Treating Patients

There are unique aspects of treating an injured worker compared to other patient populations. Below are common elements of care a provider may encounter that are specific to working with WSI.

Claim Verification

The first step in the workers’ compensation process is to ensure the injured worker has a claim filed with WSI. Claim Number Lookup allows the look up of a claim number on an injured worker.

If an injured worker has not yet filed a claim, a provider should encourage them to complete the First Report of Injury (FROI).

Primary Treating Provider

WSI considers the following practitioners to be primary treating providers: MD; DO; DDS; DMD; DC; DPM; OD; NP; PA. An injured worker may only have one primary treating provider who manages treatment and establishes functional capabilities.

Functional Capability

Establishing functional capabilities should focus on the injured worker’s abilities rather than disabilities, using the job as part of the recovery process. A primary treating provider must document the injured worker’s abilities at each visit.

The Capability Assessment (C3) form is a useful tool to aid in this documentation. The injured worker should receive a copy of the C3 to give to their employer to assist in determining appropriate job accommodations. Completion of the C3 form is not a substitute for medical documentation

Maximum Medical Improvement (MMI)

MMI is the point of recovery at which the injury is stable and will no longer improve with continued care. Medical documentation must include the injured worker's MMI status, when appropriate, as this status is required for claim management. The treating provider must document MMI status in one of the following: medical notes, C3 form, Chiropractic Progress/Final Report (C25) form, Dentist’s Report of Injury (C31) form.

Permanent Partial Impairment (PPI)

PPI benefits are one-time, lump sum cash award paid in addition to medical, wage-loss, and vocational rehabilitation benefits. WSI issues PPI benefits if injuries sustained are determined to be greater than or equal to 14% whole body impairment, according to the 6th Edition of the American Medical Association (AMA) Guides to Permanent Partial Impairment. Below is additional information regarding PPI:

  • WSI will schedule a PPI evaluation, when appropriate
  • The treating provider cannot perform a PPI evaluation
  • All body parts included in a claim must reach MMI status before a PPI evaluation can be scheduled
  • Impairment awards for amputation, loss of vision and loss of an eye are separately identified in the Injury subsection of the North Dakota Century Code

Resources

The Quick Reference for New Providers contains additional information related to treatment and authorization requirements.

If concerns arise during treatment of an injured worker, e.g. the injured worker not attending physical therapy, symptoms not consistent with the injury, cancellation of medical appointments, or noncompliance with treatment plan, contact Customer Service at 701-328-3800 or 800-777-5033.