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Completing the PIR

To speed up the claim process, make sure the PIR is:

Filled out completely, leaving areas blank may delay processing of the claim and your bills. If the condition is a disease, enter “N/A” for “not applicable” in both of the following boxes:

  • Date of injury
  • Time of injury

As specific as possible.

  • Include a complete diagnosis and appropriate Common Diagnostic Codes (ICD-9 codes). Clarify a specific body site and the definition of the injury.
  • If your patient is unable to perform any work due to the injury or disease, estimate how much time the injured worker will lose due to the injury.
  • Signed by both you and your patient.

Submitted promptly with copies of the:

  • History and physical
  • Emergency room evaluation or your office notes

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