Initial, subsequent or additional claim allowances

For initial claim allowances, causal relationship is the physician's opinion that the injury sustained and the mechanism of injury are compatible and addressed on the First Report of Injury (FROI). For subsequent or additional claim allowances, it is the physician's opinion that the requested new condition is a result of the original injury and/or previously allowed condition(s)/diagnoses in the claim. The physician requests additional conditions on the Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9). This opinion of causality is essential to directly link the alleged medical diagnosis to the workplace. Without this opinion from the physician, it is difficult for our claims service specialists to process the request.

To assist treating physicians, BWC has provided on the FROI and C-9 an area to indicate whether or not the alleged condition is causally related to the claim. In more complex cases, physicians may wish to provide an explanation in the progress notes justifying their opinion.