For a workers comp injury to be formally added to a claim, it must be “established.” The Board uses the term “established” to specify what injuries are part of the case. The resulting disability from an established injury will be considered for awards, medical treatment, and settlement. The injured worker must ensure that all injuries caused by the accident are established. Adding a body part or condition to a workers’ compensation case can be a complicated process. Because of this, the injured worker should consider consulting with an attorney as early as possible.
How to Add a Workers Comp Injury to the Case
The worker must first produce Prima Facie Medical Evidence (PFME) of the workers comp injury. PFME is a medical report. This medical report should include complaints, physical exam results, and a diagnosis by a qualified doctor. It should also state that the diagnosis is related to the accident. The doctor should reference MRI’s, X-rays, and other diagnostics that support their opinion. The injured worker will typically produce this medical report at a hearing. The judge will then review the report on the record. The report will constitute PFME if it meets required standards. PFME is a legal finding.
From there, the insurance carrier will either accept or deny the workers comp injury. If the carrier accepts the injury, it will be established. If the carrier denies the injury, more steps must be taken. Most of the time, the carrier will deny the injury and raise legal defenses. It will also have the worker examined by a paid medical consultant.
The IME Doctor Is Not Your Friend
Importantly, when the carrier denies an injury, it will usually send the worker to an IME doctor. An IME doctor is a medical consultant. Insurance carrier’s pay IME doctors to produce medical opinions. The carrier will use the IME doctor’s report to cut treatment and benefits. Not surprisingly, IME doctors almost always find that the worker has no injury. They also find that the injury is unrelated to the accident. IME doctors often state that the injury is instead related to age or some other health issue.
Even so, if the IME doctor does not agree that a workers comp injury is related, the injured worker has a due process right to cross-examination. This means the worker can question the IME doctor under oath and attack their opinion. The goal of cross-examination is to show that the injured worker’s doctor has the more credible opinion. The worker’s attorney will seek to show that the carrier’s IME doctor had incomplete information. The insurance carrier’s attorney may also cross-examine the injured worker’s physician about his or her opinion.
The Benefit of an Attorney
Cross-examination requires both legal and medical knowledge. The parties may also submit arguments to the judge. The judge will review the testimony of the doctors, the medical reports, and the arguments before making a decision. Finally, the losing party has a right to appeal the decision to a panel of judges. Adding a workers comp injury to the case is just a single step in the workers’ compensation claim process.
To achieve the best outcome in this process, the injured worker should seek a skilled workers’ compensation lawyer who is familiar with what it takes to win. Carrier doctors are experienced testifiers with complex medical knowledge. An injured worker is at a severe disadvantage if they do not retain an attorney to argue on their behalf. In fact, rarely if ever will an insurance carrier show up to a hearing or other proceeding without an attorney representing them. The Platta Law Firm attorneys have the medical and legal skills to help you successfully establish your Workers Comp Injury.