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Medical Evidence In Workers’ Compensation Claims

InjuryInsurance

As part of the Grand Bargain between workers and management, Florida workers’ compensation is no-fault insurance. But “no-fault” does not mean “automatically eligible.” Eligibility rules apply. Florida’s workers’ compensation law has strict time deadline requirements. Furthermore, injured victims must prove their condition is work-related.

Medical evidence is perhaps the biggest requirement. In some states, job injury victims may choose their own doctors. But that’s usually not the case in Florida. A company doctor’s medical report might or might not accurately reflect the victim’s true medical situation.

Therefore, a Tampa workers’ compensation lawyer is a very important part of the process. A lawyer can assess an Independent Medical Examination and determine if it meets legal and evidentiary thresholds. If necessary, an attorney can order a supplemental medical report. Usually, this examination and report costs nothing upfront.

Independent Medical Examinations

Largely depending on the company and its workers’ compensation insurance provider, the IME could be a snapshot report or a comprehensive report. Unfortunately for victims, we see many more snapshot reports than comprehensive reports.

Doctors usually prepare snapshot reports after an initial medical examination. Based largely on the physical exam, the doctor assesses the illness or injury and its effects on the victim’s everyday life. Furthermore, the doctor predicts the final outcome. So, these broad and life-changing conclusions don’t have much of an evidentiary foundation.

The nature of the doctor-patient relationship complicates matters even further. An IME physician is not really the victim’s doctor. S/he is simply examining the victim at the insurance company’s request. This relationship often affects doctor-patient communication. Victims are often less than forthcoming to IME doctors. For their part, IME doctors do not always closely listen to job injury victims.

Comprehensive reports are a bit better. IME doctors prepare these reports on more than a physical examination. They also perform diagnostic tests and evaluate the victim’s physical therapy progress. Nevertheless, the same relationship-based communication problems remain.

Supplemental Medical Evidence

This medical evidence could involve an additional medical examination or an expert’s review of the existing medical evidence.

Snapshot IME cases often require an additional medical examination. Usually, a doctor performs multiple examinations. An initial exam is basically a triage. A later examination assesses the victim’s recovery process and gives an accurate prognosis.

Comprehensive IME cases often require a second opinion from another medical expert. Frequently, insurance company doctors are not particularly well-qualified. A second opinion often significantly alters the report’s meaning.

Accurate medical evidence is usually the key to obtaining maximum benefits in a workers’ compensation case. These benefits usually include lost wage replacement and medical bill payment. Medical evidence affects wage replacement. The more severe the illness or injury, the more work the victim must miss. Obviously, the medical bill payment benefit depends almost exclusively on the medical evidence.

Reach Out to a Diligent Hillsborough County Attorney

Accurate medical evidence is often the key to maximum compensation in a job injury claim. For a free consultation with an experienced workers’ compensation lawyer in Tampa, contact Kobal Law. After-hours visits are available.

Resource:

cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Beneficiary-Services/Liability-No-Fault-and-Workers-Compensation-Reporting/Liability-No-Fault-and-Workers-Compensation-Reporting

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