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Workers’ Compensation: I Am Not a Doctor in Real Life, But I Play One in the Hearing Room: The Importance of Medical Evidence in a Workers’ Compensation Claim
How important is medical evidence in a workers’ compensation claim? Specifically, how important is it to obtain medical evidence, and to understand the medical evidence already on file? In reality, medical evidence is the driving force behind workers’ compensation claims in the vast majority of situations. Therefore, obtaining and understanding medical evidence is of the utmost importance.Of course, there are plenty of claims where there are only factual or legal issues. There certainly are plenty of claims where the actual incident is being disputed as not occurring at work, and the underlying medical as far as the injured worker’s medical condition is not in dispute. There are also claims involving legal issues; for example, when there is an argument regarding an injured worker who allegedly voluntarily abandoned his employment and may no longer be entitled to temporary total disability compensation. In this situation, the underlying medical also would be irrelevant.
There is a vast difference at hearing between reviewing the medical documents and stating medical facts, versus interpreting the medical documents and drawing conclusions from them. For example, this writer had an experience several years ago when a district hearing officer stated that this writer was “giving medical testimony.” To the contrary, this writer simply stated that an injury to the ulnar part of the hand would involve the little finger side of the hand. This is a medical fact and not an interpretation of medical records; however, to prevent such a misunderstanding in the future, this writer now brings colored documents from an anatomy book to explain such medical and physiological facts. Hearing officers may be more knowledgeable now as to such basic medical concepts; however, making such a statement at a hearing is completely different than interpreting those records or drawing conclusions therefrom. Another example of this is when an attorney attempts to interpret an x-ray or MRI report and concludes that the diagnosed conditions could not possibly be related to a work injury. The employer and employer’s counsel may be very familiar with the alleged diagnosis or condition being alleged. The employer or employer’s counsel may have personal experience with the diagnosis or condition, such as having the condition himself, or having a parent or spouse with the condition. It absolutely does not matter, as neither an attorney nor an employer can provide medical interpretations or conclusions.
Why is this important and what does this have to do with workers’ compensation hearings? No matter how obvious it is to the employer or employer’s counsel that the medical records do not support a work injury or condition, contrary medical is required from a physician, who in his capacity as an expert, interprets the records and renders medical conclusions. Very often, an employer believes the medical in and of itself clearly shows that the alleged condition is not work-related. Other than the obvious situation where a treating physician states in the office notes the condition is not work-related, a contrary medical opinion from a physician is absolutely necessary in order to prevail at hearing.
There are many situations, particularly in state fund claims, when the BWC has a medical review or exam performed on a pending issue. However, it is not at all unusual for the BWC medical review or exam to be performed so early in the claim that the BWC physician does not have all relevant medical records, including records of treatment pre-dating the injury. This can also be true for the claimant’s treating physician, in that a proper medical history was not given to the treating physician.
While all of this can be brought up and argued to the hearing officer, it is still imperative that a contrary medical opinion be obtained to refute the opinions of the claimant’s physician, and if necessary, the BWC physician. This is an extra cost to the employer, but may be well worth the expense. Obtaining contrary medical evidence can be accomplished by either a medical review of the records or an actual, independent medical examination. This is always determined on a case-by-case basis.
The bottom line is that no matter how obvious the medical evidence appears to be, if the only medical opinion on file supports the claimant’s position, then contrary medical must be obtained. Please feel free to contact Carol Strassman or any of the experienced workers’ compensation attorneys at RBS with questions or concerns regarding the importance of medical evidence.