What Medical Evidence is Needed?
An ACCIDENT is a specific event when you get hurt. For example, if you trip and break your leg at work, you have suffered a Workers’ Compensation [“WC”]
An OCCUPATIONAL DISEASE is an injury that is caused by the nature of your work and NOT by one specific event. For example, if you develop carpal tunnel syndrome because of years of working as a sheet metal fabricator, you have suffered a WC occupational disease.
A CONSEQUENTIAL INJURY arises from a WC accident or occupational disease. For example, if you break your right leg at work, you may put more weight on your left leg during your recovery. If you have problems with your left leg as a “consequence” of your right leg WC injury, you may have a consequential injury to your left leg.
WHAT MEDICAL EVIDENCE DO WE NEED?
We need a WRITTEN report from a MEDICAL DOCTOR (not a Physician Assistant or a Chiropractor) that addresses: (1) History; (2) Your Complaints Related to the Accident,
Occupational Disease or Consequential Condition; (3) Results of the Doctor’s Examination and Testing; (4) Diagnoses; and (5) Statement of “Causal Relationship.”
History If an accident, the doctor should describe the accident and the body parts you injured.
If an occupational disease, the doctor should describe the duties you performed and the length of time during which these duties were performed. More information is better than less information. Your doctor needs to have at least a basic understanding of the work that you did.
If a consequential condition, the doctor should describe the initial work-related injuries and the body parts now hurting.
Your Complaints Related to Accident/Occupational Disease or Consequential Condition
More is better than less. More specific is better than less specific. You may find it helpful to give your doctor a list of your current complaints.
Results of Doctor’s Examination and Testing
What did the x-ray or MRI show? What were the results of the doctor’s physical examination on issues like the range of motion of your arm?
What does your doctor think you have?
Statement of “Causal Relationship”
Your case cannot be successful unless your doctor believes (and states in writing) that your condition was caused by a work-related accident or occupational disease or is consequential to an established work-related injury to another body part. The standard is “reasonable degree of medical certainty.” Your doctor does NOT have to be 100% sure of causal relationship for your case to be successful.
While most doctors who treat WC patients are aware of these requirements, feel free to share this information with them as appropriate. Encourage your doctor to contact us if he or she has any questions.