Activity Prescription Form (APF) Common Mistakes

Some common mistakes on Washington State Labor and Industries activity prescription forms that may result in interruption of benefits.

Atlas Law PS

12/13/20241 min read

Activity prescription form (APF) common mistakes:

If your ability to work has been impacted and you are receiving wage replacement benefits such as time loss compensation (TLC) or loss of earning power benefits (LEP) from Washington State Department of Labor and Industries, you must visit your attending provider regularly and have that provider fill out and submit an activity prescription form after those visits. If activity prescription forms are not filled out properly and submitted regularly, there may be an interruption in your benefits.

You can find a copy of the form here:

https://lni.wa.gov/forms-publications/f242-385-000.pdf

Common APF related mistakes include:

  • Not submitting APF forms on a regular basis. While receiving wage replacement benefits, it is important to have an attending medical provider (AP) and to see this AP regularly. At these visits the provider will examine you, discuss your condition, and fill out an activity prescription form which they will then submit to the Department or self- insured employer (SIE). Every 30 days is best.

  • Not including restrictions: The medical provider must indicate what your work restrictions are. These restrictions must be related to the accepted conditions resulting from your industrial injury or occupational disease.

  • Not including objective medical findings to support restrictions: The medical provider must base your work restrictions on objective medical findings. Objective medical findings are findings that can be seen, felt, measured or reproduced. Pain is not an objective medical finding. Examples of objective medical findings include, but are not limited to, imaging studies, blood tests, and atrophy.

  • Not including dates: The APF requires the provider to indicate the date range the provider anticipates your work -related limitations will last. Providers will typically have the date range start from the date of the office/virtual visit where the APF is being filled out through to the date of the next appointment, which should be approximately 30 days later.

If you or someone you love has been injured at work or has questions about activity prescription forms, contact us here at Atlas Law and let us take the weight off your shoulders!