In a previous post, we introduced the concept of extent of injury disputes.  The most important thing to know about these types of cases is that the injured worker has the burden of proof.  This means that you have the responsibility of proving what your injuries are.  Beyond that, you have to prove that the work accident actually caused your injury.  This type of evidence is usually presented in a “causation letter” from a doctor.  In this post, we will look at a causation letter and extent of injury disputes.

What Your Injuries Are

It sounds easy to prove what your injuries are.  So many people get this wrong.  It’s not as simple as presenting an MRI report that says you have a rotator cuff tear.  That proves you have a rotator cuff tear.  It doesn’t prove how you got it.  You have to prove that you have it AND how you got it.  Proving how you got it will require expert medical evidence.  A doctor has to explain how the event that occurred at work caused the rotator cuff tear.  So, the event has to be something that science says can cause a rotator cuff tear.  If you got kicked in the shin, that doesn’t make sense as the cause of a rotator cuff tear.  But, if you fell onto an outstretched hand trying to break your fall, that’s a different story.  And that’s the basis of a causation letter.

The Elements Of A Good Causation Letter

You will want to obtain a causation letter from one of your doctors if possible.  A treating doctor or a referral doctor are your best bets.  If you are treating with a company doctor, like Concentra, you may not be able to get it from the treating doctor.  In that case, you will want to ask the doctor who Concentra sent you to for a surgical consult. 

Clear Diagnosis

A good causation letter starts out with a clear diagnosis.  Internal derangement of the shoulder is not a clear diagnosis.  That is a general diagnosis that could cover a lot of different things, even degenerative conditions.  Rotator cuff tear is a clear diagnosis.  SLAP tear is a clear diagnosis.  Internal derangement is not.

Mechanism Of Injury

After establishing the diagnosis, you want the doctor to explain your mechanism of injury.  Mechanism of injury includes all of the details about how you got hurt.  ALL of the details.  You can’t just say, “I fell and hurt my shoulder.“  Why did you fall?  Did you fall forward or backward, or sideways?  Did you twist as you fell?  How did you land?  What hit the ground first?  Did you land on your hand?  If so, what happened to your shoulder?  The details about how falling resulted in damage to your shoulder are important.  The doctor has to show that she understands what happened.  That is the only way she can truly explain how the accident caused your injury.

Forces Caused By The Work Accident

Third, you want the doctor to describe the forces that were caused by the work accident.  Was there blunt trauma from landing on your shoulder?  Was there a rotational force from twisting the arm as you held on to a rail to catch yourself?  Did you have a hyperflexion of the shoulder?  By understanding all of the details of the mechanism of injury, the doctor can present the forces that were in play.  Forces make for a great causation letter.

How Did Those Forces Cause Your Injury

Next, after the injurious forces are defined, the doctor must explain how those forces acted upon your body to cause the shoulder injury.  How did the rotational force from the twisting of your arm cause a tear in your shoulder?  How did the blunt force from landing on your elbow cause damage in your shoulder?  It has to make sense.  Slipping and falling backwards onto your butt isn’t a likely cause of bruises and scrapes on your knees.

Reasonable Medical Probability

Finally, ask the doctor to include a sentence stating that she gave her opinion within a reasonable degree of medical probability.  That’s just fancy language that makes judges happy and helps you meet your burden of proof.  It means that the doctor’s opinion makes sense from a medical and scientific standpoint.  If the doctor can reference a medical journal article about how twisting causes rotator cuff tears, that helps too.

A causation letter is the single most important piece of evidence in an extent of injury dispute.  As you can see, it is a very complex thing.  It’s hard to get a doctor to write one because it takes time and effort.  If you need help getting one, that’s a good reason to hire a lawyer.

Comment below if you have any thoughts on causation letters or extent of injury.

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