GREY & GREY
DETAILS MATTER PART 1: ACCIDENT REPORTS AND MEDICAL RECORDS
Two of the most important pieces of information in any workers’ comp claim are (1) how the accident happened; and (2) what body parts were injured. At the beginning of a case, that information is recorded in three places: the worker’s accident report to the employer, the C-3 claim form that is filed with the Workers’ Compensation Board, and in the reports filed by the injured worker’s doctors.
It is very important for worker to report the accident history (how s/he was injured) clearly and consistently to the employer, the Board, and the doctors. When different forms have different versions of how the accident happened, the insurance company may begin to question whether the claim is legitimate, or dispute whether the injuries were caused by the accident.
It is also very important for an injured worker to report ALL of the injuries from an accident, instead of falling into the trap of only reporting “what hurts the most.” When the initial medical treatment is in a hospital Emergency Room, it is very common for the doctors and nurses to focus on the worst injury and to overlook those that seem more minor at the time. Similarly, if the injured worker goes to a doctor who specializes in one part of the body (like a hand specialist), that doctor may not report other injuries that were caused by the the accident. Although the Workers’ Compensation Law allows a worker to claim an injury for up to two years after the accident, as time passes it becomes much harder to persuade a judge that the injuries were caused by the accident.
In one recent case, the Board found that a worker’s knee injuries were not related to her accident because she did not report pain in her knees early until one year after the accident and was instead being treated for a serious back injury.
The Board’s C-3 claim form, treating doctors, and insurance company doctors will also ask if there was any relevant “past medical history” – whether the injured worker ever injured or received treatment to that part of the body before. Any previous injuries or treatment should be reported, because failing to do so may not only result in part of the claim being disallowed, but could even result in a fraud claim against the injured worker.