How to Get Work Restrictions from Your Doctor After a Job-Related Injury or Illness
Learn How Risk, Capacity, and Tolerance Affect the Types of Work Restrictions Your Physician Provides
Whether you have work restrictions affects you and your employer’s rights and responsibilities under the Occupational Safety and Health Act (OSHA), Family and Medical Leave Act (FMLA), unemployment, Social Security disability, and workers’ compensation laws.
Work restrictions come from physicians, whom government agencies, insurers, employers, claimants, and attorneys ask to complete papers describing what their patients can do at work but should not. These work status reports certifying your abilities and restrictions and how judges, attorneys, and parties interpret them may determine your eligibility for benefits or how much you receive through a workers’ compensation settlement.
But, as you will see in this article, providing work restrictions is more art than science.
Further, the American Medical Association (AMA), insurers, and employers encourage physicians to keep patients at work or release them to light-duty work as soon as practicable. This philosophy may force you to return to work before you are ready or accept a lower lump sum because your permanent restrictions are less limiting than you feel they should be.
Fortunately, a skilled work injury lawyer can help you handle return-to-work issues and discussions with your physicians, so an early release to return to employment before you are ready does not delay your physical, mental, or financial recovery.
Continue reading to learn more about work restrictions and physician decisions on work abilities and limitations.
And call my firm at (804) 251-1620 or complete this form if you have worker compensation questions. We help injured employees throughout the Commonwealth of Virginia and want to see you get every medical treatment and penny you deserve.
What are Work Restrictions?
A medical restriction is a communication from any company or treating physician stating your current environmental, mental, and physical limitations and capabilities because of your work-related injury or occupational disease.
Your work restriction letter can come from any medical provider treating you for a workplace injury or occupational illness, including your orthopedic surgeon, pain management doctor, neurologist, psychiatrist, psychologist, cardiologist, pulmonary specialist, or chiropractor.
Are Work Restrictions Temporary or Permanent?
Medical work restrictions can be permanent or temporary.
Physicians start with temporary restrictions on work, except when a work-related head injury causes traumatic brain injury (TBI) or coma or a spinal cord injury results in paralysis.
In most cases, the doctor continues to ease the work restrictions, permitting you to do more until you reach maximum medical improvement (MMI). Then, when you reach MMI, your doctor will issue permanent work restrictions or refer you to a functional capacity evaluation (FCE) to help decide any permanent limitations or impairment rating (an exam you need to obtain permanent partial disability benefits).
Why Do Work Restrictions Matter in Workers’ Compensation Cases?
You must have written work restrictions from a treating physician to prove your entitlement to wage loss benefits (temporary total disability, temporary partial disability, or permanent and total disability payments) or keep them under a workers’ compensation award order.
Countless court holdings state that as the injured employee seeking benefits, you bear the burden of proving disability and the periods of your disability.
Further, the law does not presume you will remain disabled indefinitely once you prove disability. You must, therefore, ask your treating physician for a letter addressing your work status at each office visit. Otherwise, you risk losing cash payments that can keep you and your family financially afloat while you recover.
Do My Medical Work Restrictions Have to be in Writing?
Yes.
You must get your treating doctors to put your work restrictions from the occupational injury in writing to give yourself the best chance of winning benefits at a workers’ compensation hearing.
The format of your written “off-work” slip does not matter. Your doctor can put the restrictions in an office visit note or a separate letter, email, text message, form, or questionnaire response.
Oral communication – such as the doctor or their staff saying you cannot do your regular job during a clinical examination or phone call – is not good enough for several reasons.
First, the insurance claim adjuster will not offer an agreement form unless you have written restrictions. I know this based on handling thousands of claims.
Second, you will not be allowed to testify about what the doctor told you about restrictions if your workplace injury case goes to trial. This type of testimony – saying what someone else told you – is hearsay evidence and is usually not admissible in court.
Your attorney, however, can ask questions about your understanding of your restrictions at the hearing. But the judge may not give weight to testimony on this issue unless you have papers from your doctor supporting your testimony.
Is It Difficult to Get Accurate Work Restrictions from Your Doctor?
It can be.
Many doctors hesitate to give their patients work restriction notes.
There are three reasons for this.
First, most physicians have not received training in assessing a patient’s ability to work after an industrial accident or car crash. This lack of training leaves doctors feeling unqualified to discuss specific work restrictions.
Second, some physicians want to avoid taking part in litigation at all costs. They fear depositions and court testimony. Instead, they want to focus on diagnosis and treatment.
I get this. But a hands-off or avoidance approach to work status can harm a patient. Refusing to provide medical work restrictions to a patient increases the risk of the Workers’ Compensation Commission denying wage loss benefits or the insurer refusing to authorize ongoing treatment for the work-related injury. Both scenarios cause stress and impede healing.
Third, the physician might not be familiar with the workers’ comp claims process or understand an injured employee’s responsibility under the law.
I see this frequently happen in psychiatric (PTSD, depression, etc.) and occupational disease claims (heart disease, lung disease, Legionnaires, etc.).
The physicians who focus on these illnesses do not treat as many workers’ comp patients as orthopedic surgeons, neuropsychologists, or pain management specialists. This lack of familiarity means your doctor may not understand the importance of writing work restriction letters for your claim.
How Do I Get Work Restrictions?
Your doctor has two goals.
First, to diagnose your injury.
Second, to treat your injury so that you have the best possible outcome and recovery.
Re-injury or too much stress on the injured body part too soon impedes recovery.
Remind your doctor of this. Then ask your physician for proper work restrictions after providing a written job description for the position where you suffered an injury and explaining all the tasks you performed pre-injury.
Ask your doctor or nurse practitioner for a written letter describing your work restrictions at each appointment. Make two copies: one for your employer and one for your attorney.
In the next section, I will explain the factors your doctor may consider when deciding whether to give work restrictions.
Use this knowledge to explain to the doctor why you hesitate to return to work.
What Do Doctors Consider When Determining Your Work Status?
The AMA published a book titled A Physician’s Guide to Return to Work that recommends physicians think about three concepts when asked about a patient’s work ability: risk, capacity, and tolerance.
Your doctor may not follow this guidance. But knowing that your physician may have read this publication can help you discuss return-to-work issues during medical appointments.
Let’s look at each term.
Risk
Risk means the chance that you will suffer re-injury or some other harm if you perform a specific work activity.
Capacity
Capacity means your ability to perform specific strength, flexibility, or endurance activities.
Your capacity may change during your recovery, for better or worse. For example, an occupational injury that requires surgery may lead to deconditioning and reduced ability.
Tolerance
Tolerance is how long you can sustain a work activity at a certain level.
Examples of Work Restrictions
When assessing your ability to return to work, your doctors should evaluate your ability to handle physical and mental tasks and environmental settings.
Let’s take a look at these three categories of work restrictions.
Common Physical Work Restrictions
Depending on the type of injury you suffered, ask your doctor to address your work restrictions for:
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- The amount of weight you can lift or carry frequently and occasionally throughout the work day.
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- The number of hours you can sit during an eight-hour shift (i.e., whether you can do sedentary work)
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- The number of hours or minutes you can sit at once before taking a break.
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- The number of hours you can walk or stand in an eight-hour work day.
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- The number of hours or minutes you can walk or stand at one time before taking a break.
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- How far you can walk without stopping.
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- Whether you should use an assistive device like a cane, crutch, walker, or wheelchair during all or part of your shift
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- Whether you will need to lie down during the day and, if so, how often.
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- How often you can reach above your shoulders with one or both arms (overhead reaching) during a shift
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- How often you can reach down to waist level with one or both arms during a shift
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- Whether you can handle objects and, if so, how often (gross manipulation).
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- Whether you can use your fingers to handle smaller objects and, if so, how often (fine manipulation).
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- If you will have difficulty with postural activities such as bending, squatting, and kneeling and, if so, how often you should do each
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- Whether you will need frequent breaks if you cannot move your head from side to side or up and down at a desk because of an injury to your neck or post-concussion syndrome
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- Whether there are any limitations on your driving ability and, if so, what those are. For example, a hurt truck driver with a torn rotator cuff or back injury may be able to operate a regular car but not an 18-wheeler, preventing them from returning to their pre-injury job.
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- Whether you need to elevate your legs to reduce swelling from complex regional pain syndrome (CRPS) or an ankle or foot injury
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- Whether you can protect yourself physically if your job exposes you to workplace violence and volatile patients (a common scenario for nurses, police officers, firefighters, teachers, daycare employees, corrections officers, and security guards)
Common Mental Work Restrictions
If you experience chronic pain from an occupational injury or have developed a mental health condition because of a work-related incident, ask your doctor to address any work restrictions involving the following:
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- Medication side effects
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- Your ability to remember different locations and work-like procedures
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- Your ability to understand and remember short and simple instructions
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- Your ability to understand and remember detailed instructions
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- Your ability to maintain attention and concentration for extended periods
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- Your ability to keep regular attendance and show up to work on time (for example, you may require part-time employment due to your symptoms)
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- Your ability to perform your work without special supervision
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- Your ability to work with or close to others without being distracted
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- Your ability to make simple work-related decisions
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- Your ability to complete a typical work day or work week without interruptions
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- Your ability to interact with members of the general public
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- Your ability to accept criticism from supervisors
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- Your ability to get along with coworkers and supervisors
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- Your ability to manage everyday work stress
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- The number of days you would need to miss each month because of your work-related psychiatric injury
Common Environmental Work Restrictions
Those of you who suffer from work-related CRPS, heart disease, or pulmonary conditions should ask your doctor to address work restrictions related to your physical surroundings, including the following:
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- Your ability to work in extreme temperatures.
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- Your ability to work in plants and factories that expose you to strong smells, gases, or dust
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- Your ability to work near loud noises or bright lights
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- Your ability to operate heavy and moving machinery like forklifts, cranes, or other equipment found on construction sites
Other Types of Work Restrictions
In addition to the physical, mental, and environmental restrictions described above, you should also ask your doctor to address the number of hours you can work each day and the number of days you can work per week.
This information is vital in determining whether you must accept a light-duty job offer if the employer makes one and whether you must look for light-duty work (market your residual functional capacity) to receive workers’ comp payments.
Were You Hurt at Work?
Call 804-251-1620 if you have concerns about returning to the job after an injury and want to know how to discuss work restrictions with your doctor. My law firm has helped thousands of injured employees navigate conflicts and disputes over work ability and resolve their claims successfully.
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