When a serious injury happens to you at work, having access to your medical records might be the last thing on your mind. You trust the medical professionals to provide the best possible care every step of the way. But medical errors happen every day. When an injury is serious enough to require surgery, the results can be long-lasting and devastating. Everything that happens during your treatment is a part of your work-related injury.
The Workers’ Compensation Process
If you are injured from a work-related accident, you will report the accident to your employer. In California, you must report your injury within 30 days of the accident. If you fail to meet the time requirement, you may lose your eligibility for compensation. Even if you require emergency care and are in the hospital for the first few days after your injury, the 30 days gives you enough time to meet the time requirement.
Your employer will provide you with the necessary documentation to file your claim. You will fill out the employer portion of the claim and return it to your employer. Your employer is required to complete the employer section and provide you with a signed copy. They will then submit the form to the insurance company with whom they have workers’ comp coverage. The insurance company will inform you within about two weeks whether your claim is approved or denied. If it is denied, it doesn’t mean you are out of options. See a workers’ comp attorney to learn more about your rights and the appeals process.
Although it is important to follow the process for filing a workers’ comp claim within the proper time limits, you shouldn’t wait to get any of the medical treatment you need. Workers’ comp attorneys always advise clients to tell medical providers that their injuries are work-related. Today, that advice extends to requesting your own medical record.
Why Your Medical Records Could Make or Break Your Workers’ Comp Claim
When you see your doctor, you don’t really think about what they write down in your records. We hold medical professionals to a high standard. It’s easy to think that errors don’t happen very often in the world of medicine. In reality, medical error has now become the third leading cause of death in this country. If doctors can make that kind of mistake in practice, imagine the types of errors and omissions there might be in your medical record!
Under normal circumstances, you might never have reason to realize your records aren’t accurate. When you’re pursuing a workers’ comp claim, it becomes central to your case. Here are some of the reasons why:
1. You Need Accurate Records as Evidence
Your medical records are legal evidence. Without accurate records, you have no way to prove the cause of your injury. Insurance companies frequently challenge workers’ comp claims stating that the injury was pre-existing. They check to see if you follow your doctor’s treatment recommendations and go to follow-up appointments. If there are gaps or errors in your records, you could lose your case.
2. The Insurance Company Can Use Them to Deny Your Claim
With medical bills for hospitalization and surgery surging, you could end up with a mountain of unpaid bills if your claim is denied. Obtaining your medical records at the time services are performed will allow you to correct omissions and errors when they occur. It’s better to know exactly what is in there now rather than to be surprised when the other side raises an issue you can’t explain.
A good workers’ comp attorney can look at your medical records and determine the best strategy for your case. He knows what is relevant and what the insurance company can use to deny your claim. For example, they may spot a discrepancy between the accident report and your initial medical record. Obtaining your medical records will let you and your attorney know what you’re up against.
3. To Pay for Future Treatment
A serious injury that requires a hospital stay can easily run into the thousands of dollars. That’s just for the initial treatment. Serious injuries often require ongoing medical treatment. A spinal injury might require surgery, physical therapy, and lifelong medication. A soft tissue injury might require multiple surgeries to restore the injured area, both structurally and aesthetically. All of this comes at a high cost. The insurance company will use your medical records to verify your injury before they approve the additional treatment. If the record doesn’t show the injury or its severity, they will deny payment for any additional treatment.
The process to request future treatment is a very complex one. It involves the use of state guidelines, medical records, and the recommendations of the treating physician. When the medical records aren’t provided or considered during the process, patients can be denied the treatment recommended by their doctor. Many people have been devastated due to the failure to get the treatment they badly needed.
In some cases, the insurance company’s claims administrator might approve a different treatment than the one requested. This often happens if the requested treatment is significantly more expensive than the approved one. This treatment might not be the best one for the patient’s condition. Ask your attorney about your options if either of these outcomes happens to you.
If you don’t agree with the claims administrator’s decision, you still have options. The next step is to file a dispute called an independent medical review (IMR.) All of the relevant medical records should be considered during this review. The insurance company is required to send them to the utilization reviewer, but sometimes they withhold them. This makes it difficult to get the desired outcome from the IMR process, as well.
Another option is to send your medical records with the IMR request. It isn’t your obligation but it could make a difference in the outcome of the review. This is one reason that you need to keep your medical records. It’s also important to have a workers’ comp attorney who knows the laws and processes in your state.
A Note on Electronic Health Records (EHRs)
There are many benefits to electronic health records. For one, it allows all providers to have access to a single patient’s medical records. This reduces the risk of over-medicating, prescription abuse, and inaccurate diagnosis.
EHRs also come with some problems. If you’ve ever visited a healthcare facility with a newly implemented EHR system, you already have an idea of the problems. It isn’t uncommon for records to get lost in the transition. They often get sent to the wrong file or aren’t translated properly. Lost records can put your health and your life at risk. They can also compromise your workers’ compensation claim and cost you thousands of dollars in benefits.
You should take a pro-active approach to managing your medical records for all of your health care. When a serious injury occurs, take all the steps necessary to have the pertinent medical records available to submit your claim.
If you’ve been seriously injured on the job, contact The House of Workers’ Compensation. We’ll help you understand your rights and get all the documentation you need for your claim.