4123-3-09, 4123-3-16 and 4123-5-18.
Resolutions R-03-1-01, R-92-1-1 and R-94-1-12.
Chief of Operational Policy, Analytics and Compliance (Signature on file)
Rev. 07/15/13; 02/26/14
The purpose of
this policy is to ensure BWC appropriately allows psychiatric conditions in
accordance with the law and rules.
applies to Field Operations, Medical Services and Legal Division staff.
for purposes of this policy and related procedure, means where the injured worker’s
psychiatric conditions have arisen from sexual conduct in which the injured
worker was forced by threat of physical harm to engage or participate.
Injury: for purposes of this
policy and related procedure, includes psychiatric conditions when the injured
worker’s psychiatric conditions have arisen from an injury or occupational
disease sustained by that injured worker, or where the injured worker’s psychiatric
conditions have arisen from forced sexual conduct.
Sexual conduct: for purposes of this
policy and related procedure, means vaginal
intercourse between a male and female; anal intercourse, fellatio, and
cunnilingus between persons regardless of gender; and, without privilege to do
so, the insertion, however slight, of any part of the body or any instrument,
apparatus, or other object into the vaginal or anal cavity of another. Penetration,
however slight, is sufficient to complete vaginal or anal intercourse.
A. General policy statements
1. It is the policy of BWC to
evaluate initial and additional allowance requests for a psychiatric condition(s)
in a claim that arise from:
a. An injury or occupational
disease sustained by the injured worker when a compensable physical injury
sustained by the claimant causes the mental condition. Armstrong v.
John R. Jurgensen Co., Slip Opinion No.
b. Forced sexual conduct.
2. It is the policy of BWC that
for recognition of a psychiatric condition(s) the request is accompanied by
supporting medical documentation consisting of the following:
a. The medical report is
submitted by a:
iii. Licensed Professional Clinical
Counselor (LPCC); or
iv. Licensed Independent Social
b. The medical report is
detailed and includes the following:
The specific psychiatric
condition(s) diagnosis with narrative description and the appropriate diagnosis
iii. The psychiatric findings;
iv. Detailed explanation of the
causal relationship of the diagnosed psychiatric condition to the work-related
injury or occupational disease;
v. Information that is clearly
reasoned and rationalized.
c. The medical report verifies
the psychiatric condition(s) arose from an injury or occupational disease
sustained by the IW or forced sexual conduct.
d. The medical report addresses
each psychiatric condition(s) requested.
3. It is the policy of BWC that
a request for a psychiatric condition(s) will not be based on a medical report
a. Advanced Practice Registered
Nurse (APRN), or
b. Advanced Practice Nurse
4. It is the policy of BWC that
BWC may obtain a psychiatric independent medical examination or physician file
review to provide a medical opinion on the following:
a. The presence of a psychiatric
condition in a claim as an initial determination or an additional allowance
b. The necessity and
appropriateness of psychiatric treatment;
c. The extent of a psychiatric
B. Initial determination request
for a psychiatric condition(s)
1. BWC may receive an initial
determination request for psychiatric condition(s) on a First Report of an
Injury, Occupational Disease or Death (FROI-1) concurrent with the request
for a physical injury or as a result of forced sexual
a. An initial determination
requesting a psychiatric condition(s) as a result of
forced sexual conduct is treated the same as any other claim for an initial
b. A request for psychiatric
condition(s) arising out of forced sexual conduct is the only instance where
the law allows for the initial determination of psychiatric, emotional or
stress claim absent a physical injury.
2. It is the policy of BWC that
an injured worker must sign and date the FROI-1 application requesting a
3. BWC does not require an
injured worker declaration statement for a psychiatric condition(s) filed for
an initial determination request.
C. Additional allowance request
for a psychiatric condition(s)
1. BWC must receive an
additional allowance request for a psychiatric condition(s) on a Motion (C-86).
2. For each requested
psychiatric condition, BWC must receive a signed and dated declaration
statement from the injured worker that says, “I am aware that this motion is
being filed to request that the bureau or commission recognize my emotional
problem, nervous condition, or psychiatric disability as being a result of the
injury for which this claim is allowed.”
3. BWC will not process requests
for a psychiatric condition(s) recommended by a treating physician on a Physician's
Request for Medical Service or Recommendation for Additional Conditions for
Industrial Injury or Occupational Disease (C-9).
D. BWC may approve and/or
reimburse for psychiatric evaluations and/or treatment when an injured worker’s:
1. Psychiatric condition is
allowed in the claim;
2. Psychiatric independent
medical examination is scheduled by and for BWC purposes;
3. Psychiatric condition is
allowed in the claim and the injured worker or provider previously paid for an examination performed to provide evidence to
support the Motion (C-86);
4. Evaluation and/or treatment
is part of an approved vocational rehabilitation or catastrophic treatment
5. Evaluation is part of an
authorized pre-admission evaluation for an approved chronic pain program;
6. Evaluation and/or treatment
is part of an authorized chronic pain program;
7. Evaluation and/or treatment
is part of an authorized detoxification or substance abuse program.
E. Psychiatric conditions and
1. Specialties licensed to treat
and who can certify periods of disability based on psychiatric allowance(s)
a. Medical Doctors (M.D.), and
b. Doctors of Osteopathic
Medicine (D.O.), and
2. Specialties licensed to treat
without the supervision of a psychiatrist or psychologist (i.e., they may work
independently to request treatment and provide medical/psychiatric services to
an injured worker), but who cannot certify periods of disability or sign any
forms used for compensation (e.g., MEDCO-14) include:
a. Licensed Independent Social
Workers (LISW); and
b. Licensed Professional
Clinical Counselors (LPCC).
F. Psychiatric conditions and
1. It is the policy of BWC not
to schedule exams for psychiatric condition(s) requested in self-insured claims
unless the Industrial Commission (IC) orders such an exam.
2. If an exam is ordered, the
self-insured employer is responsible for the cost of the psychiatric condition(s)
independent medical examination scheduled at the request of the IC by BWC.