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What to Do If Your Work Injury Claim Is Denied for a Lack of Medical Evidence

smartphone with medical recordsSometimes workers’ compensation claims are denied because of problems with the medical evidence that was provided. For example, maybe the insurance company will argue your records do not establish that a pre-existing condition was aggravated by your job. Maybe the insurer will argue the medical evidence does not establish the injury is work-related.

If you are denied workers’ compensation benefits due to a lack of medical evidence, a Bakersfield workers’ compensation lawyer from Berry, Smith & Bartell may be able to help. If you have a valid claim, we can gather evidence that may help prove your eligibility for workers’ compensation. We are also prepared to manage every step of your appeal.

Talking to the Doctor

One of the most important things that you should do to support your workers’ compensation claim is to talk to your treating doctor. Let him or her know how the accident happened and the limitations you have experienced since then. Do not exaggerate your injuries, but do not minimize them either. 

Also, if you have a pre-existing injury, be sure that you distinguish the symptoms that you experienced before the work accident and those you experience afterward. Providing this level of detail can help show that your condition was made worse by the work accident. For example, report any of the following to your treating doctor:

  • More pain
  • New symptoms
  • Additional limitations

Evidence that May Help You

You can start gathering evidence that may help you and that the independent medical examiner can review in assessing your claim, such as:

  • Doctor’s notes that state your diagnosis and conclude that the injury is work-related
  • Medical records that detail the dates, nature and duration of treatment
  • Prescription records your treating physician provided to you, their names and the reason for them
  • Security footage from your workplace that shows the accident happening there
  • Statements from coworkers who observed the accident

Attending an Exam with a Qualified Medical Evaluator

A qualified medical evaluator (QME) is a physician who conducts and exam at the request of an injured worker or the employer or its insurance carrier. The exam is done to help resolve a dispute between the two sides. The results of the examination can be used in front of the Workers’ Compensation Appeals Board. The exam may provide the evidence you need to overturn a denied claim.

Your medical records will be sent to the QME so he or she can determine your level of disability and whether your current limitations are due to a work injury or a past injury.

During your exam, the doctor may ask about how the accident happened. Provide plenty of details about the event so that the doctor has a good understanding of what occurred. If you have a pre-existing injury, discuss how the symptoms of your work injury are different from the symptoms of your pre-existing injury. Describe difficulties you are having with your work and home life due to the accident.

How a Workers’ Compensation Lawyer Can Help

If you were injured in a work-related accident, you may be eligible for workers’ compensation benefits. Our California workers’ compensation team can review your injury and may be able to help you in pursuing benefits.

Contact us to schedule a free, no-obligation consultation. We can explain what benefits you may be eligible to receive, as well as how we can assist you with your claim. We charge no upfront fees and payment is only due if you receive benefits.

For a free case evaluation with Berry, Smith & Bartell, a Professional Law Corporation call 1-800-848-6288 today!

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