How Medical Documentation Affects Your Workers' Compensation Claim

When it comes to your workers' compensation claim, having all of the facts of the case available can mean the difference between a successful payout and a claim denial. Medical documentation plays a key role in the decision-making process throughout all aspects of your case. The following offers an in-depth look at this documentation and the impact it can have on your workers' compensation claim.

Types of Documentation

The medical documentation you'll need to prove your workers' compensation claim can come in a variety of forms. In most cases, your documentation will come in the following forms:

  • A handwritten note on a doctor's letterhead or prescription pad
  • Handwritten notes kept inside your patient charts
  • Typed and signed treatment notes produced after patient examination

To be considered admissible as legal evidence in your workers' comp claim, the above must be signed by a doctor or another qualified medical provider, such as a nurse or physician's assistant.

What Insurers and Judges Look For

When it comes to your medical documentation, there are specific items that the insurance company or judge presiding over your case may look for when determining payments for medical treatment, as well as payments for lost wages. These items are usually in the form of specific language that provides clear statements of the facts regarding the case.

As the judge or insurance company examines your medical documentation, they may look for language that clearly states the type of treatment recommended by your doctor and provides confirmation that the treatment is necessary to address work-related injuries.

When considering compensation for lost wages, the insurance company or judge also look for specific language that clearly states the following:

  • That you're under medical restrictions that prevent you from earning full wages, and
  • That medical issues caused by repetitive job duties or a specific work injury are responsible for your current disability

If your need for medical treatment or current disability was caused in part by pre-existing conditions or other medical issues, the insurance company or judge may search your medical documentation for language that clearly defines a specific work injury or repetitive job duties as a significant factor in creating your current condition.

Obtaining Sufficient Documentation

Not having enough medical documentation to back your work-related injury claim can result in your claim being delayed or even denied. To prevent that from happening, here are a few things you can do to ensure your medical condition and injuries are properly documented:

  1. See your doctor as soon as the injury occurs. Only your doctor can provide the medical documentation needed to help your workers' comp claim.
  2. Don't hesitate to speak up about injuries caused by repetitive job activities or injuries involving pre-existing conditions. In many cases, your doctor may not comment about these aspects of your injuries.
  3. Have your attorney ask questions. In some cases, your attorney may need to inquire about the causes and effects of your work injury, especially if insufficient medical documentation causes your claim to be delayed or denied.
  4. Don't be afraid to get a second opinion. You and your doctor might not see eye-to-eye when it comes to your injuries, and some doctors may even shy away from workers' comp cases altogether. Seeing a different doctor may help push your case forward.

Keep in mind that if your claim is denied by the insurance company due to insufficient evidence, you can always gather and present additional evidence when your claim is brought in front of a judge.

You should also make sure that your medical documentation does not conflict with the information provided in your accident report. Such conflicts could further complicate your workers' comp claim, leading to unnecessary delays or even a denial. For more information, contact a workers' comp lawyer at a law firm such as Prediletto, Halpin, Scharnikow & Nelson, P.S.