable to work. After the injured worker completes Part I, send the C-84 to BWC.

Click here to view all provider forms.