Insurer Activity Prescription Form


Insurer Activity Prescription Form

About the Activity Prescription Form

L&I considers the effective use of the Activity Prescription Form (APF) as a best practice in occupational medicine. The form communicates an injured worker's physical restrictions and ability to work as well as the provider's treatment plans. In addition, workers' time-loss benefits depend on the APF and your chart notes.

Voc counselors can request an APF and other information

In addition to claim managers sometimes asking the attending provider for a new form, private vocational rehabilitation counselors are authorized to ask you to complete a new APF:

  • If they need clarification or updated information on physical capacities, or
  • If the worker's condition has changed.

If you recently submitted an APF and nothing has changed, ask the vocational provider to check the Claim & Account Center or to contact the insurer.

If you complete a new APF for a vocational provider, be sure to submit the form to L&I to ensure that you get paid for completing it.

Vocational providers may also request your review and response to:

  • Job modifications or pre-job accommodations.
  • Proposed work-hardening program.
  • Plan for graduated, transitional, return-to-work.

What employers can ask

State Fund employers can contact the attending provider to clarify physical capacities related to returning to work. However, employers can't ask a provider to complete an APF. (L&I does not pay for APFs completed at the request of employers or attorneys.)

State Fund employers can also ask providers for:

  • Concurrence with a performance-based physical capacities evaluation (PBPCE).
  • Authorization for a worker to participate in a PBPCE.

You can remind employers to review the completed APFs that are a part of the worker's claim file in the Claim & Account Center.Secure


Call the Provider Hotline 1-800-848-0811 with your questions about the APF.

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