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Use of Medical Records in Workers’ Compensation Claims – 5 Important Considerations

Medical RecordsA workers’ compensation case is evaluated on the basis of the documentation of the injury or illness in the claimant’s medical records. It is also important that the treating physician knows that he/she is treating a work-related injury – this is vital not only to ensure compensation for the claimant but also to make sure that the treating physician’s claims are not denied following a medical claims review. Workers’ compensation benefits help an injured employee receive the appropriate treatment to recover from a work-related injury/illness. It also enables to replace the earnings lost during recovery at least to a certain extent, and helps the injured person get back to work.

Let us look at 5 important considerations with regard to medical record use in a workers’ compensation claim.

  • Medical records are indispensable in a workers’ compensation claim because they contain the documentation of injury or health condition. They are proof of the injury and provide information about the extent of injury, thereby helping in making a treatment decision.
  • Being legal evidence, all parties involved in litigation will be given opportunity to inspect the records. To ensure justice, all records relevant to a workers’ compensation claim will be considered.
  • Lack of information in medical records, and evident discrepancies as regards entries may lead to claim denial. Workers not reporting their injury or illness immediately may have their claims denied. Similarly, if discrepancies are noticed between the initial medical records and the accident/illness report, there is every chance the claim may be denied.
  • Initial medical records showing the presence of illegal drugs in the claimant’s system may be used to deny the claim.
  • Accurate documentation is important to show that an illness/injury exists. In that way these records support treatment requests made by the applicant. If the documentation shows no record of injury, the request will not be granted.

Claims that are filed after an employee is fired or laid off are likely to be denied. Another occasion when a claim could be denied is when the applicant refuses to sign medical authorizations or give the payer a recorded statement.

When taking up a workers’ compensation case, attorneys utilize the services of a medical record review company to find out whether the claim is legitimate. These services are also useful for physicians undertaking peer review to identify appropriateness of treatment provided to the claimant.



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