Primary Treating Doctor's Progress Report (Narrative or PR-2)
or last medical report delineating any temporary or permanent work restrictions
or last medical report delineating any temporary or permanent work restrictions
The Primary Treating Physician's (PTP) Progress report or (PR-2) is the standardized medical report format that a PTP is to report medical findings to the insurance company or designated claims administrator. The PTP may submit a narrative report in lieu of the PR-2 form; however, pursuant to Title 8 California Code of Regulations Section 9785(f)(8), "If a narrative report is used, it must be entitled 'Primary Treating Physician's Progress Report' in bold-faced type, must indicate clearly the reason the report is being submitted, and must contain the same information using the same subject headings in the same order as Form PR-2." The PTP must file a PR-2 or the narrative report at minimum of every forty-five days to the claims administrator. The report is only to be filed by the Primary Treating Physician (PTP). Secondary Treating Physician's must submit reports to the PTP in the manner requested by the PTP. In a California Worker's Compensation claim there can only be one designated PTP. The injured worker or the injured worker's attorney must select a Primary Treating Physician at the commencement of their claim. The injured worker may change their PTP during the course of their claim; however, excessive changes are frowned upon. The PTP is the only one of an injured worker's treating physicians that is technically able to determine an injured worker's disability, unless a dispute is initiated that requires an evaluation of the injured worker by a Qualified Medical Examiner or an Agreed Medical Examiner.
The second section provides the patient's (injured worker's) demographics:
The third section provide the claims administrator's demographic and claim information:
The PR-2 or appropriate narrative report can provide the claims investigator valuable information when conducting interviews, completing background investigations, and surveillance investigations. The form is essentially separated into nine (9) sections of information.
In the first section the PTP must check the box or state in the narrative the reason that the report is being filed. The options for the physician are as follows:
- Periodic report (required 45 days after last report)
- Change in treatment plan
- Released from care
- Change in work status
- Need for referral or consultation
- Response to request for information
- Change in patient's condition
- Need for surgery or hospitalization
- Request for authorization
- Other
- Last name
- First name
- Middle Initial
- Sex
- Address
- City, State, & Zip Code
- Occupation
- Social Security Number
- Phone number
- Name of the claims administrator
- Claim number
- Claims administrator address
- Claims phone number
- Claims fax number
- Employer name
- Employer phone number
The forth section is where the PTP relays what the injured worker's subjective complaints are relating to their experience of their claimed injury(ies). Comments may include the frequency and intensity of any pain, numbness, or other physical symptoms. This section may also include when and how these symptoms are increased or decreased such as with certain physical activities. In addition, the clinician may describe what limitations as a result of their injury(ies) the injured worker has relayed to them. The claims investigator can take the representations that the injured worker makes here and compare them with what the injured worker states in an interview with the investigator or perhaps what is depicted in surveillance video of the injured worker.
The fifth section is where the PTP includes any significant findings via their examination or review of records which are objective in nature. Things such as tenderness, loss of strength, loss of range of motion, x-ray findings, other diagnostic testing findings (i.e. MRI, CT Scan, EMG/NCV, etc..).
The sixth section is were the PTP provides their diagnoses with associated ICD-9 coding. This is a section where the investigator may ascertain or confirm the claims injuries and/or body parts/systems claimed injured by the claimant.
The seventh section is the treatment plan section. In this section, the PTP is to describe the medical treatment rendered to date, any current treatment, and any recommended future treatment. The treatment plan should be described by the PTP listing the method, frequency and duration of the treatment. The PTP should state the names of any contributing secondary treating physicians or the names of recommended consultations. If there is any change in a previously prescribed treatment plan, the PTP must also describe the change and the reason for the change. In this section, the investigator, may gain clues and leads for additional investigation for medical records at other facilities that may be obtained by the claims administrator or worker's compensation defense attorney. In addition, this naming of other facilities may also serve the surveillance investigator in obtaining additional locations where surveillance may be undertaken.
The eighth section is the work status or disability section.
This section will indicate the injured worker's current disability status. If the box "Remain off-work until ____" is checked than the injured worker is Temporarily Totally Disabled (TTD) and unable to work within the open labor market. If the box is checked "Return to modified work on ________ with the following limitations or restrictions" the injured worker is Temporarily Partially Disabled (TPD). This means they may return to some form of work within the prescribed work restrictions or limitations. When conducting an interview of the injured worker, the investigator can determine if the injured worker is aware of their temporary work restrictions and question them on their compliance with the work restrictions prescribed by their PTP. For the surveillance investigator, they may comment upon the injured worker's compliance with the work restrictions and to their physical observance of the them during discreet surveillance. If the box is checked "Return to full duty on __________ with no limitations or restrictions" the injured worker is released to return to full duty work without limitations or restrictions.
The final or ninth section of the PR-2 is states the name and demographics of the PTP, their signature, and includes the mandated fraud declaration language pursuant to California Labor Code Section 139.3. The demographics of the physician include the following:
- California License Number
- Place signature executed at
- Date of signature
- Name of physician
- Address of the physician's practice
- Phone number of the physician's practice
- Medical specialty of the physician
The PR-2 or PTP narrative progress report is another valuable resource for a claims investigator to utilize in the process of their investigation.
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