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Workers' CompensationE. Report Writing, Magic Words; Standards for Injury, Aggravation and Occupational DiseasePrepared by members of Oregon Workers' Compensation Attorneys Reports from physicians constitute prima facie evidence of causation, nature and extent of impairment, etc. 23. What information should a physician expect to receive from a patient's attorney when the attorney requests a doctor's written opinion? The attorney should briefly and clearly describe: a. The matter at issue; b. A list of the medical/legal questions that need to be answered; and c. The standard of proof required for each of the medical/legal questions. 24. What are some examples of "matters at issue"?
25. What terminology is currently required for proving a new compensable injury when the worker has no preexisting condition? a. "Within reasonable medical probability, the work injury was a (major) material contributing cause of [diagnosis]. The diagnosis is supported by the following objective findings..." b. Subjective responses to "objective findings" if they are reproducible, measurable or observable. For example, tenderness to palpation that is reproducible from one office examination to another. 26. What is the definition of a preexisting condition? A preexisting condition is any injury, disease, congenital abnormality, personality disorder or similar condition that contributes to or predisposes a worker to (a) disability or (b) the need for medical care. 27. What is the current terminology necessary to prove a compensable injury where the worker has a preexisting condition which combines with the accidental injury to cause a "combined" condition? "Within reasonable medical probability, the injury is the major contributing cause (the 51% cause) of the current disability or need for treatment." Please note: The injured worker always has the "Burden of Proof." If the medical provider does not provide chart notes or narrative form reports, the injured worker will almost certainly not be able to prove his claim. The worker will not receive workers' compensation, and medical bills will not be covered by the workers' compensation carrier. 28. How does a doctor show that an injury is the "major contributing cause"? A two part analysis is required: First, the doctor must show that the injury is the predominant cause, i.e., more than 50% of the condition (diagnosis). Second, the doctor must compare and analyze other potential causes. That is, the major injury must be a greater cause than all other causes combined. Mere conclusions may not support the physician's opinion. It is fact specific in each case. 29. How symptomatic must a preexisting condition be previously (if at all) to be considered a preexisting condition? If a preexisting condition was asymptomatic, that is only one factor to be considered by the physician when analyzing major contributing cause. If the accidental injury has combined with the preexisting condition to result in disability or the need for medical treatment, then the doctor is only obliged to show that the injury is the major contributing cause of the disability or need for treatment of the combined condition. 30. What is a consequential condition? A consequential condition (as opposed to a direct condition) is one that arises indirectly from an injury. Examples include:
31. What is necessary for proving a consequential condition? The doctor must describe how the secondary consequences logically result from the primary consequences of the compensable injury. The primary injury must be "the major cause" (that is, the 51% cause; it does not need to be the sole or only cause) of the "consequential" condition. 32. What is the current terminology for proving aggravation of a compensable condition? a. The doctor must establish that "an actual worsening of the compensable condition has occurred." Proof requires medical evidence, objective findings, evidence of disability, and evidence that the current condition is more than a waxing and waning of the previous condition. "Actual worsening" means an identifiable worsening of the condition, rather than a mere flare-up of symptoms. b. The temporary worsening of a compensable condition may give rise to a viable claim for aggravation. 33. What is the current definition of an occupational disease? Occupational diseases are either: a. Diseases/Infections from dust, fumes, vapors or other "external" substances; b. Mental disorders; or c. Gradual onset conditions (e.g. carpal tunnel syndrome, tendinitis arthritis). 34. What is the current terminology for proving an occupational disease? Diseases/Infections and gradual onset conditions use the same terminology. The physician must state "within reasonable medical probability that the work exposures or exertions constitute the major contributing cause of [the diagnosis]." The diagnosis must be supported by objective findings that are reproducible, measurable or observable. 35. What does the "major contributing cause" mean in occupational disease cases? The "major contributing cause" is the single most important cause of the condition and need for treatment. It requires a comparison among all potential physiological causes, including preexisting conditions. 36. What non-job-related cause must be considered in occupational disease cases? The physician must compare the worker's work exposures or work exertions with all other off the job potential environmental causes or exertions that occurred. The worker's occupational exposure must be a greater cause of the condition than all other causes combined. 37. What is the current terminology for proving a compensable occupational disease when a preexisting condition is involved? The patient's "work is the major cause of the pathological worsening of the preexisting condition and the major cause of the combined condition (diagnosis)." Return to Answers to Medical Questions Front Page Collection: Rates, Bills, Settlements | Aggravation | Communication with Attorneys, Insurers and Patients | Notices for Return to Work and Modified or Light Duty | Report Writing, Magic Words; Standards for Injury, Aggravation and Occupational Disease | Treatment after Claim Closure and in Aggravation Situations | Time Loss Authorization Last update: June 1, 2001
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