Workers Comp Medical Records OCR: Forms, IMEs, Reviews

To OCR workers comp medical records, sort the claim's medical file into three kinds of page before you convert: short state forms and work status slips, long examiner reports, and treatment review decisions. Each kind converts differently. Run recognition on each group, then search the text for restrictions, ratings and causation opinions, checking each against its page.

This post covers the documents that make a comp medical file unlike any other. For the ordinary chart notes, hospital records and imaging reports in the same claim, the general post on medical records sets out a method for converting a records set, and nothing in it changes for comp.

The examples use an invented claim. Tomasz Brandt, a warehouse worker for Kestrel Freight, hurt his right shoulder lifting a pallet.

Work status slips and the examiner report are the pages to search for restrictions and for any workplace safety note about how the injury happened. Also look through the early treatment notes for emergency medical treatment on the day of the injury. Those pages are exhibits at the workers compensation hearing. Confirm the exam date, the body part, and the restriction dates on the image before the binder is assembled.

What medical records does a workers' compensation claim collect?

A workers' compensation claim collects the usual treatment records plus a layer of paper that exists only because the claim does: first reports of injury by a doctor, periodic progress forms, work status slips, examiner reports ordered by a party or the agency, and decisions approving or refusing requested treatment.

The names differ from state to state, and so do the forms. The categories are steadier.

To see how concrete the form layer is, look at one state's list. California's Division of Workers' Compensation publishes its forms on one page, including the doctor's first report of occupational injury or illness (Form 5021), the primary treating physician's progress report (DWC PR-2), the primary treating physician's permanent and stationary report (DWC PR-4) and the request for authorization for medical treatment. Texas lists a Work Status Report (DWC073) and a Report of Medical Evaluation (DWC069) on its numeric index of workers' compensation forms. Find the equivalent list for your own state and keep it open while you sort, because the form number printed in a page corner is the fastest way to identify a page.

Wage statements and benefit payment printouts travel with the medical file but are a different job. They are tables of money, covered in the post on getting workers' compensation records into a spreadsheet.

How is a comp medical file different from a personal injury one?

A comp medical file differs from a personal injury one in three ways that affect conversion: it is full of repeating forms, the same report reaches you from several senders, and the pages that decide the claim are single lines on those forms. A personal injury file is mostly narrative chart notes read for the story of treatment.

Forms repeat on a schedule. A treating doctor in a comp claim files a form after the first visit and again at intervals until the worker is released. Eighteen months of treatment can mean twenty copies of one form, each differing from the last in a date, a few boxes and two lines of restrictions. A chronology built from a personal injury chart looks for what happened at each visit. In comp you are more often comparing one field across twenty forms.

Copies arrive from every direction. The doctor sends a report to the carrier, the carrier serves it on the parties, the opposing lawyer attaches it to a filing, and the agency's file holds it as well. Expect to receive the same progress report four times, with different fax headers and different stamps. Convert the cleanest copy and record the others as duplicates.

The decisive content is small. Whether the worker can lift more than ten pounds, the date a doctor found the condition had stopped improving, a percentage of impairment, a sentence on whether work caused the condition: each is a few characters or one checked box. Recognition that gets 99 words in 100 right can still miss the one that matters.

Reports are cited by doctor and date. With twenty versions of one form in the file, a citation only identifies a report if it names the doctor and the date. Your index needs those two fields for every document, which the form layout makes easy to capture once the text is searchable.

These differences change the plan. In a personal injury file you split by provider. In a comp file, split by document type first, and then by doctor within each type.

Converting work status reports and state board medical forms

Convert work status reports and board forms in batches of the same form, export them as searchable PDFs for the file, and then read the boxes and blanks from the image. Printed labels convert well. Check marks, circled answers and handwritten entries are where recognition is least dependable.

A work status slip is a hard page for software for reasons that have little to do with print quality.

• The answer is a mark, not a word. An X in a box beside "may return with restrictions" has to be detected and tied to the right label.
• The boxes are close together. A mark that drifts slightly can be assigned to the neighboring option.
• Restrictions are often handwritten into a two-line blank: "no lifting over 10 lbs R arm, no overhead work".
• The form may have been faxed, sometimes more than once.

The post on medical records for attorneys deals with handwritten chart notes and provider signatures, and its advice applies to the handwritten blanks on these forms: read them yourself and never quote recognized handwriting unchecked. Field-by-field form conversion is the subject of the post on OCR for scanned forms.

A work status table built by hand from converted forms

Because the same form repeats, the most useful product is a table with one row per form. Use the searchable text to find each form and its date. Fill the status columns from the image.

Read down the third column and the claim's shape appears: two weeks off, seven weeks of restricted duty, then off again. Those periods are what the benefit payments should track.

A procedure for a stack of forms:

1. Gather every copy of the form from the claim file into one working PDF, in date order, dropping exact duplicates.
2. Upload it. Schema Law reads PDF, PNG or JPEG files up to 20 MB, and the how it works section of the homepage shows the three steps.
3. Search the converted text for the form's title or number to confirm that every page was picked up.
4. Search for the date label, such as "Date of Exam" or "Date of Visit", and step through the hits, entering one row each.
5. Open each page image and fill in the status box and restrictions by eye.
6. Flag any form where a box is ambiguous, two boxes are marked, or the restrictions cannot be read. Ask the doctor's office to clarify those.

Independent medical examination reports as long typed documents

Independent medical examination reports are long typed narratives, and they are the easiest documents in a comp file to convert accurately. They are also the ones you will quote most. Convert each report as its own document, export Word for quoting and a searchable PDF for the file, and map its sections before you read.

The examiner goes by different names: independent medical examiner, qualified or agreed medical evaluator, designated doctor, impartial physician. Check your state's term. Whatever the title, the report tends to follow a predictable outline, which makes it easy to navigate once it has text.

Using the records-reviewed list

The list of records reviewed deserves separate attention. It is the examiner's own index of the medical file. Paste it from the converted report into a spreadsheet and compare it with your index of what you hold. A record the examiner lists that you do not have is a record to request. A record you hold that the examiner never saw may be a point to raise about the opinion.

In the Brandt claim, the examiner's list runs to 62 entries and omits the MRI report of 3 June, which Kestrel Freight's carrier received a week after the records were sent to the examiner. That gap took minutes to find by comparing two lists and would have been easy to miss in a read-through.

Measurement tables

Range of motion and strength figures are often set out in a small table with columns for right and left, and sometimes for normal values. Small tables in a typed report can come out as a run of numbers with the columns lost. If the figures matter, check the table against the page and retype it if needed. A swapped left and right column on a shoulder claim is the kind of error that survives several readings.

Supplemental reports

Examiners are often asked follow-up questions and answer in a short supplemental report. Convert each and file it beside the original, named with the examiner and date. A search for the examiner's surname across the whole file should then return the full run of that doctor's opinions in date order.

Utilization review decisions and treatment request forms

A treatment dispute leaves a paper pair: the doctor's request form and the reviewer's written decision. Convert them together and file them as a pair, because neither makes sense alone. The request is a short form with codes. The decision is a typed letter with a determination, reasons and deadlines.

Procedures and names vary by state. California's is a well-documented example. Its Division of Workers' Compensation explains in its utilization review questions and answers that a treatment request is made on the DWC Form RFA, that decisions to modify or deny a request may only be made by physicians, and that a written decision modifying or denying treatment must include, among other things, the date the request was first received, the date of the decision, a description of the treatment requested and a clear explanation of the reasons for the decision. Look up the corresponding rules where your claim is pending before you rely on any of that.

Those required contents are also a guide to what to pull from each converted decision.

Pairing requests with decisions

1. Convert every request form and every decision letter.
2. Build a table with one row per requested item, not per document. A single request for an MRI, an injection and twelve therapy visits is three rows.
3. Enter the request date from the form and the received and decision dates from the letter.
4. Enter the outcome for each item.
5. Sort by request date and look for requests with no decision and decisions with no request in your file.

Request forms are frequently handwritten or filled in by hand over a typed template, and the diagnosis and procedure codes on them are short strings with no context. Read codes from the image. The decision letter usually restates the request in type, which gives you a second source to check the first against.

A reviewer's letter often quotes long passages from a treatment guideline. Those passages make search results noisy, since a search for "shoulder" will hit guideline text that has nothing to do with this worker. Searching for the worker's surname, the treating doctor's name or the claim number alongside the term brings you to the case-specific paragraphs.

Which searches find restrictions, ratings and causation opinions?

Search for the words doctors use on each topic, in several forms, and then read every hit against its page. Restrictions hide behind "lbs" and "duty". Ratings sit beside a percent sign. Causation opinions cluster around a few stock phrases. No single term finds all of one kind.

Some habits make these searches more reliable.

• Search fragments. "restrict" finds restricted, restriction and restrictions. "aggravat" finds aggravated and aggravation.
• Search symbols and units. A percent sign or "lbs" finds figures however the sentence around them is worded.
• Search both spellings of anything hyphenated. "pre-existing" and "preexisting" are different strings.
• Expect misses on forms. A restriction written by hand into a blank will not be found by search at all. Your hand-built work status table covers that gap.
• Watch for negation. "No evidence of a work-related cause" and "evidence of a work-related cause" both match a search for "work-related". Read the whole sentence on the image.

When a rating is the point, record more than the number. Note the body part, the edition of the rating guide or schedule the doctor says was used, the date of the opinion and the page. Two ratings in one file often differ because the doctors rated different things or used different methods, and the converted text lets you put the two passages side by side.

A last word on handling. These are medical records, and whether they may be uploaded to any online service depends on your own professional duties, the terms on which you received them and the rules of your jurisdiction. Schema Law makes no compliance claim about health records. What it does state is in the commitments on its homepage, which you can weigh against your requirements before a single page leaves the office.