The C-4.3 form controls your permanency award. One form. Enormous consequences.

Your doctor files one form at the end. Make sure it is right.

The C-4.3 is the Workers’ Compensation Board’s permanency medical report form. Your authorized treating doctor completes it at maximum medical improvement (MMI) — the point at which further treatment is unlikely to improve your condition. The form asks the doctor to state the affected body part, the diagnosis, and most critically, the schedule loss of use percentage — the fraction of normal function that has been permanently lost due to the work injury.

The SLU percentage on the C-4.3 is then multiplied against the statutory week value for that body part under § 15(3) of the WC Law — for example, 312 weeks for the arm, 288 weeks for the leg, 160 weeks for the knee, 205 weeks for the foot, 244 weeks for the hand — and multiplied again by your established weekly benefit rate. A one-percentage-point change in the SLU rating on a leg case at $800 per week is worth $2,304. Accuracy is not academic.

The insurance carrier sends their own doctor — the IME physician — to file a competing permanency report after your C-4.3 is submitted. The carrier’s IME doctor almost always rates lower. The Workers’ Compensation Law Judge weighs both reports and sets the final SLU percentage. Factors that strengthen your doctor’s C-4.3 include objective imaging (MRI, X-ray), range-of-motion measurements taken by a physical therapist, and a functional capacity evaluation (FCE) that documents what you can and cannot do.