GREY & GREY
WORKERS’ COMP AND MEDICAL EVIDENCE
When someone is out of work because of an on-the-job injury their two top priorities are getting medical treatment and being paid for lost wages. In the workers’ compensation system, both of those things depend on medical evidence, in the form of a doctor’s opinion.
Workers sometimes believe that a test result, a visible injury, or a doctor’s diagnosis is enough to “prove” disability. Unfortunately, that is not the case. Although those things can help support a doctor’s opinion that a worker is disabled they are not, standing alone, proof of disability. Instead, to receive workers’ comp benefits for lost wages, the injured worker’s doctor must submit a medical report at least once every three months stating that the person is not working, is disabled from work, and including the doctor’s opinion about the level, or “degree” of disability. For any period of time in which medical reports with an opinion about disability are not filed, the employer or insurance company is not required to pay compensation benefits for lost wages.
The Workers’ Compensation Board provides a number of different forms that a doctor can use to file reports. Some of the forms simply require the doctor to fill in the blanks, while others allow the doctor to attach office notes or a medical narrative. Whatever form the doctor chooses to use, it is essential that it include the injured person’s work status and the doctor’s opinion about whether they are disabled from work. Similarly, an injured workers’ access to medical treatment also depends on their doctor following the Board’s treatment guidelines and using the proper forms. For treatment that is pre-approved by the guidelines, no forms or authorizations are needed – the doctor can simply follow the guidelines and provide the pre-approved treatment. For treatment that is not pre-authorized, the doctor may need to use one of two different forms, depending on the nature of the request. When a health care provider submits an unnecessary request for authorization, uses the wrong form, sends the form to the wrong place, in the wrong manner, or at the wrong time, the injured person’s medical treatment can be significantly delayed.