Accurate Medical Documentation Vital in Workers’ Compensation Claims

An employee who is injured on the job is entitled to certain benefits via workers’ compensation. It is a legal remedy program whereby the injured worker receives benefits such as medical care, vocational rehabilitation services, indemnity wage benefits and/or death benefits. Typically, the benefits are paid by the employer or its WC (workers’ compensation) insurer. Often, the claim process can prove tough and challenging because the interests of the worker may be pitted against the interests of the employer. It is here that the services of a lawyer experienced in handling WC cases become necessary. The lawyer well-versed in relevant laws applicable to each state can provide the right advice tailored to the specific situation of the claimant.

A workers’ compensation claim can be filed as soon as the worker becomes injured on the job or develops and illness associated with his/her work. Delay in reporting the injury may lead the insurer to suspect that benefit claim may not be wholly legitimate. When notifying the employer of the work-related accident, it is important to include the date, time and place of injury and how the injury occurred. List of witnesses can also be provided.

Need for Accurate and Complete Documentation

It is vital that the work-related injury is well documented in the claimant’s medical records. The claimant has to ensure that a detailed list of all physicians that have been consulted for the injury is maintained so that a complete and accurate medical history of the injury can be later obtained. If there are contradictory medical opinions as regards a claimant’s condition or ability to work, the Office of the Workers’ Compensation Administration may appoint an independent medical examiner to examine the claimant or review the relevant medical records. The claimant or his/her attorney will have to request all relevant records from each physician or hospital that treated him/her for the injury. Once all the documents are received, the claimant will be scheduled for an independent medical examination. Before the appointment, all medical records will have to be sent to the independent medical examiner who will review them after the claimant’s physical exam and interview. During the medical record review for ascertaining the injury or disability, the reviewer will be looking for evidence that the doctor has documented the injury as a work related one.

When Claimants Need a Workers’ Compensation Attorney

When an injury is so severe that the claimant’s life will be permanently altered either because of permanent physical injury or inability to work, a workers’ compensation lawyer can present the case and advocate on the claimant’s behalf to ensure that he/she receives medical care and due benefits. The lawyer can also provide advice regarding filing for Social Security disability benefits if the injury permanently prevents the claimant from working. An attorney can be of significant assistance in the following scenarios.

• If the claimant believes that he/she cannot work any more on a regular basis in any job.
• If the claimant has significant pre-existing conditions.
• If the injury is severe enough to require surgery.
• If the work-related impairment is moderate to severe, and the claimant and the treating doctor believe that the claimant’s health cannot return to the condition it was before the injury.
• If the claimant wishes to dispute an unfavorable decision made by the employer/employer’s insurance company/state workers’ compensation division regarding his/her WC claim.
• If medical benefits are denied.
• If the claimant believes that the correct benefits are not being paid and doubt whether additional benefits can be obtained.
• If the employer has disputed a decision made by the state WC division.
• If the claimant believes he/she cannot return to their current job, but could work in some capacity.
• If the claimant is not well-versed in the workers’ compensation process and would feel more relaxed if a professional were representing him/her.

Attorneys can help claimants obtain training or monetary payment to support them while they obtain an alternate job. In case there is a dispute regarding the claim either with the employer or the employer’s insurer, an attorney’s services are vital. The entire dispute process involves intricate legal rules and procedures, and is highly legal. To ensure that the claim process is proceeding in the right direction, it is best to consult an attorney early enough. This will give the attorney sufficient time to collect evidence and push the claim in the right direction.

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