If you are the first doctor to diagnose a worker for an occupational injury or disease, you are responsible for reporting the claim to the self-insured employer. To initiate the claim for your patient fill out and send the Physicians Initial Report (PIR).

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

(1) 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

(2) 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.

(3) Submitted promptly with copies of the:

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