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Medical Evidence’s Role in Worker’s Compensation Claims

Medical evidence plays an important role in the successful outcome in worker’s compensation claims. It helps determine the extent of your injuries and provides evidence of your eligibility for benefits. The right kind of medical documentation props up your case by establishing a causal link between a work-related injury or illness and your job duties.

A workplace accident attorney knows medical evidence is essential in establishing your right to worker’s compensation benefits that include temporary or permanent disability. Choosing an attorney experienced in workplace compensation claims is the best way to determine:

How do you prove an injury happened at work?

Proving that an injury or illness happened at work is an important step in a worker’s compensation claim. It falls under the obligation of the employee as part of the burden of proof required for worker’s compensation claims.

Here are some ways you can validate an injury or illness happened on the job:

  • Report the injury or illness immediately. If you’re injured or begin to feel ill while on the job, it’s important to report it to your supervisor as soon as possible. Your employer must document your notification, which you can later use if there are problems obtaining worker’s compensation benefits.
  • Seek medical treatment. Don’t wait. Visit your doctor or an emergency room for treatment of your injuries immediately. Having your injuries or illnesses evaluated by a health professional lends to your credibility.
  • Document the accident. If your injury or illness happened after an accident at work, take photos of the accident scene, any equipment involved, and any visible injuries to yourself. Getting witness statements (when applicable) is also recommended.
  • File a worker’s compensation claim. Once you’ve been treated for your injuries or illness, file a worker’s compensation claim with your employer’s insurance company. Doing so triggers an investigation into your claim.
  • Consult a worker’s compensation attorney. Don’t wait until your employer challenges your worker’s compensation claim. Reach out to a workplace accident attorney to gather and present evidence that supports your claim.

What is the burden of proof for NM worker’s compensation claims?

In New Mexico, the burden of proof for worker’s compensation claims falls on the employee. You must show that your injury or illness happened while carrying out your job duties or while on the clock.

To meet the burden of proof in New Mexico, the employee must establish three things.

  1. The injury or illness happened because of their job.
    You must show that your illness or injury was caused by a specific work-related incident or a specific duty you’re required to carry out while on the job.
  2. The injury or illness happened during regular job duties.
    Were you doing something you’re required to do on the job, or did your illness or injury happen when you were engaged in another activity on work premises? If it’s the latter of the two, your employer may not be responsible for covering your treatment.
  3. The injury or illness is compensable.
    You must show that your injury or illness qualifies for compensation under worker’s compensation laws. New Mexico’s worker’s compensation system covers medical expenses, wage replacement, and other related costs.

Once your workplace accident attorney establishes these three elements, the burden of proof shifts to the employer or their insurance carrier to either prove the injury or illness isn’t compensable or is not related to your job duties.

A man carries packages from a van to a home he's delivering for an employer.
Commuting to and from work isn’t covered, but injuries while performing official work duties fall under worker’s compensation laws.

Which issues aren’t covered by worker’s compensation?

New Mexico’s worker’s compensation system is designed to provide benefits to workers who become injury or ill because of their job duties. However, there are some issues that aren’t covered. Here are some of the instances when you may not be covered by New Mexico worker’s compensation.

  • Intentional acts. If you’re injured by a supervisor or employee engaging in an intentional act, you may not qualify for worker’s compensation. In those instances, a civil lawsuit seeking compensatory damages from the other person may be more appropriate.
  • Self-inflicted injuries. If you intentionally injure yourself, and your employer can prove it, you’re not covered by worker’s compensation. Even worse, you might be criminally prosecuted if your intent was to commit worker’s compensation insurance fraud.
  • Injuries sustained while under the influence. If you hurt yourself or become ill on the job because you were under the influence of drugs or alcohol, your employer isn’t liable.
  • Commuting injuries. Your employer is only responsible to injuries you obtain if you’re making an official trip for them while on the clock. If you end up in an accident on your way to or from work, that doesn’t qualify for worker’s compensation.

Every worker’s compensation case is unique, which is why it’s important to discuss your circumstances with an experienced worker’s compensation attorney.

An MRI technician stands at the end of an MRI machine.
MRIs are considered medical evidence that can support your worker’s compensation claim.

Which documents are considered medical evidence?

Medical evidence is an important component of a worker’s compensation claim. It’s one of several pieces of documentation you’ll need to prove your case if your employer issues a challenge.

Some types of documents that fall into the medical evidence category include:

  • Diagnostic test results. CT scans, X-rays, MRIs, and other diagnostic tests can prove the extend and nature of the injury or illness.
  • Expert testimony. In some cases, expert testimony from medical professionals (physicians, rehabilitation specialists) can support your claim for benefits.
  • Medical bills. The cost of medical treatment and rehabilitation services can demonstrate the extent of medical expenses you incurred after your work-related injury or illness and support your claim for fair compensation.
  • Medical records. Physician notes, test results, and treatment plans support your claim of being injured on the job. They also can rule out pre-existing conditions employers sometimes try to use to deny your claim.
  • Vocational rehabilitation assessments. If you’re unable to return to your previous job because of work-related injuries, a vocational rehabilitation assessment determines your ability to perform alternative job duties.

Independent medical examinations – when ordered by your employer’s insurance carrier – also can be used to support your worker’s compensation claim if the findings match those of your medical provider.

How is medical evidence used in worker’s compensation cases?

Medical evidence determines the extent of your injury or illness and dictates the appropriate level of benefits you should be awarded under New Mexico’s worker’s compensation system. Medical evidence also is used to assess your ability to return to work and whether any vocational rehabilitation is needed.

As a rule, the primary purpose of medical evidence is to support your claim and ensure you receive the worker’s compensation benefits to which you’re entitled.

Boost your worker’s compensation claim success

Given the importance of medical evidence in worker’s compensation claims, it’s crucial that employees seek prompt medical attention after a work-related injury or illness. Working closely with an experienced workplace accident attorney ensures you receive the full benefits to which you’re entitled.

Contact us today to schedule your free case evaluation.

March 21, 2023