What is Form C-4.3

When a claimant’s treating physician believes that the claimant has reached Maximum Medical Improvement and/or has a permanent impairment, he or she will complete Form C-4.3 to render an opinion regarding the level of the claimant’s permanent impairment.

 

The claimant’s treating physician may determine that the claimant has a permanent impairment as a result of a work-related injury. The evaluation of a permanent disability occurs when there is a permanent impairment remaining after the claimant has reached MMI.

 

According to the Workers’ Compensation Guidelines, “a finding of MMI (Maximum Medical Improvement) is based on a medical judgment that (a) the claimant has recovered from the work injury or illness to the greatest extent that is expected and (b) no further improvement is reasonably expected. The need for palliative or symptomatic treatment does not preclude a finding of MMI. In cases that do not involve surgery or fractures, MMI cannot be determined prior to 6 months from the date of injury or disablement, unless otherwise stated or agreed to by the parties.”

 

The claimant’s treating physician will render an opinion on MMI on Form C-4.3 in Section D. In the case where the treating physician determines that the claimant has not reached MMI, the doctor must provide an explanation as to why and must propose a further treatment plan for the claimant.

 

In Section E, the claimant’s treating physician will provide an opinion regarding the degree of permanent impairment. In the case of non-SLU awards, the physician must record the body part, impairment table, and severity letter grade for each body part or system using the 2012 Workers’ Compensation Guidelines.

 

For more information regarding permanency, please contact Bedoya & Hussain Law Firm, LLC at (201) 880-9374.