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A physician’s report is key with workers’ compensation appeals

On Behalf of | Nov 10, 2023 | Workers' Compensation |

When a California worker is injured on the job, workers’ compensation benefits are essential for them to move forward, get the treatment they need and to make ends meet. However, not every case is approved. There are many reasons for a claim to be denied. Some of the most prominent are clerical such as not filing the claim in a timely manner. Others are based on a dispute regarding the medical assessment.

A worker who files an appeal before the Workers’ Compensation Appeals Board needs to understand the importance of providing the necessary medical evidence to prove they were injured and that benefits are warranted. Since this is so vital to a case and there is a chance of it being denied again, it is imperative to know what needs to be in the medical report.

A physician’s report can make a major difference in an appeal

When the Appeals Board considers a denied claim, it will need medical evidence. In general, it does not seek medical witnesses during a trial unless there is good cause to do so. The medical report will be relied upon to make an assessment as to the merits of the claim.

In the medical report, the physician will provide all the relevant information. Some of it is basic such as the date in which the examination took place. Other aspects are critical. The injury itself and its history; the complaints the worker is making; the information that the physician received when preparing the report and what was used in crafting the medical opinion as to the worker’s injuries; and the medical history.

After the examination, the physician will list their findings. They will make a diagnosis as to what is ailing the person and then give opinions on the disability. That is the foundation of the case. If, for example, the worker suffered a back injury and worked a job like construction that involves lifting, carrying and moving heavy items with a significant amount of bending and standing, then the back injury could hinder their ability to work. The physician will state its nature, how severe it is and how long it is expected to last.

The cause of the disability is also important as there could be a back and forth as to whether it happened at work or elsewhere. It will also be vital for the physician to detail if there is permanent disability or it is temporary. This impacts the benefits, should they eventually be approved.

There are options to appeal a denied claim

Being injured at work and left unable to perform their duties as before can feel like a rollercoaster. If they apply for workers’ compensation benefits and the claim is denied, the worker is inevitably left wondering how they will provide for their families and get the treatment they need.

Although this is worrisome in the immediate aftermath of the denial, it is wise to remain calm and know the alternatives. It is still possible to successfully appeal the denied claim. Part of that is knowing what a physician’s role is when appealing. For these and other issues related to workers’ compensation benefits, workers should be ready for the case, accrue evidence and know what can be done in every eventuality.