Why Medical Record Retrieval Is Crucial For Worker’s Compensation Cases

Why Medical Record Retrieval Is Crucial For Worker’s Compensation Cases

Understanding how to order, manage, and improve upon medical record retrieval in the legal field is crucial to succeeding in worker’s compensation cases. One of the biggest hurdles in these caseloads is insufficient or incomplete medical documentation, which can lead to a myriad of issues for lawyers looking to achieve success for their clients.

It’s no surprise that delays or denials for medical records can spell disaster, which is why it’s important for legal teams to understand the medical record retrieval process and how to handle it properly. We’ve put together a guide to medical record retrieval for law firms in the past — but today, we’ll be focusing on worker’s compensation cases.

A Brief Look at the Worker’s Compensation Process

Once an injury is sustained and subsequently reported to the worker’s compensation insurance company, it’s up to an insurance adjuster to make the decision regarding payment or denial within two weeks.

Information within medical documentation is what an adjuster’s decision is based off of, and if a worker’s claim gets denied, a formal case is then made. Attorneys like you, who specialize in these cases, must understand the ins and outs of medical records to identify key areas that could affect the outcome of the case.

Some of this may entail understanding the difference between EHRs and EMRs, which could influence what type of documentation needs to be requested. Let’s dive deeper.

The Complexities of Medical Documentation

Medical record retrieval is a delicate and time-sensitive process, one that requires the requesting party to understand what they’re looking for and where to look for it. Typically, written or typed notes that a doctor has drafted and signed are on the top of the list. Handwritten notes in a worker’s chart could also be helpful in a worker’s compensation case. Usually though it is the completed dictated and typed doctor’s treatment notes following an examination are what makes a worker’s compensation case.

Medical Record Retrieval To Support the Case

When it comes to obtaining worker’s compensation, there are a few primary factors involved.

  • Medical treatment
  • Weekly wage benefits

Injured workers, or their legal representative, must make a case to a judge or insurance company a worker should be awarded worker’s compensation. This proof often lies in medical records or medical documentation — and is integral to the success of the case. Therefore, we must focus on two central elements that a decider may consider:

  1. Documentation stating the type of treatment a doctor recommends
  2. Documentation stating a worker requires specific  treatment for a medical problem caused by their work (injury, etc.)

Insurance companies and judges alike are looking to see if a worker sustained a work disability that prevents them from earning their full wages. This could be outlined in medical documentation by a doctor’s order stating that a worker shouldn’t lift heavy objects or shouldn’t be working at all. They’ll also be looking to identify documentation that shows a worker’s injuries or disability was caused by work.

While pre-existing conditions or health issues can certainly impact a case, they play a crucial role in the medical record retrieval process — so it’s important to seek these documents as well. It could also be possible that the repetitive nature of a job causes flare-ups of a pre-existing condition. In that case, clients will need to discuss this possibility with a doctor and request a letter for worker’s compensation.

It’s also possible that a worker’s compensation lawyer will need to write a formal letter and request to a secondary doctor with specific inquiries to be reviewed to help learn the cause and consequences of the injury sustained at work. This sometimes occurs when a case is delayed due to insufficient medical documentation.

Second opinions can also help strengthen a case, especially if the initial doctor refuses to take part in the worker’s compensation case. So, it may be worth having your client go to a different doctor to receive the information and notes needed for your case.

Requesting and Obtaining Medical Records For Law Firms

Law firms of all sizes need to have processes in place for medical record retrieval, especially when it comes to worker’s compensation cases. While some legal practices may choose to manage medical record retrieval in-house, many choose to outsource as there are significant advantages to hiring a designated service.

Not only are medical record retrieval services familiar with the detail-oriented and time-sensitive nature of obtaining crucial documentation, but they also have established relationships with providers and record custodians that drastically helps speed up the process. We’ve listed the top reasons why your law firm needs professionals to handle your medical record retrieval; take a look.

Whether your firm needs a hand with medical record retrieval because the legal team is too busy or you simply want a more dedicated set of hands working on your behalf — outsourcing is a viable option for law firms nationwide. To learn more, request this Pricing White Paper.