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What You Need to Know About Your Doctor

Sunday, March 11, 2001 | 1125 | 0 | min read

Knowing what medical care you are entitled to and how you are to receive it are important issues to your case because the physicians who treat your medical condition are also responsible for making decisions about entitlement to further disability and indemnity benefits. In California, since 1994, the primary treating physician's medical opinion carries a rebuttable presumption of correctness.

Honesty is the best policy. The history of how your injury occurred and the conditions surrounding its origin are extremely important. All information surrounding your injury should be disclosed, even if a non-work condition or situation contributed to your injury.

All information regarding your injury gets recorded in a medical report. The medical report is what will govern your benefits. While physicians and other experts can be made to testify at an Appeals Board hearing, this is extremely rare and will be required by a workers? compensation judge only in the most extreme instances (usually where there is an allegation of medical fraud). See Regulation section 10606.

A physician's expert medical opinion must meet the 'substantial evidence' test ' and a primary question asked is whether the medical history contained in the medical report is materially accurate such that another expert could rely on the information and arrive at the same conclusions, diagnosis, and other opinions. The ONLY way to guarantee that a workers' compensation judge must at least consider a medical report is to ensure that it has an accurate history. To meet the substantial evidence test a medical report must also have accurate medicine " be scientifically sound " but that is out of your control and you must rely on the expertise of the physician.

You need to remember when giving your medical history that, with the exception of psychiatric injuries, the threshold for workers' compensation liability is miniscule. The only benefit that is affected by prior injuries or conditions is permanent disability indemnity, and many times prior conditions or injuries may not be relevant to apportionment.If you are in disagreement with your treating physician, you may be entitled to change physicians depending on when you first saw that doctor, whether you told your employer before you were injured that you had a personal physician, whether you are part of an HCO program, and other factors. You may wish to consult an attorney if you are having problems with your doctor or your insurance company.

The treating physician is required to send written reports to the insurance company every thirty days or less. There are particular elements that must be addressed in every report. Failure of the physician to do so may render the report inadmissible, or in the least cause the judge to declare that it is not substantial evidence. See Regulation 9785.


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