Properly Documenting Your Colorado Workers’ Compensation Claim
Posted in Legal Claims on October 21, 2020
Injuries at work will happen, particularly in fields involving manual labor. When such injuries occur, it is important that you immediately report any injury major or minor, and do so in writing. A verbal report is not sufficient as we explain in our related article, I Just Got Injured at Work in Colorado, What Should I Do? If you do not report your injury within four (4) days a penalty will reduce your benefits.
Request A Medical Appointment
After you have notified your employer, request names of potential treating physicians to diagnose and treat the injury. You should report and seek treatment for any injury to the head, neck, shoulders, back, or knee, even if you believe it is minor. Early medical treatment is key to documenting your injury and minimizing the impact of the work injury. The earlier you seek medical attention, the more promptly you can get treatment and minimize the harm. Delay by the injured worker in getting proper treatment can make a minor injury become a significant injury. The earlier you document the accident and the injured body parts, the less likely the insurance will question or deny your claim.
When You Seek Medical Care Keep the Following in Mind
Four Options for Medical Providers
When you request medical attention your employer must provide you with a list of at least four medical providers so that you can choose an authorized treating physician. The four medical providers should be at separate medical facilities. However, there may be fewer than four medical options in rural communities because there may be limited medical providers who perform workers’ compensation medical treatment. In most cases, you will be able to choose between four or more medical providers. If your employer does not provide you with optional medical providers your employer could be in violation of the workers’ compensation statutes and then you may be able to choose your own doctor, which could include your family doctor.
Should your employer not give you the names of medical providers or refuse to file a first report of injury after you have given the employer written notice of your injury, you will need to take further action. You should document the first and last name of the supervisor, when you spoke with that supervisor, and the details of the conversation. Provide this written documentation to your Human Resource (HR) department or another supervisor and keep a copy for your own records. If your employer refuses to file a first report of injury or does not offer a list of four medical providers, you should call an experienced workers’ compensation attorney for advice and/or potential representation.
The First Medical Appointment
This is the most critical medical appointment in regard to your workers’ compensation claim. At this appointment, it is important that you provide a detailed explanation of how the injury occurred and what body parts were injured. The more detail, the better. Did you fall? What did you hit when you fell? What exactly did you lift? How much did it weigh? Were you twisting? Were you bending? You should write down a description of what you were doing at work, how the injury occurred, keep a copy, and provide a copy of this to your doctor. This will substantiate in your medical records that the injury was in the course of your employment. You will want to list all of your body parts that are injured. Something apparently minor can become a major medical issue once the pain from other injuries subsides. Doctors, your employer, and its insurance carrier often go back to the original medical examination to verify the body parts that were specified soon after the injury. Also, doctors hired by the insurance company will use the first medical exam against you if you did not describe a body part as being included in the injury. Keep a copy of any letter or document you provide to the doctor or to an employer for your own records.
Why is this first medical appointment so critical? This is the appointment that your employer, the insurance company, and any insurance company attorney will review to decide whether your injury happened at work or if it could have been from a source outside of work.
State Your Work Injury Happened at Work
If you do not say where the injury occurred the doctor may not ask if it was a work injury. This could lead to the physician billing your health insurance rather than the workers’ compensation carrier. The doctor will likely ask questions about the injury and its history if he/she is notified it occurred at work. If you fail to state at that first appointment that it was a workers’ compensation injury, the workers’ compensation insurance company could deny your claim if you later state it is a workers’ compensation injury. Do not be generic by merely saying “this happened at work.” Give additional information about what you were doing and where it took place. Describe the specific job duty you were performing at the time of the injury. As indicated above, explain how the injury happened in detail. Keep in mind that your injury is work-related if you were hurt while staying at a remote facility even if you were driving to or from the assignment.
Explain All of Your Injuries
Each time you go to the doctor make sure you address all of your work-related injuries, even if they are resolving or resolved. You may have a major injury that is masking some minor injuries. Once your medical providers have sufficiently addressed the major injury and controlled your pain, you may realize that the “minor injury” is now the main source of your pain. If that injury worsens at a later point, the prior documentation will be critical should the insurance company challenge it as not work-related. When you go to the doctor you should start at the top of your head and go to your feet in listing all injuries that you relate to your work accident. Do not just hope a minor injury will go away. Address it with your doctor.
Be careful in answering pain level questions that ask you to rate your pain on a level of 0 – 10. Please keep in mind the following information. Ten on the scale of pain is the worst pain a human can experience. It is not the worst pain you have experienced. Someone being burned alive is a 10. A 10 is a pain that would likely cause one to lose consciousness or scream for mercy. Eight or nine pain would cause you to go to an emergency room, seek treatment, or be hospitalized. If you are not going to the emergency department and have not passed out from the pain, you are not an 8, 9, or 10 on the pain scale. Exaggerating your pain may lead to the doctor stating in his notes that you are magnifying your symptoms. This is not a label you want from your doctor. Any pain level from 3 to 7 is considered reasonable and will get your doctor’s attention. Level 8, 9, and 10 will be met with skepticism unless you are in need of prescription pain medication, cannot sit still, or are on the verge of shouting.
Things to Remember
The information you give is critical. It is being documented and will be in the medical record. The doctor, other medical providers, the insurance company, and the administrative law judge will be looking to those records months, even years, down the road to determine your credibility and the validity of your claim. Always treat your medical appointments as your opportunity to document your injuries without being viewed as one who exaggerates. Your medical records should support your workers’ compensation claim and your credibility.
Killian Davis Richter & Mayle can help you document your Colorado Workers’ Compensation Claim. Feel free to contact Killian Davis Richter & Mayle to discuss the process or any other questions about your claim.