DWC-25 Form

What the form carries

The DWC-25 is short, and each entry has direct financial consequences:

• Work status — no work, restricted work, or full duty. This determines whether you receive temporary total disability, temporary partial disability, or nothing.
• Specific restrictions — lifting limits, positional and postural limits, hours. These determine whether a light duty offer is suitable employment you must accept.
• Maximum medical improvement — whether you have reached it, and on what date. Checking this box ends temporary benefits.
• Impairment rating — the percentage that converts into weeks of impairment income benefits.
• Treatment plan and referrals — the care you’re requesting from the carrier.

A fifteen minute appointment can produce a document that changes your weekly income.

The reporting deadlines

Section 440.13(4)(a) sets a strict sequence, and it has teeth: a claim for medical or surgical treatment is not valid or enforceable unless the physician meets it.

• Third business day following the first treatment — the physician must furnish a preliminary notice of the injury and treatment.
• Within 15 days after that — a complete report.
• Progress reports thereafter — if requested, at intervals of not less than three weeks.

Restrictions should also be actively reviewed. Section 440.13(14)(b) requires the provider to reassess restrictions and limitations at each patient exam and upon receiving new information, with consideration given to upgrading or removing them based on objective findings.

You are entitled to a copy.

Under § 440.13(4)(b), the health care provider must furnish you or your attorney a copy of the office chart, records, and reports on demand. The provider may charge no more than 50 cents per page for copying.

Ask at every visit. Injured workers routinely learn their own work status from their employer, or from a change in their benefit check, rather than from the doctor who decided it.

The privilege waiver

This part surprises people, and it is worth knowing.

By reporting a work related injury, you waive physician patient privilege as to any condition or complaint reasonably related to what you are claiming compensation for. The employer, the carrier, an authorized qualified rehabilitation provider, or their attorneys may obtain your relevant medical records and discuss your medical condition with your doctor directly, provided the discussion is restricted to conditions relating to the workplace injury.

Release of that information does not require your authorization. The discussion may happen before or after a petition is filed, without your knowledge, consent, or presence, and without your attorney there.

This is why what appears on the DWC-25 matters so much, and why it should reflect the conversation you actually had.

Where the DWC-25 goes wrong

• Restrictions that don’t match the appointment. Extremely common. The form is often completed after you leave, from brief notes.
• Vague entries. “Light duty” with no pounds, hours, or prohibited movements is unenforceable when your employer tests it.
• MMI checked without discussion. Workers frequently discover they were placed at MMI weeks earlier, when the checks change.
• An impairment rating that omits a body part. Multi site injuries are often rated for the primary injury only.
• Stale restrictions carried forward. The same limits copied visit after visit despite the statutory duty to reassess at each exam.
• You never see it. The most common failure of all.

What this means for your claim

Ask for the DWC-25 before you leave every appointment, and read it there.

Check three things: does the work status match what the doctor told you, are the restrictions specific enough to be enforceable, and are all your injured body parts addressed? If something is wrong, say so while you are still in the office — corrections made at the visit are simple, and corrections attempted months later look like disputes.

Keep every copy. In a contested claim, the sequence of DWC-25 forms is the spine of the medical record a judge will read.