How to Prove an Occupational Disease for a Workers’ Comp Claim

Unlike sudden workplace injuries, occupational diseases creep up over time. This can make them trickier to prove when you need to make a workers’ comp claim, but it’s not impossible. An occupational injury attorney can help you to make a claim and smooth the road as you seek compensation for this type of injury.

How to Prove an Occupational Disease for a Workers’ Comp Claim

Talk With an Occupational Injury Attorney

If you have been diagnosed with an occupational injury, or if you suspect that you have one even if you have not yet been diagnosed, it’s always a good idea to talk with an attorney. These claims can be difficult to prove, and you are more likely to face denial at delays or even appeals. A lawyer understands both the process and the law and will help you to make a strong case and fight for your rights at every point.

Determine If Your Condition Counts

The law defines an occupational disease as a health condition that has been caused either by your job duties or by your workplace environment. Something caused by your job duties might be a repetitive strain injury, like carpal tunnel syndrome, while something caused by the environment might be lung disease from inhaling toxic fumes. These are not one time injuries but conditions that develop gradually as you are constantly exposed to a hazard at your workplace. Your lawyer will help you to evaluate whether your condition meets the legal requirement, which is that it must “arise out of and in the course of employment.”

In other words, your job has to be the direct cause or a major contributing factor to your condition. There are some things that you might think would count, but which do not. For example, if you get the flu and all your coworkers had the flu first, you might naturally assume that your workplace environment was the direct cause of your illness. This would not likely be covered, however, partly because this is not a hazard that’s unique to your workplace, partly because it’s an “ordinary disease of life,” and partly because it would be impossible to actually prove definitively that you got the flu from a coworker and not from somewhere else.

Work With Your Lawyer to Meet the Legal Requirements for a Claim

Once you and your lawyer, with the help of your doctor, as well, have determined that your condition is more likely than not directly related to your workplace, you then need to put together your claim in such a way that it will meet the legal criteria for acceptance. You will have to show a connection between your job and your disease using solid evidence. Your doctor’s evaluation will be very helpful here, and your lawyer will help to connect the dots and make a strong case legally for why your doctor’s evaluation is correct.

You will also likely need to gather evidence to show that there’s no possibility that your condition has been caused by something else. For example, if you have chronic back pain and work a job where you do heavy lifting, you will need to show that the back pain is a result of your job and not a natural consequence of aging or due to another factor. If you regularly play pick-up football with friends on the weekend, for example, the insurance company may want to investigate whether there’s a possibility your sports activities have something to do with your injury.

Report Your Injury in a Timely Fashion

As soon as you know that your injury has been caused by your job, which will normally be either the time that you begin to suspect it or the time when you get a confirmation from your doctor, you have an absolute maximum of 180 days to report this to your employer. Bear in mind that if you go beyond 180 days, there’s no chance that your claim will be accepted, but you can still jeopardize your claim by waiting anything longer than 14 days to report. If you wait longer than 14 days to report your injury, you will then have to have an explanation for the delay. It’s important to act quickly as soon as you know that your job is what’s causing your symptoms.

Gather Medical Evidence

Medical proof is going to be essential here, so you want to talk to a doctor as soon as possible, and preferably one who works in occupational health. You need the doctor to document your diagnosis and to give an educated, professional opinion that your job is more likely than not the thing that has caused or worsened your condition.

This means that when you go to see the doctor, it’s a good idea to bring along anything that can help give details about your work. This might be just jotting down what exactly you do, any substances that you handle and how long you’ve been exposed to them, any accidents that you’ve had in the workplace before, etc. The more that your doctor knows, the stronger their testimony on your behalf will be.

File Your Claim

You will make your first formal claim through your employer’s workers’ compensation insurance carrier. At that point, the insurance company will either accept the claim, accept it with modifications, ask for more information, or deny it outright. If they ask for more information, you may need to undergo an independent medical examination (IME) by a doctor that the insurer chooses to verify that your condition is genuinely related to your work. If there is a conflict between the IME’s opinion and your own doctor’s opinion, your lawyer will help you to get other expert testimony.

If your claim is approved, you should receive benefits for medical treatment, wage replacement benefits up to a certain percentage, and possibly even disability payments depending on your situation. If your claim is denied, you will get a written explanation for this. Many times, occupational disease denials come down to a dispute over causation or insufficient evidence. Your lawyer will help you to review the denial and then decide on next steps, which may include mediation or appeal.

Tips for Success

It can be difficult to prove that an occupational disease is linked to your workplace, but there are some strategies that will help you improve your chance of success:

Work With an Experienced Lawyer

It’s important not to choose just any lawyer but a lawyer with extensive experience specifically in workers’ compensation cases. Ideally, choose a law firm that only does workers’ comp. Remember that it’s important that your lawyer know Minnesota law and the local court system, so choosing a local Minneapolis or St. Paul lawyer is key.

Be Thorough with Evidence

The more evidence you have, the stronger your case will be. Collect all your medical records and work history, any exposure logs that you have, any communication that you’ve had with your employer on the subject, and ask your lawyer about getting expert opinions.

Work with Your Doctor

Your doctor is a very important person in this process, so ask him or her to provide you with a detailed report of exactly why they would link your condition to your job duties. The clearer and more extensive the details in this report, the better your chances will be.

At the Atkinson Gerber Law Office in St. Paul and Minneapolis, we work exclusively on workers’ comp cases. Contact us today to talk about your case.