When you’re injured on the job, workers’ compensation is supposed to provide coverage for your medical expenses and wage replacement benefits. However, if you don’t have solid medical evidence to support your claim, it may be denied by your employer’s insurance company. At Nappa, Monterosso & Poznansky, LLP, our workers’ compensation lawyers in Staten Island have helped injured workers in the greater NYC area get the benefits they need for more than 30 years. Here, we discuss why medical evidence is so important to building a strong workers’ compensation claim.
Why Medical Evidence Matters in NY Workers’ Compensation Claims
Medical evidence serves two critical functions in workers’ compensation claims: proving you were injured and connecting that injury to your work. Insurance companies are always looking for reasons to deny claims, and the lack of compelling medical evidence makes it much easier for them to do so.
That’s why it’s vital to make sure you submit comprehensive documentation with your claim. If medical records are missing, incomplete, or inconsistent, even if you’ve obviously suffered from a workplace injury, they may deny your claim, delay medical treatment, or reduce your wage replacement benefits.
Strong medical records not only prove that your injury or occupational disease exists, they also demonstrate how serious it is and why it’s directly related to your duties or workplace environment. Working with an experienced workers’ compensation lawyer can help to ensure your medical records and are submitted in a timely manner and include all relevant information that supports your claim.
Types of Medical Evidence
Strong medical evidence doesn’t simply involve getting a doctor’s note. It usually includes a multitude of test results, health care provider evaluations, and other records that fully document your injury and its impact on your ability to work.
Medical Reports
Your treating physician is required to write reports about your treatment for the insurer and the New York State Workers Compensation Board (WCB). These reports must include information such as how the workplace injury occurred, the severity and nature of the injury, recommended treatment, and whether you are disabled or have work restrictions. Our workers’ compensation attorneys work closely with medical providers to ensure they use clear language and include information that demonstrates the nature of your injury and how it’s related to your job.
Diagnostic Test Results
Diagnostic tests are often powerful evidence because they provide objective documentation of an injury or illness. Common diagnostic tools include:
- Blood tests
- X-rays
- MRIs
- CT scans
- Ultrasounds
- Electromyography/Nerve Conduction studies (EMG/NCS), often used to diagnose repetitive stress injuries like carpal tunnel syndrome
Test results can help support your medical providers’ diagnosis and opinions and provide solid proof of your injury.
Treatment Records
Treatment records from all your injury-related medical visits should be included with your workers’ compensation claim or appeal. This includes physical and occupational therapy, specialist appointments, surgeries, hospital stays, and any other relevant records. These treatment records help document your injury and establish continuity of care. Always follow doctor’s orders and attend every recommended appointment. Gaps in treatment can make it appear that your injury isn’t as severe as you claim.
Independent Medical Examinations (IMEs)
In many cases, an insurance company may require an injured worker to undergo an independent medical examination with a doctor of their choosing. It’s important to be cautious about what you say to an IME doctor because they are often biased in favor of the insurance company and may try to minimize your injuries. Your workers’ compensation attorney can advise you on how to handle your appointment with an IME doctor and help you challenge any inaccurate or unfair findings.
Functional Capacity Evaluations (FCEs)
FCE tests measure your ability to perform work-related tasks like lifting, standing, walking, or sitting. A functional capacity evaluation can be an important tool to prove work limitations or the need for accommodations in the workplace.
Expert Testimony
In workers’ compensation claims and appeals that involve complex injuries or asbestos-related conditions like mesothelioma, expert testimony may be required. Our workers’ compensation attorneys have longstanding professional relationships with well-respected medical and occupational experts that offer clarity on the connection between your work and your condition.
How to Avoid Common Problems
Certain mistakes can cost you when it comes to your workers’ compensation claim. Being consistent in your statements to medical providers, your employer, their insurer, and the WCB is critical to protecting your credibility. Always be clear and consistent when describing your symptoms, injury, and how it occurred.
Waiting too long to report your injury to your employer or seek medical attention can also cast doubt on whether your injury was work-related. In New York, you have 30 days from the date of your injury to report it to your employer. However, reporting accidents and injuries immediately and seeking medical care as soon as possible can help support your claim.
Generally, in New York you must choose a health care provider authorized by the Workers’ Compensation Board. However, in some cases, your employer’s insurer may require you to see a doctor from their approved network for your initial visit. If you feel the network provider isn’t a good fit, after 30 days you can switch to any other authorized doctor on the WCB list.
How Our Staten Island Workers’ Compensation Lawyers Can Help
We know that navigating a workers’ compensation claim can be overwhelming, especially when you’re trying to recover. Your workers’ compensation attorney can help you find WCB-approved doctors who understand the workers’ compensation system and know how to properly document your injuries and work restrictions. Our workers’ compensation lawyers work closely with your health care providers to make sure your medical records consistently reflect the seriousness of your condition and its connection to your employment.
If an insurance company’s IME doctor issues a biased or inaccurate report, we can aggressively challenge it by cross-examining the doctor, submitting rebuttal evidence, or arranging for additional evaluations. If your claim is disputed or you receive a workers’ compensation denial, we know how to present strong medical evidence at your appeal hearing and advocate for the full benefits you deserve.
We understand the nuances and processes involved in navigating the system and have built professional relationships with judges and others who work in the NYWC division. With our local legal team by your side, you have the best chance of securing all the benefits you’re entitled to receive. Attorney and Partner Rolando Cubela proudly serves our Spanish-speaking clients in the greater New York City area.
Contact a Staten Island Workers’ Compensation Lawyer
At Nappa, Monterosso & Poznansky, LLP, we care about injured workers in our community. To learn more, call 718-273-9000 or contact us schedule a free consultation with a workers’ compensation attorney in the greater NYC area.
