Medical Records in Your L&I Claim Must Be Clean and Precise

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This week has been very busy. Among many other things, I deposed several attending providers and attended litigation matters at the Board of Industrial Insurance Appeals (BIIA). Every time I depose a medical provider, it reminds me of the supreme importance of the attending provider in L&I workers' compensation claims.

The opinion of the attending physician in L&I claims

The attending provider oversees the completion of important claim related forms and responds to claim management inquiries. In litigation setting, the attending provider’s opinion is given special consideration. Therefore, it is important for attending providers to give thorough and well-reasoned opinions. Those opinions should be supported by objective medical evidence and complete clinical findings.

When things are put together properly (such as medical records, medical exam reports, chart notes, and everything else in between), they significantly increase the likelihood that the attending provider’s opinion will prevail and dictate the claim outcome without question. However, when the opinions and records in the file are inaccurate, unclear, or inconsistent and lacking in objectivity, the opposing counsel will challenge them, and things can get very messy.

Clear and clean medical records in workers' compensation claims

Because the attending provider’s opinions are so important, I encourage my clients to always communicate effectively with their doctors. Injured workers should know what's in their medical records. They must address and correct inaccuracies and inconsistencies shortly after they happen, instead of waiting months or years to tackle them eventually in litigation.

The administrative aspects of an L&I claim can be overwhelming. The medical records in a workers' compensation claim can be confusing. It is important for injured workers to understand the medical evidence and opinions in their case. Medical providers spend years obtaining special education and training in order to provide treatment to patients. They have the knowledge and expertise to explain their opinions in plain terms that patients can understand. However, ultimately, it is the responsibility of the work injury patient to ask questions and request simple explanations.

Opinion on a medically more probable than not basis

In workers’ compensation claims in Washington State, attending providers need to give input and opinions on a medically more probable than not basis. That means they need to be able to say what they think is more probably true than not true. When they testify, providers often rely on records and chart notes to remember critical facts. If those chart notes are hard to read, unclear or inaccurate, the provider will struggle to give a more probable than not answer.

In my experience, the testimony of attending providers is always better when the provider and the injured worker communicate openly and effectively. This kind of communication ensures that the attending provider understands the facts. Those facts provide a good foundation for the opinions they give because they can more easily correlate the facts with the objective medical and clinical exam findings.

Advocate for yourself in your workers compensation claim

As an injured worker and as a patient, one of the most effective ways you can advocate for yourself is to understand your medical providers’ opinions. Knowing the contents of your medical records is key, and you should correct any mistakes or issues as they arise (or as soon as you find them).

One thought on “Medical Records in Your L&I Claim Must Be Clean and Precise

  1. albert venti says:

    LnI in matters for truck drivers is bull they freaked out when i advised them that virginia mason refund the money paid for me. Why the changed the medical record whi ch under the jurisdiction of dept of transportation driver qualfications – the carrier in question is a habitual offender – I noted Social security was upset that I knew the provider who made a claim that I am not credible in my ability to work- that was a cause of a driver provider issue. The history of my claim does not match nor a mystery IME i never was aware of and SSA claims iwent backt my jobo how nice they gaVE ME my job back. then how come i did about 8 esd cases and my low life employer lost each time right

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