What is the Activity Prescription Form or APF?

L&I claim activity prescription form APF



The Department of Labor and Industries (L&I) provides time-loss compensation and loss of earning power (LEP) benefits during the open and active phase of a workers’ compensation claim. However, there must be a medical basis, or certification for entitlement to the benefits, before L&I will provide them.


What is Activity Prescription Form or APF?

For state funded claims, a component of this certification is when the attending provider completes an Activity Prescription Form or APF. In my experience, often time injured workers and attending providers overlook the importance of the details contained on this form. Instead, they view it as merely another piece of paper in the constant shuffle of claim related paperwork. However, when completed, the APF provides vital claim related information. In fact, a thorough APF can provide a complete snapshot of the current status of the claim. The following information should help in understanding important information contained on the APF. It will also cover issues that can arise if the APF includes inaccurate or incomplete information.


Sections of interest in the Activity Prescription Form (APF)

The “General Info” section contains general information about the claim. This includes the injured worker’s name, claim number, the name of the provider completing the form, the date of injury (or date of manifestation for occupational disease claims), and the diagnosis. While the box for diagnosis isn’t a large area, it is important to include the accurate claim related diagnosis or diagnoses. If the listed diagnosis is not related to the claim, benefits could be denied on the basis that the provider’s estimate of capacities is based upon non-claim related conditions.


The “Work Status” section of the form is required. This section is an easy way to see whether an injured worker’s conditions currently impacts 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 injured worker is in the acute phase of injury or surgical treatment, the attending provider checks the box releasing the worker to modified duty or limited hours. This does not necessarily mean that the injured worker will return to work.


Legal considerations

If the employer of injury cannot accommodate the modifications or limited hours, the injured worker will remain off work and time-loss compensation is payable. The employer always has the right to offer the injured worker a job that fits within the injured worker’s abilities. Also, LEP may be payable if you meet the conditions for LEP.


It is critical that the attending provider include “measurable objective findings” to support their estimate of physical capacities and recommendation regarding work status. While the Department of Labor and Industries (L&I) may overlook failure to include objective findings on occasions, repeated failure to include objective findings will result in time-loss compensation benefits being denied.


Tips and recommendations

The “Estimate” of current capacities is the attending provider’s best estimate of the injured worker’s current physical abilities. It is difficult, if not impossible for a provider to state conclusively what the physical abilities are. However, based upon objective findings, history and examination, medical providers can usually enter a fairly accurate estimation. However, 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 (PCE or FCE, respectively).


Finally, the APF also contains a section regarding the treatment plan. This section quickly highlights the current treatment progress, prognosis, and whether any additional treatment recommendations or referrals have been made. As you can see, this one-page form contains a plethora of claim related information.  Typically, this info is spread out over pages of medical records, chart notes, and vocational records. For this reason, I always encourage injured workers to review their APFs carefully. Also, you should address any questions you may have with your provider. Additionally, check if the from contains any inaccuracies regarding diagnoses, claim information, or in the estimate of abilities. If it does, you must bring them to the attention of the attending physician so that they can be corrected.


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