Working Compensation Cases

If an insurance company or a judge is considering whether to pay for an injured workers' medical treatment, the insurer or judge will be looking for language that states two things. First, the documentation must state the type of treatment that the doctor is recommending. Second, and most importantly, the documentation must state that the worker requires the treatment to address a medical issue that was caused by work; either a specific injury or the worker's repetitive job duties. If an insurance company or a judge is considering whether to pay for injured workers' lost wages, the insurer or judge will again be looking for language that states two things. First, the documentation must state that the worker has a work disability; this means that the worker has certain medical restrictions that prevent the injured worker from earning full wages, sometimes the doctor will provide certain physical restrictions such as ‘no lifting,' sometimes the doctor may simply say ‘light duty only' or ‘no work at this time.' Second, and most important, the documentation must again state that the worker's disability is due to a medical issue caused by work; either a specific work injury or the worker's repetitive job duties. Sometimes, injured workers have pre-existing conditions or other medical issues that may be partially to blame for the worker's disability or need for medical treatment. In this circumstance, when the doctor comments on the cause of the injury, the insurance company or a judge will be looking for language that states that the specific work injury or repetitive job duties are ‘a major cause' or ‘a significant factor' in bringing about the disability or need for treatment. The law does not require that the work injury be the only cause of a disability or need for treatment in order to receive workers' compensation benefits. Sometimes the doctor may not be one hundred percent certain as to what caused an injury. When a doctor is uncertain, injured workers are still entitled to workers' compensation benefits as long as the doctor explains that the work injury or repetitive job duties ‘more likely than not' caused the worker's disability or need for treatment. In other words, the doctor only needs to be 51% certain. However, a doctor's note stating that worker's disability and need for treatment ‘could be' or is ‘possibly' related to a work injury or repetitive job duties, will generally be insufficient. The law states that the doctor must give an opinion as to the cause of the disability or need for treatment based on probability, not a mere possibility.