Work comp: Form -- Report of Work Ability

The Report of Work Ability (RWA) form is filed by the employee’s primary health care provider to provide the employee, employer, insurer, qualified rehabilitation consultant or commissioner with information about the employee's work restrictions. This form is also used to advise the employee of functional restrictions that may affect daily activities and to assist the employer in bringing the employee back to a job at work that is within the employee's physical restrictions.

The primary health care provider may also respond in a narrative report that contains the same information as the RWA form.

The primary health care provider must complete this form:

• within 10 days of a request by an insurer or every visit, if visits are less frequent than once every two weeks;

• every two weeks if visits are more frequent than once every two weeks, unless work restrictions change sooner; and

• upon expiration of the ending or review date of the restriction specified in previous reports of work ability.

The primary health care provider can give the form to the employee at the office visit. The employee sends the form to the employer or insurer and the qualified rehabilitation consultant, if one has been assigned to the case.

For more information, see:

• Minnesota Statutes 176.231, subd. 3, 5 and 6, 7;

• Minnesota Statutes 176.251; and

• Minnesota Rules 5221.0410, subp. 6.