Disability Forms

Please do not request any of our pain physicians to fill any “Disability Forms”. We do not do disability determinations, work restrictions, return to work determinations, disability ratings, impairment ratings, or continuing disability reports, assessments, determinations, or forms. If any of the above is needed, we can refer you to a physical or occupational therapist for a Functional Capacity Evaluation, with possible impairment ratings. Insurance disability forms will need to be completed by your primary care physician’s staff. If such paperwork has to be filled by us, there will be an additional charge prior to the form being filled. Please allow two (2) weeks for completion. No “rush” requests will be done.

• North Carolina Workers Compensation Disability Guide
• Social Security Disability

Impairment Evaluations

We prefer not to do impairment evaluations in our own patients. Therefore, for an independent impairment rating evaluations, we recommend that you contact:

· H.C. Hansen, MD - The Pain Relief Centers, PA - Street: 37 13^th Avenue NE • Hickory, NC 28601 • (828) 261-0467 • Mailing: PO Box 5939 • Statesville, NC 28687 • (704) 871-0222 or 3451 Graystone Place
Conover, NC 28613 (P)828-261-0467 • Website: http://www.painphysician.com/frmain.htm

· Gerald M. Aronoff, MD, DABPM, DABPN - Carolina Pain Associates - 1900 Randolph Road, Suite 606 Charlotte, North Carolina 28207 • Phone: 704-347-5110 • Fax: 704-347-5025 • e-mail: geraldaronoffmd@msn.com • Website: http://www.painexpert.com/

If an impairment rating is desired, the patient is referred to a physical therapist for a “Functional Capacity Evaluation”. Using the results of this evaluation, along with “The AMA Guides to the Evaluation of Permanent Impairment”, published by the American Medical Association, an impairment rating is determined. This processed is billed directly to the patient and it is not covered by most medical insurances. Contact your physician for specific fees.