Disability Evaluators' Panel (DEP) services
Permanent partial disability examinations
The purpose of the exam is to provide an unbiased, objective estimate of the
whole-person, percent impairment for a given allowed condition. This must be based
on the most current edition of the American Medical Association's (AMA's) Guides to the
Evaluation of Permanent Impairment, using the available medical documentation, history
and physical examination. Examining physicians should generate reports, which identify
the appropriate tables or figures from the guides they used to reach their conclusions.
There is no decision making process other than interpretation of the medical exam,
medical records and history, and applying this information to the guides. Most physicians
who perform these exams must receive additional training that explains the process,
since these examinations are not routinely performed in medical residency. The more
examinations a physician performs, the better the physician becomes at the process.
Primary issues are objectivity of the examiner and appropriate use of the guides.
In some areas of the state there are shortages of qualified examiners for particular
File reviews for requests to increase permanent partial disability benefits
This review requires the physician to visit the local BWC customer service office
and review medical files with newly submitted medical documentation from the injured
worker to determine whether to grant additional impairment. It does not require
clinical decision making in terms of alternative treatment, diagnosis or examination
of the patient. It requires a good knowledge and application of the Guides to the
Evaluation of Permanent Impairment. These physicians may be involved in auditing and
dispute resolution of permanent partial issues in the quality assurance program.
90-day, 200-week and independent medical examinations
These exams require the physician to review medical records, obtain a history and
examine the injured worker to answer questions raised by a party in the workers’
compensation process. It does not require the use of the American Medical Association
guides. Typically, questions address continuation of treatment, recommendation of future
treatment or procedures, determination of maximum medical improvement or return-to-work
issues. Ideally, physicians performing these exams should be experts in their
specialty and up to date on treatment options. An active clinical practice, which
includes treatment of injured workers, would be preferred.
Medical file review
This review usually requires the physician to review medical records completed online
by authorized DEP file-review providers to answer specific
questions about treatment continuation, specific treatment requests, appropriateness
of medication or claim allowance. Physicians should be knowledgeable of appropriate
treatment and up to date on commonly accepted practice guidelines. They do not
need to have a current clinical practice. In fact, many may have retired or quit
performing surgical procedures.
Alternative dispute resolution (ADR)
Physicians involved in the ADR process are often specialists and sub-specialists,
who help resolve difficult dispute resolution issues such as whether requested medical
services are medically necessary and appropriate based on the allowed conditions in the
claim. They should be in active clinical practice and highly regarded in the medical
community performing up-to-date procedures and practices. Spine surgeons, hand surgeons,
joint replacement orthopedists, and physical medicine and rehabilitation physicians are
some examples. Many of these physicians will not perform medical file reviews or permanent
partial disability evaluations.
Click here to learn more about reviewing the BWC online claims documents.