What Proof Do I Need For A Workers’ Comp Case In California?

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Answer

A lot of people are unclear as to their course of action after a work injury. They don’t know what their responsibilities are or what proof they may need to support a workers’ compensation claim.

The truth is that there’s no single formula that fits all accidents. Your response should suit the injury. The more serious the injury, the more you want to document everything you can. You want photos, witness information, medical records and incident reporting information. You also want to know why these matter.

Understand The Purpose Of Your Evidence

California workers’ compensation is a no-fault system. This means you do not need to prove your employer caused your injury. This is how the system for workers’ compensation differs from the way insurance companies and courts deal with personal injury cases. In fact, with some notable exceptions, you can receive workers’ compensation for job-related accidents that were entirely your fault.

However, you must still show that your injury was work-related. This is where your documentation and proof come into play. Nearly all businesses pay for insurance to cover their employees’ workers’ comp claims. Your employer might want to help you, but those insurance companies have a mindset that focuses on cost-containment. They look for every way to minimize or deny their responsibility for claims.

It is not uncommon to face an insurance denial at some point. This is where solid proof can help. You can either convince them to approve your request in the first place, or you can force them to reconsider. Notably, you may have this struggle at multiple steps throughout the process. It’s not just one thing. You can have one part of your claim approved and then, later, face a denial for some important medical testing.

Seven Types Of Evidence That Can Strengthen Your Workers’ Compensation Claim

It seems obvious that if you suffer a head injury at work, you should have your workers’ comp claim approved. However, I’ve seen situations before where somebody had severe bruising and the insurance company denied that they had a head injury.

In that case, my client was fortunate to have a coworker who took a photo of the blood trickling down their hair and another where the coworker moved away the hair and revealed a big goose egg of a bump. That’s just one of many cases that shows you have to be vigilant.

You have to treat every situation according to your needs, but it helps to have a checklist of things you can do and document to help your case:

•  Photos of your injury
•  Photos of the accident site
•  Names and contact information for any coworkers or other witnesses who saw what happened
•  The details of what they saw
•  The name of the supervisor or superior to whom you reported your injury and your desire to seek medical attention
•  The day and time you reported your injury
•  Medical records from your evaluation and any follow-up appointments

Again, the steps you take will depend largely on the severity of your injury. If you just cut your finger and bandage it up, that may be no big deal. But if you fall and lose consciousness momentarily, you don’t want to get into a car, go home and sleep it off. You want your employer to call the paramedics and take you to an ER to get you checked out.

If you slip and fall and your knee feels funny afterward, you might want to check it out in Urgent Care. If a forklift strikes you and breaks your arm, you want to go to the ER. Your response depends on the circumstances, but the general rule is the same: You want to document as much as you can.

Remain Vigilant Throughout The Process

Depending on the severity of your injury, your recovery may take weeks or months, possibly longer. You may need testing with specialists and additional treatments. It’s important that you continue to document your situation throughout the process, and a good attorney can help you.

When you meet with your attorney, bring any X-rays, MRIs, CT scans and other medical records related to your case. It’s especially important that you do this if you feel the doctors are downplaying your injury or the insurance has denied some type of testing.

It is common for injured workers to say that an emergency room doctor’s report was wrong or incomplete. ER doctors focus on the most immediate and important work first. They’re saving lives and repairing broken bones. They assess the most urgent situation and address it first. They may forget, for example, to report that someone lost consciousness. You may have an orthopedist working in the ER, and your brain injury may fall outside that doctor’s realm of expertise. Once you leave the ER, any problems with the medical record may travel from one appointment to the next like a bad game of telephone.

Your Workers’ Comp Attorney Is Your Ally

Workers’ comp is a no-fault system, but it can still feel adversarial. That’s one of the reasons it helps to have a smart workers’ compensation attorney on your side. Your attorney can help push back against the insurance company when it denies medically necessary testing or procedures. If your medical record is inaccurate, a good attorney will likely have connections with doctors who can catch the problems other doctors might have missed.

Importantly, workers’ compensation attorneys work on contingency. They don’t get paid until you get a settlement. Until then, the legal advice is basically free. Meanwhile, you had better believe that the insurance company is working with attorneys, so why not you? You want an attorney who is good enough to take your documentation and your other evidence and then put you on equal footing with the insurance.

Disclaimer:

The answer is intended to be for informational purposes only. It should not be relied on as legal advice, nor construed as a form of attorney-client relationship.

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