Workers’ compensation claims are like other types of insurance claims in that they rely on certain evidence to demonstrate your entitlement to benefits. But some claims may require more evidence than others.
If your insurer has denied your workers’ compensation claim or you are afraid they will, understanding the strongest types of evidence to submit in connection with your claim can be helpful. It also doesn’t hurt to talk to a workers’ compensation lawyer in New York about your legal options after a claim denial or delayed benefits.
Do You Need To Provide Evidence With a Workers’ Compensation Claim?
The National Safety Council reports that as many as 3.95 million medically consulted injuries happened in 2024 arising from workplace incidents. That same year, approximately 4,337 preventable injury-related deaths occurred due to occupational concerns, equating to 2.9 deaths per 100,000 full-time equivalent workers.
Workers’ compensation is a benefit available to most workers injured while performing their job duties. If this is your first time filing for workers’ comp, you may wonder about the types of evidence you need to submit.
Proving a workers’ compensation claim isn’t the same as proving a party’s negligence in a lawsuit. Workers’ compensation does not require proof of employer negligence, but the claimant still must establish the required elements of the claim, including a work-related injury.
To have a solid workers’ comp claim, you must show that you were injured and connect your injury to your work. How easy it will be to do this depends on the circumstances surrounding your injury.
For example, if you very clearly hurt yourself while you were at work, a manager wrote up an accident report, and you promptly sought medical treatment, it may be fairly easy to prove your claim. But if you were injured when no one was around, you didn’t pursue medical attention until days later, or other details of your accident were fuzzy, you might need more evidence to strengthen your claim.
In either case, certain documentation is required, and without that evidence, the insurer may deny your claim even if you very clearly suffered a workplace injury.
Evidence To Provide With Your Workers’ Compensation Claim
The most crucial evidence to provide with your workers’ compensation claim will be medical in nature. However, there are several types of medical evidence that serve different purposes. It may not be enough to simply submit the medical documentation you received after your emergency room visit.
Below are the types of medical evidence and other documentation that can support your workers’ compensation claim.
Medical Reports
Medical reports are written documents that detail your medical treatment. Authorized healthcare providers create these documents specifically to submit to the insurer and the New York State Workers’ Compensation Board (WCB) as part of a workers’ comp claim. They form the basis of your claim and must include pertinent information, such as:
- How the work related injury occurred
- The nature and severity of the injury
- The recommended treatment plan
- Any work restrictions arising from the injury
- Whether the injured person is disabled by the injury
Submitting documentation with this specific information, prepared by a medical professional, can go a long way toward supporting your claim for benefits. The medical narrative should expressly address whether the injury is causally related to your work activities. For example, the doctor might state that it is reasonable to believe the injuries are consistent with the stated workplace incident.
Diagnostic Test Results
Along with a medical report, you can submit other types of medical records to provide further evidence of the nature and severity of your injuries. For example, your doctor may have recommended X-rays, CT scans, MRIs, or other tests to better diagnose your injury. Submitting the results of these tests can provide additional objective documentation beyond the provider’s opinion of what is going on.
Treatment Records
Treatment records detail any therapeutic appointments or procedures you have undergone to help treat the injury. These may include physical or occupational therapy, hospital stays, specialist appointments, or surgeries.
Authorized providers generally submit treatment reports and bills directly through the workers’ compensation system. Claimants may separately request reimbursement for eligible out-of-pocket and travel expenses. Attending these appointments shows that you are doing your part to seek recovery and supports the severity of your injury and claim.
Expert Testimony
Expert testimony may be applicable if your injuries are complex. For example, workers who experience asbestos-related conditions like mesothelioma often rely on expert testimony to explain the relationship between the condition and their work duties and clarify the long-term prognosis.
If your medical documentation doesn’t clearly tie your injuries to your workplace, or if you are facing a claim denial, expert testimony may be required. A workers’ compensation lawyer in New York can help you with this.
Independent Medical Examinations (IMEs)
Insurance companies sometimes require independent medical examinations (IMEs) in addition to other medical evidence. These are examinations performed by a doctor of the insurer’s choosing who would provide an assessment of your injuries to either support or disprove your claim.
When the insurer begins requesting an IME, it is often a good time to contact an attorney. These assessments are not always fair or accurate, and they can complicate your claim.
Functional Capacity Evaluations (FCEs)
Finally, the insurer may request functional capacity evaluations (FCEs) to determine your ability to perform work-related tasks, such as standing, walking, and lifting. These documents act as valuable evidence to demonstrate that you are unable to perform the same work you did previously.
What To Do When Insurance Companies Challenge Your Medical Evidence
Filing a workers’ compensation claim is often straightforward, especially when you can clearly tie your injuries to the incident in question. But if the insurer challenges your medical evidence, this could hinder your claim and ability to obtain compensation.
Start by reviewing the IME and looking for any statements from the doctor that you disagree with. You may be able to challenge or rebut any IME findings through the workers’ compensation process.
You may need to collect additional objective evidence, such as X-rays, MRIs, and other test results, to demonstrate the severity of your injuries.
Finally, consulting a workers’ comp lawyer in New York can help you understand your options, litigation strategy and next steps.
Request a Consultation With a Lawyer for Workplace Injuries
If your claim has been denied or your insurer is challenging your evidence, speaking with a workers’ compensation attorney in New York may be wise. At Pyrros, Serres & Rupwani, we represent clients in connection with their workers’ compensation claims and third-party lawsuits.
Contact us today at 718-626-7730 to request a free consultation. Then review our guide to AI and workplace injury claims.
Frequently Asked Questions
Can witness statements strengthen a workers’ compensation claim?
Witness statements may help strengthen a workers’ compensation claim, especially if the insurer is challenging the circumstances of the accident or its work-related status.
What if your workers’ compensation claim is unfairly denied?
If the insurer unfairly denies your workers’ compensation claim, you may be able to challenge the denial with the help of a workers’ comp lawyer in New York.
What are the odds of winning a workers’ comp case in NY?
The odds of winning a workers’ comp case in NY depend heavily upon the evidence and the overall strength of the case.
