What Constitutes Substantial Medical Evidence in California (LC 4628)

Injuries in the workplace are unexpected and can cause significant disruption to the productivity of any company. When it comes to workers’ compensation claims, however, not just anyone can receive compensation from their workplace. Often, it is a matter of the evidence that is provided to prove that your injuries were the result of the workplace environment. This can leave you wondering what constitutes substantial medical evidence in California.

There are specific laws and regulations in place to protect businesses and corporations from being wrongfully prosecuted for worker’s injuries that were not their fault. If your business is facing workers’ compensation claims that are not your responsibility, it is important to seek legal counsel as soon as you can.

Substantial Evidence

Medical evidence is the factor in workers’ compensation cases that greatly affects whether the claim is granted and approved. As an employer, you could deny a claim if you believe the injury in question was not your fault or that of your company. Substantial evidence that is needed in these cases can include medical records, the patient’s medical history, physician’s reports, lab tests, witness testimony, and more.

As an employer, it is crucial to ensure that only viable workers’ compensation claims are granted. If there is a lack of evidence, you and your attorney can fight the claims being made. The employee making the claim must be able to prove that their injury was caused by their job and that it happened while at work.

If an employee strains their back while moving or lifting something heavy while at work, for example, they will need to prove such as medical records showing a physician assessed them and determined their injury was due to the strain. They may also need photographic evidence indicating where the injury occurred and witnesses from the workplace corroborating their story. Oftentimes, the word of an injured employee is not enough, and medical evidence is required.

Apportionment

Apportionment refers to the work that is done to determine what portion of an injury was directly caused by or on the job. This helps to ensure that a company is not being held responsible for injuries that were not their fault. Apportionment seeks to prove that the injuries sustained were mostly or completely caused by or on the job. It can be difficult to handle a case and show apportionment on behalf of a company, which is why you need the help of an attorney.

Physician’s Reports

One very crucial aspect of medical evidence in worker’s compensation cases is the physician’s report. While an employee may claim that their injury was a result of a wrong on the company’s behalf, that may not always be the case. An honest evaluation performed by a physician can help reveal whether the worker’s claim is truthful or not.

According to the California Code of Regulations, there are many factors that a medical report must include, some of which are

• A history of the patient’s injury
• The medical history of the patient
• The physician’s findings upon examination of the patient
• A formal diagnosis
• Treatment that has taken place in the past and present
• An opinion from the physician on the percentage of the disability or injury that was caused by the company and their reasoning for coming to that opinion
• A signature from the physician indicating that the information they provide in their report is trustworthy and honest.

How a Lawyer Can Help

Navigating a case involving workers’ compensation can be complex and long. For these reasons, it can be helpful to have an experienced attorney by your side. They know what evidence to look for to ensure that your company is not required to provide compensation for which they are not responsible. An attorney can also know how to make sure all medical evidence that is presented is adequate and substantial.

FAQs

Q: What Is Substantial Medical Evidence?

A: Substantial medical evidence refers to medical evidence found within a case that is sufficient and reasonable enough to support a conclusion. In simple terms, evidence is found to be substantial if the likelihood of it being true is greater than the likelihood of it not being true. Medical evidence can relate to anything relevant to the medical field, including medical records, diagnoses, photographs, test results, and more. Medical evidence can also include expert witness reports from various healthcare professionals.

Q: What Is the Definition of Substantial Evidence in Medical Terms?

A: There are a variety of specific definitions which explain what substantial evidence is in medical terms. Simply put, substantial evidence is adequate facts and data that point to a conclusive conclusion. This can be regarding various types of evidence, such as witness reports, medical records, drug testing, and more.

Q: What Is a QME Causation?

A: A QME is a qualified medical evaluator. A QME causation refers to a medical evaluator who is responsible for assessing the causes of injuries and/or illnesses. This oftentimes is in relation to workers’ compensation cases, in which employees have been injured at the workplace and are seeking compensation from their company. A QME causation in these cases would seek to differentiate between work-related causes and outside causes and factors that are unrelated to the workplace.

Q: Can You Dispute a QME Report?

A: You can dispute a QME report in California. It is not a simple process, however. Disputing this type of report requires extensive legal knowledge and adequate experience in handling and disputing such things. An attorney can help you do this, but even so, you should be prepared for a lengthy process. You and your attorney will need to gather an adequate amount of additional research and evidence, which can be difficult and take a long time.

California Workers’ Compensation Attorney

If your business or company is facing a workers’ compensation claim, there is no time to waste in obtaining legal assistance. You need someone fighting on behalf of your company. The experienced defense attorneys at Bober, Peterson, & Koby, LLP are ready to help you and can answer any questions you may have. Reach out today to learn more about how you can get legal help.