|
< Date >
< Doctor's Name >
< Doctor's Address >
Dear Dr. < Surname >,
| Re: |
Request for an Opinion
Regarding a Delayed NEL
< Your Name > |
| WSIB Claim No.: |
< Your Claim Number
> |
I have some concerns about the Workplace Safety
and Insurance Board's (WSIB) decision to delay the assessment of
permanent impairment resulting from my workplace injury. This assessment
is necessary for the payment of a Non-Economic Loss (NEL) award.
NEL awards are meant to compensate for any permanent physical or
functional loss resulting from a workplace injury. A worker is eligible
for an award when he or she has reached maximum medical recovery
(MMR).
I am writing to ask your opinion on whether
I have reached maximum medical recovery. MMR is the point at which
a worker has recovered as much as possible from his/her workplace
injury or disease and is not likely to improve substantially even
with additional treatment.
If it is your opinion that I have not yet reached
maximum medical recovery, would you please inform me. No report
is required or necessary.
If, however, in your opinion my condition is
not likely to improve substantially, please send a report to the
WSIB Adjudicator handling this claim. Your report to WSIB should
include the following:
- My name and claim number, and the date of
your examination;
- State that I have reached MMR and have a
residual impairment;
- Provide reasons why you feel I have recovered
as much as possible from the injury; and
- Specify why you believe further treatment
would not improve my injury or disease.
I will follow-up with WSIB.
If you intend to charge a fee for your
report to WSIB, please discuss this with me prior to preparing any
report. You may bill WSIB for the cost of preparing the report.
WSIB has a fee schedule and may reimburse you. WSIB pays for helpful
medical reports that assist in the decision-making process.
If you need additional information, please
feel free to contact me. Thank you for your consideration of this
request. I look forward to your reply.
Yours truly,
< Sign Your Name Here >
< Type/Print Your Name >
< 123 Your Street >
< Your City, Ontario >
< X0X 0X0 >
|
