Understanding Legal Causation In Your Workers Compensation Case

If your treatment is more urgent, you may be allowed to see a doctor fast, but don’t assume that the insurance company is done checking your story.

In a worker’s compensation claim, once you notify your employer in writing of your injury or illness, the insurance company will take a closer look at your case before you can begin your treatment.

If your treatment is more urgent, you may be allowed to see a doctor fast, but don’t assume that the insurance company is done checking your story. In this type of case, it’s the burden of the injured worker to show legal causation whenever the insurance company questions a case.

seeing the workers compensation doctor

What Does Legal Causation Mean?

Missouri workers can receive workers’ comp benefits only for the injuries or illnesses that have been directly caused by their place of employment.

For a lot of these cases, the matter is pretty straightforward. Take a slip and fall, for instance, that results in the worker breaking their arm. The insurance company may approve the claim without pushing back since the case is clear: the employee slipped at work while on the clock, and broke their arm. Therefore, they need medical attention.

Other cases, however, may be more difficult than that, in which case the insurance company may question the legal causation, meaning the relationship between the injury and the place of employment.

One instance when the legal causation may be questioned is in mental health injuries. If, for instance, an employee goes through a traumatic event at work and develops PTSD, they may be legally allowed to seek mental health treatment covered by worker’s compensation benefits. But mental health conditions are complex and don’t always have such a direct cause.

In these complicated cases, the insurance company will get a medical expert to weigh in on the case and see if there is indeed a clear, direct link between your job and your injury. If their experts decide there isn’t, or questions if the job is the sole cause of your injury, your claim may get denied.

You Can Fight Back

Here, you have the burden to demonstrate that your injury or illness is eligible under worker’s comp laws. However, that may be difficult to achieve for most people because to do it you’ll essentially have to build a case with a lot of evidence and argue in your favor.

So it’s always best to bring in a professional to help. An experienced St. Louis worker’s compensation lawyer can argue in your favor with the insurance adjuster and make sure they reconsider their initial decision, by gathering:

  • Medical records
  • Witness testimony
  • Expert testimony
  • Other evidence deemed relevant

Speak With an Experienced Attorney

If you’ve hit a dead end with your worker’s comp case, don’t assume that you have no other options. Reach out to a St. Louis work injury lawyer for a free case evaluation. Based on your situation, an experienced lawyer can devise a good strategy to get you the full amount of compensation you are legally entitled to.

Speak With a Workers Comp Attorney

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Call (314) 361-4300
Updated: June 18, 2020