The Department of Labor and Industries (L&I) provides time-loss compensation (TLC) and loss of earning power (LEP) benefits. These benefits are available to work injury claimants during the open and active phase of an L&I claim in Washington State. However, there must be a medical basis or certification to receive these benefits.

Activity prescription form (APF)

One key component of the medical certification the Activity Prescription Form (or APF form in short). For certification, it’s important for the attending provider to fill and submit the form in every visit. Personally, in my experience, work injury claimants and their attending physicians often overlook the details in this form. Instead, they view it as merely another piece of paper in the L&I claim process. However, if you complete and submit the activity prescription form regularly and properly, it can provide vital information throughout your claim. In fact, a thorough APF form can provide a complete snapshot of your workers’ compensation claim.

How to fill the APF form

The “General Info” section in the form contains high-level information about the L&I claim. It includes the name of the work injury claimant, claim number, and the name of the provider. Also, it includes the date of injury (or manifestation date for occupational disease claims), and the diagnosis. While the box for diagnosis isn’t a large area, it is important to include accurate medical diagnosis or diagnoses. In fact, if the diagnosis isn’t relevant to the claim, then L&I can deny benefits. Specifically, L&I can argue that physical conditions in the provider’s report do not relate to the work injury.

The attending provider must fill the “Work Status” section of the form. This section is an easy way to see whether the worker’s medical conditions impact their ability to work. The options in this section include: (1) A full release to work at the job of injury without restrictions; (2) A release to modified work; (3) A release to work for limited hours; or (4) A complete lack of release to perform any work what-so-ever. Often, unless the worker is in the acute phase of injury or surgical treatment, the attending provider will check the box and release the worker to “modified duty” or “limited hours”. However, this doesn’t mean that the work injury claimant will return to work.

Legal considerations

Sometimes, the employer of injury cannot accommodate work modifications or limited hours. Then, in such instances, the work injury claimant will remain off work. In this scenario, L&I will pay the worker time-loss compensation. Furthermore, the employer always has the right to offer the worker a job that fits within their physical abilities. If the worker is capable of working reduced hours, then L&I may pay loss of earning power benefits.

It is critical that the attending provider includes “measurable objective findings” to support the physical capacity estimate for the worker. In addition, it’s advisable for the attending physician to include recommendation regarding work status. If the activity prescription form is missing objective findings, then L&I might overlook the missing details. However, when details are repeatedly missing from the report, L&I can deny or terminate time-loss benefits.

Tips and recommendations

The “Estimate” of current capacities is the attending provider’s best estimate of the worker’s current physical abilities. It’s difficult, if not impossible, for a provider to state conclusively what are the physical abilities. However, based on objective findings, history and examination, medical providers can enter a good estimation. Yet, in some cases, it may be appropriate for the provider to recommend a more formal evaluation of abilities. This evaluation is called a Physical or Functional Capacities Evaluation (i.e., PCE or FCE, respectively).

Finally, the APF form also contains a section regarding the treatment plan. This section quickly highlights the current treatment progress, and prognosis. Furthermore, it shows if there are any additional treatment recommendations or referrals. Evidently, this one-page form contains a plethora of relevant information for your L&I claim. Typically, this information is spread out over pages of medical records, chart notes, and vocational records. Therefore, I always encourage work injury clients to review their activity prescription forms carefully. Also, if you have any questions, you must address them with your provider. In addition, you should check the from and see if it contains any inaccuracies. For example, regarding diagnoses, claim information, or in the estimate of abilities. If it does, you must bring them to the attention of the attending physician to correct them.

Additional resources: The Activity Prescription Form (APF) on the L&I website