The Occupational Safety and Health Administration (OSHA) reported 2.6 million private-sector non-fatal workplace injuries across the United States in 2023, representing an incidence rate of approximately 2.4 injuries or illnesses per 100 workers.
Whether a construction accident or a repetitive use injury in a daycare setting, most private-sector employees are covered by workers’ compensation insurance. However, accessing this insurance often requires a partnership between a workers’ compensation law firm and medical professionals, who can ensure the worker’s injuries are properly documented and compensated by insurance companies.
Medical professionals must understand their role in securing compensation for workplace accident victims so they are prepared to offer their expert testimony when necessary. These are the key roles that doctors, clinicians, and other staff play in helping patients secure financial compensation.
Proving Injury Causality
Workers’ compensation differs from personal injury claims because it does not require proof of negligence. Instead, claimants must demonstrate that the injury occurred within the scope of employment and arose directly from workplace duties. Even when an employee contributes to the incident, compensation may still apply if the injury occurred during working hours and was connected to occupational activities.
Insurance companies often attempt to argue that the injuries were preexisting or due to an unrelated cause. This is especially true if the victim had an inconsistent medical history, such as failing to undergo regular physicals.
For example, assume a trucker suffered a herniated disc due to an accident on the Dan Ryan Expressway in Chicago. The trucker presents to the emergency room and undergoes diagnostic testing that highlights a herniated disc. The Illinois Workers’ Compensation Commission may seek to deny the claim by asserting that the herniated disc predated the accident. This would be defensible by the insurance company because, as the Mayo Clinic notes, many herniated discs are asymptomatic.
Chicago Injury Center is one example of a legal service that offers initial consultations for individuals seeking guidance on workers’ compensation claims. If a firm is engaged, it may work with medical professionals to assess the age of the injury using clinical indicators such as inflammation or signs of tissue regeneration. Through these diagnostic findings, doctors and legal teams can help establish that the injury is recent, that symptoms developed after the incident, and that the condition is medically consistent with the reported accident.
Developing Care Plans
Boards like the Illinois Workers’ Compensation Commission have their own physicians who will conduct exams and may have differing opinions about what work a person can perform. However, workers are entitled to choose their own physicians who can provide unbiased, expert opinions on their needs.
These medical professionals must prove when a person can feasibly return to work and what types of work they can complete upon their return. There are four types of workers’ compensation insurance, depending on whether the person suffers temporary or permanent disability and whether they can complete any tasks while recovering. The physician’s opinion can help shape what compensation the individual receives.
Workers’ compensation also includes reimbursement for justifiable medical expenses directly related to the injury, with the goal of achieving maximum medical improvement (MMI) and ensuring the worker can return to the workplace. Physicians can recommend specific treatments, such as surgery or deep tissue massage, to reduce pain and improve function. Documentation and explanation of how these medical interventions work will help prevent insurance denials.
Care plans help attorneys calculate economic damages, including medical bills and related expenses like accessibility modifications. The attorney can also incorporate future medical needs into a settlement negotiation, such as revision surgeries, regular physical therapy, or mental health support.
Documenting Treatment Adherence
Case law entitles insurance companies to dismiss a claim if the plaintiff fails to follow their treatment plans. This was a key defense in the Illinois court case Baker v. Hudson, where the plaintiff discontinued treatment against the doctor’s orders and so had their verdict partially overturned.
As such, a care team’s meticulous documentation of treatment adherence can prove invaluable to a workers’ compensation claim. By keeping careful clinical records, including noting injury progression and asking patients about what interventions they are performing at home, physicians can prove that the patient is following medical advice.
This complements expert testimony about when a patient can achieve maximum medical improvement and what accommodations they may need to return to the workforce. Through comprehensive data about disease progression or injury healing, professionals can more accurately determine a client’s future needs.
Holistic Medical Treatment Improves Workers’ Comp Claims
When medical professionals coordinate care across multiple disciplines, workers’ compensation claims are supported by stronger clinical evidence and clearer documentation. Combined expert opinions help present a more complete picture of the patient’s condition while improving transparency during claim assessments.
Through collaboration with legal professionals, clinicians can ensure a smooth claims process for their patients while supporting overall patient well-being. Thorough documentation, comprehensive diagnostics, and ensuring treatment adherence are all critical components of advocating for patients injured at work.
Disclaimer
The content provided in this article is intended for general informational and educational purposes only and does not constitute legal, medical, financial, or professional advice. Open MedScience does not provide legal representation, medical diagnosis, treatment recommendations, or workers’ compensation guidance. Readers should not rely on this material as a substitute for advice from qualified professionals, including licensed healthcare providers, solicitors, or workers’ compensation specialists.
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