Proposed
COP RTW Case Worksheet
lTriage Code 1 – Catastrophic – Obtain info, notify SN immediately, close
case
lTriage Code 2 – Emergency Hospitalization – Obtain info, notify SN
immediately, close case
lTriage Code 3 – Surgery Imminent – Obtain info, close case
lTriage Code 4 – Claimant Not Cooperative – Document
non-cooperation, close case
lTriage Code 5 – No Return to Work – Obtain info, close case after 30 day
intervention
lTriage Code 6 – Return to Work Part-Time – Obtain info, close case after
30 day intervention
lTriage Code 7 – Return to Work Full-Time LD – Obtain info, close case
after 30 day intervention