Anatomy of a Workers’ Compensation Claim: Part V

Anatomy of a Workers’ Compensation Claim: Part V

Part V: Conference and/or Hearing preparation.

James Batchelor Lawyer

You have successfully notified your employer of your work injury. (See, Blog 2) Their Insurer has denied some part of your claim. You initiated a claim with either a Claim Petition or a Medical/Rehabilitation Request. (See, Blog 3):

Now what? The court will schedule you for either an Administrative Conference at the Department of Labor and Industry/Office of Administrative Hearings or an actual hearing at the Office of Administrative Hearings. In whatever jurisdiction you are assigned, is critical that you be prepared.

  1. 1. Medical Support. The most critical issue in a Worker’s Compensation case is normally the quality of the medical support for your claim. As explained in blog 1, in order for a doctor’s opinion to carry any weight with the judge at the Office of Administrative Hearings and/or specialist of the Department of Labor and industry, that opinion must have “foundation”.

In order for a doctor to have proper foundation he/she must be aware of ALL of the relevant medical information. The most critical information to a doctor, usually, concerns past medical history. That is to say, that the doctor must be aware of all previous injuries, accidents or treatment in order to issue a properly founded medical opinion. Accordingly, if you have a past history of other Worker’s Compensation injuries or motor vehicle crash injuries or any type of personal injury that resulted in medical treatment to the body part at issue (even any body parts remotely connected to that body part), it is necessary to make your doctor aware of that past treatment.

What is most helpful to the doctor in that regard is prior x-rays, MRI scan, CT scans or any type of diagnostic study connected to that prior incident. Furthermore, if it was either an auto collision or Worker’s Compensation claim the doctor will want to know if a permanent partial disability rating was assigned or a permanency opinion issued. Any information about your past injuries that you can provide to the doctor will be extremely helpful. You will also make that doctor’s opinion more credible which gives you greater support as you make your case to either the Worker’s Compensation specialist at the Department of Labor and industry (DLI) or the Worker’s Compensation judge at the Office of Administrative Hearings (OAH).

  1. 2. Organization/Exhibits. In order to be successful and to make it easier for Worker’s Compensation specialist or judge to award your claim, it helps to be organized. As indicated in part 1, you should have a formal report from your treating doctor addressing the critical issues in your claim. Secondly, if you have outstanding medical bills make sure that you have the itemized statements from each provider verifying the amounts due, the date of service on which the treatment was rendered,
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    You should also then have the office notes from each one of those dates

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At the conference/hearing you will be given an opportunity to state your case. Saying more words is not necessarily better. Be prepared to talk about the critical issues that the Court

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will need to decide. Please look at log 6 for the 3 critical questions facing the specialist/Judge: causation, reasonableness and necessity. If you can present exhibits that address these issues and you can talk about any past medical issues as well as any change in symptoms that would indicate you sustained a new injury, and you should do so and if you do so in an organized fashion, you will have an opportunity for success.

As always, if these demands or the thought of the presentation is too intimidating or difficult and you would like to get some professional assistance, please do not hesitate to contact an experienced Worker’s Compensation lawyer. We all operate on a contingency fee and offer free telephone or in-person consultations.

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