Medical Evidence in Workers' Compensation Claims

Workers’ compensation provides medical care and financial support for employees injured on the job or who become ill due to their job. But you can’t just ask for workers’ compensation benefits. You have to prove your case through the workers’ compensation system.

Having strong medical evidence is an integral part of the claims process. Medical records show the connection between your injuries and your claim. These records help determine fair compensation. You can face delays, reduced benefits, and even denials without solid medical evidence. A workers’ compensation attorney can perform a case evaluation and identify the evidence you need for a successful claim.

Workers’ Compensation

Workers’ compensation is employer-paid insurance coverage for employees who incur work-related injuries or illnesses. It pays medical bills and lost wages. Workers’ comp is no-fault insurance. You give up your right to sue your employer in exchange for speedy reimbursement for workplace injuries. Employers benefit because it protects them from most employee lawsuits for injuries and occupational illnesses.

The Role of Medical Evidence in Workers’ Compensation Claims

Medical evidence in workers’ compensation cases refers to healthcare professionals’ documentation and expert opinions supporting an injured worker’s claim.

Medical evaluations and medical documentation are the cornerstones of workers’ compensation claims. They are important for several reasons.

First, medical records show that your injury or illness is directly related to your job. You have to establish causation to get benefits. Second, medical documentation demonstrates the extent of the injury. The severity of the injury determines your compensation and how long you will get workers’ compensation benefits.

Examples of Medical Evidence

Medical evidence can take many forms, including:

• Doctor’s notes
• Doctor’s diagnosis and treatment plan (your doctor’s plan to treat the injury, which may include medications, physical therapy, or surgery)
• Hospital records
• Specialist reports (reports from specialized doctors, such as orthopedists or neurologists)
• Diagnostic test results (results that provide objective data about your injury, including scans such as X-rays, MRIs, or blood work)

Your employer or the insurance company may also request an independent medical examination (IME). IMEs are typically requested to verify the injury’s extent and the claim’s legitimacy. An alternate healthcare provider handles the IME—your treating physician does not conduct it.

This evidence helps to build a strong case for receiving workers’ compensation benefits.

How To Gather Medical Evidence

Gathering medical evidence is an essential step in building a strong case. Collecting medical evidence begins with seeking medical attention as soon as possible.

After your treatment starts, get copies of your medical reports and make a list of your treating sources.Some legal experts recommend getting business cards from your healthcare providers during the first visit. You can then use the cards as a reminder when creating your list.

Then, send your medical providers a written request asking for your records. This letter should be signed and dated. It should state your name and phone number, the name of your health care provider, and where your records should be sent. Large medical facilities generally require medical record requests and releases to be sent to the medical records department. Your authorization to release your records is good for one year.

Be prepared to follow up for records you haven’t received in a couple of weeks. Sometimes, you can request medical records using your medical professional’s online patient portal.

Gaps in your medical history can jeopardize your claim. Update your medical records if your medical treatment takes place over a long period of time.

Common Challenges in Medical Evidence Collection

Below are some common challenges in medical evidence collection:

Cost of Medical Records

Medical records can be expensive. Physicians can charge a fee to copy them or charge a preparation fee.

In workers’ compensation cases,the defendant pays for medical records. Your lawyer generally pays for the medical records if you have a lawyer. Some lawyers ask for reimbursement when your award is received. Others consider paying for medical records as their cost of doing business. Check with your lawyer to see how they handle this matter.

Incomplete Documentation

Make sure that your injury is well-documented by your healthcare professionals. It’s difficult to prove the extent of the injury and whether it’s work-related if your medical records lack detailed information about your injury, symptoms, and treatment plan.

Pre-Existing Conditions

Pre-existing conditions are a challenge in workers’ compensation claims. Establishing the impact of a workplace incident can be difficult if an injured worker has a pre-existing medical condition. Employers and insurance companies carefully scrutinize such conditions to determine whether the injury is work-related. Medical evidence should demonstrate that the workplace incident significantly contributed to the already existing injury or illness.

Delayed Medical Treatment

Not seeking medical attention promptly after an injury can raise questions about its severity and weaken the claim. 

Non-Compliance With Treatment

Missing appointments and not following treatment plans will weaken your workers’ compensation claim.

These issues can weaken your claim. They can make it difficult to prove a relationship between the work injury and your medical condition. 

The Help and Experience of a Lawyer

Navigating the workers’ compensation claims process can be overwhelming. Getting medical evidence can be especially difficult. Thorough medical records are necessary to prove your workers’ comp claim. An experienced workers’ compensation lawyer can get your medical records and present information that will strengthen your case.