Information, Resources and Links
Primary Treating Physician’s Permanent and Stationary Report (PR-4)
2005 permanent disability rating schedule
Primary Treating Physician’s Permanent and Stationary Report (PR-3)
1997 permanent disability rating schedule
QME’s Findings Summary Form (QME 111)
unrepresented cases only
For Patients without an Attorney:
- Currently, there are very few MPNs that have treating psychiatrists that will take workers’ compensation patients.
- Work Comp Medical Services, Inc. can seek authorization outside the MPN.
The Disability Evaluation Unit (DEU) determines permanent disability ratings by evaluating medical descriptions of physical and mental impairment. The determinations are used by workers’ compensation administrative law judges, injured workers and insurance claims administrators to determine permanent disability benefits.
Copies of the ACOEM guidelines are available for review at local DWC offices. The ACOEM guidelines are also available at many law, university and public libraries.
For purposes of compliance with the California Code of Regulations, Title 8, division one, chapter 4.5, subchapter one, article 5.5.1, utilization review standards, a claims administrator may make copies of incidental portions of original editions of Occupational Medicine Practice Guidelines, Second Edition, as necessary in connection with a decision to modify, delay or deny services in a specific case under review. Such copies may not be published on the Internet or in any other media. All rights in the Guidelines are reserved by ACOEM.
If you have any questions, please contact:
American College of Occupational and Environmental Medicine (ACOEM)
25 Northwest Point Boulevard, Suite 700
Elk Grove Village, IL, 60007