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We want injured workers to know how to beat insurance companies at the games they play.  One of the more common games they play is disputing your extent of injury.  Most of the time, the insurance company will accept liability for a very minor injury like a bruise, a sprain or a strain.  Then the adjuster denies coverage for the more serious injury like a meniscus tear or a herniated disc in your spine.  When this happens, it is called an extent of injury dispute.

Why Do Insurance Companies Deny Extent Of Injury?

Insurance companies deny extent of injury to save money.  A bruise is much cheaper to fix than something that requires spine surgery.  They get away with this because the law requires injured workers to prove what their injuries are.  The adjuster knows that if she denies something, most people will walk away and do nothing about it.  People who are severely injured should not walk away, they should fight for coverage.

What Evidence Will I Need?

When you decide to fight for treatment for all of your injuries, then you will need the right evidence.   If your doctor thinks you have an ACL tear in your knee, then you need to get an MRI report that shows it.  Maybe you think you have carpal tunnel syndrome – get an EMG test that shows it.  Whatever your doctor thinks you have based on a clinical exam needs to be confirmed with testing. 

Once you have a good diagnosis, you may need causation evidence to prove your extent of injury.  Causation means linking the work event to the diagnosis.  It’s easy to understand how falling onto an outstretched arm caused a broken arm.  You don’t need causation evidence for that.  But most people don’t understand the link between lifting and a herniated disc in the spine.  That does require causation evidence.  And you will definitely need causation evidence if you have degenerative problems in the same body part as the work injury. This type of evidence is usually presented through a letter of causation.

Dispute Resolution

After you obtain a good diagnosis and some causation evidence, you are ready to proceed with dispute resolution.  Dispute resolution is the litigation process established by the Division of Workers’ Compensation.  It starts with a Benefit Review Conference, which is like a mediation.  If that does not resolve the dispute, then you proceed to a Contested Case Hearing, which is like a trial.  You should get an attorney for the litigation process.  It won’t cost you anything up front and you only pay attorney fees if you get workers’ comp benefits.

Once you establish your extent of injury, you can get all of the treatment necessary for your recovery.  It also makes it easier to get you paid for longer periods of time off work.  And, finally, it often increases your impairment rating.