Workers’ Compensation Benefits For Occupational Diseases – An Overview For Medical Record Review

by | Published on Nov 12, 2021 | Workers Compensation

An illness acquired as a result of the specific nature of the workplace is known as an occupational disease and may be compensable under workers’ compensation insurance. This blog focuses on an overview of workers’ compensation for occupational disease and the relevance of medical chart review in this regard. An occupational disease is different from an accidental injury in that the former is acquired as a result of the employment over a significant period of time whereas the latter is an injury that results from a work-related mishap or accident.

Allergies, heart disease, lung disease, and orthopedic diseases involving the back, neck, shoulder, knee, or hip are examples of occupational illnesses.

  • Occupational illnesses caused by physical hazards such as heat stroke, skin burn, hearing loss, and those caused by chemical hazards such as mercury poisoning, thyroid dysfunctions, inflammatory bowel disease and skin disorders
  • Infectious diseases such as tuberculosis, hepatitis, COVID-19 and so on
  • Respiratory diseases such as chronic obstructive pulmonary disease (COPD), occupational asthma, interstitial lung disease and so on
  • Musculoskeletal disorders such as carpal tunnel syndrome, tension neck syndrome, rotator cuff tendinitis
  • Skin diseases such as contact dermatitis, latex allergy, and allergic dermatitis
  • Cancers related to specific occupations mesothelioma, lung cancer and so on

In any of the above-mentioned conditions, medical record review for workers’ compensation is an important consideration. Now, let us look at the criteria to be met to qualify for workers’ compensation with an occupational disease.

  • There should be a direct relationship between the disease and the work conditions
  • The job must be the immediate cause of the disease
  • The illness must follow a natural incident of the work performed by the employee
  • The worker should not be equally exposed to the hazard outside of the employment
  • The illness should be related to the character of the business
  • The disease should be from a risk associated with the employee’s occupation and proceeded from it as a natural consequence
  • The prevalence of the disease must be significantly greater in the particular occupation or industry than in the general population

Federal employees are required to submit a detailed report from the treating physician, and a signed statement from the employee to support the report given by the physician.

Medical records and detailed analysis of these records are very important when it comes to successful resolution of the claim. The treating physician should know all key facts such as the exact work nature of the employee, his/her working hours, what they are exposed to, symptoms and their onset, and the severity of the illness. To review the medical records and establish a link between the disease and the worker’s job nature, physicians may rely on the support provided by a medical record review company. Medical chart review would clearly highlight the nature of the occupational disease, its cause and symptoms, its impact on the employee’s ability to work, severity of the disease, and the extent of damages caused by the disease. The review of relevant medical records would also help rule out any pre-existing illness that could make the worker ineligible for workers’ compensation benefits.

Ours is a company providing medical record review for workers’ compensation attorneys, and we know that the coverage provided for occupational diseases under workers’ compensation varies from one U.S. state to another. The severity of the disease is another determining factor in this regard. Typically, the employee may be provided compensation for lost wages, medical expenses, disability, vocational training, and death benefits for survivors in case the employee dies.

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