Diagnostic Testing Workers Compensation

Within Workers’ Compensation, Injured Workers are requested to undergo diagnostic testing. This article will discuss the importance of diagnostic testing and why it is important for the Injured Worker to get the proper diagnostic testing.

What is Diagnostic Testing?

Diagnostic Testing, within the field of medicine, is used to evaluate an individual’s medical status.  Testing takes many shapes and forms.  Testing can be used to determine as to whether someone has a particular diagnosis.   Sometimes, testing can be used to “rule out” as to whether an individual has a medical condition.

What are Examples of Diagnostic Testing?

Diagnostic Testing is used within the entire spectrum of medicine. This includes the fields of orthopedics, internal medicine, and neurology. In orthopedics, diagnostic testing can include x-rays, magnetic resonance imaging (MRI), computed axial tomography (CAT), and bone scans. In internal medicine, diagnostic testing can include echocardiograms, complete blood counts (CBC), colonoscopies, electrocardiograms, bronchoscopy, and oxygen saturation test. In neurology, diagnostic testing can include nerve conduction testing.

Why Is Testing Done in Workers’ Compensation? 

Testing is essentially done in workers’ compensation for two reasons.  First, diagnostic testing is done as part of an Injured Worker’s treatment.  For example, an Injured Worker falls down a flight of stairs and lands on their leg.   A diagnostic test, an x-ray, may be required to see if the leg is broken.  Second, diagnostic testing is done as Medical-Legal Discovery to prove up the Injured Worker’s claim. For example, an Injured Worker claims that they contracted tuberculosis in the workplace.  A diagnostic study of a TB test may be used to prove up the claim of injury.

What is “Medical Treatment” Testing?  

Medical Treatment Testing is done in accordance with Labor Code Section 4600. Labor Code Section 4600 (a) provides that the Injured Worker be provided “(a) Medical, surgical, chiropractic, acupuncture, and hospital treatment, including nursing, medicines, medical and surgical supplies, crutches, and apparatuses, including orthotic and prosthetic devices and services, that is reasonably required to cure or relieve the injured worker from the effects of his or her injury shall be provided by the employer.”

With respect to workers’ compensation medical treatment, it is implied that diagnostic testing is part of it.  Proper diagnostic studies are needed to provide proper diagnoses to medical conditions so that proper treatment can be provided.

How Does One Get “Medical Treatment” Diagnostic Testing? 

Medical Treatment Diagnostic Testing is obtained via a Treating Physician.  A Treating Physician can order diagnostic testing for the purposes of treating the individual.  In order to obtain Medical Treatment Diagnostic Testing, the Treating Physician must make a “request for authorization” (RFA) for the diagnostic study.   Once the request is made, the “request for authorization” is subject to utilization review (UR) from the Insurance Company for approval.   If the “request for authorization” is denied, it is then subject to an appeal through the Independent Medical Review (IMR) procedure.

What is “Medical-Legal” Diagnostic Testing?  

Medical-Legal Diagnostic Testing is authorized under a different section of the Labor Code. Pursuant to Labor Code Section 4620(a) “ a medical-legal expense means any costs and expenses incurred by or on behalf of any party, the administrative director, or the board, which expenses may include X-rays, laboratory fees, other diagnostic tests…for the purpose of proving or disproving a contested claim.” [emphasis added]

In sum, Medical-Legal Diagnostic testing is used to assist Injured Workers in providing that they have sustained injuries, sustained injuries to particular body parts or regions and sustained a level of permanent disability.   Also, testing can be used to determine future medical care needs as well.

Medical-Legal testing is diagnostic testing that is not done for the purposes of providing medical treatment.   This testing is used for the purposes of proving up an Injured Worker’s case.   For example, if there is a question as to whether an injured worker has carpal tunnel syndrome, then the provision of an EMG nerve study can be ordered to prove that there is carpal tunnel syndrome. Generally, Medical Legal Diagnostic Testing is ordered by evaluating physicians and not treating physicians.   This includes Qualified Medical Evaluators, Agreed Medical Evaluators, and Judge appointed evaluators called Regular Physicians.

What is Medical-Testing Used for?

Medical-Legal Diagnostic Testing can be used to prove up any aspect of a workers’ compensation case. This testing can be used to address issues such as injury arising out of and in the course and scope of employment, body parts or systems injured, total temporary disability, permanent disability, need for medical care, and entitlement to the voucher.

How Does one Get Medical-Legal Diagnostic Testing?

During the course of a workers’ compensation claim, an issue can become contested.  At that point, the parties can agree to or get assigned to a “Medical-Legal” evaluator.  Most commonly, evaluators will either be a Qualified Medical Evaluator which is a doctor assigned via a state-issued Panel or an Agreed Medical Evaluator who is mutually agreed upon by the parties.  These Evaluators, as part of their evaluation, may employ diagnostic testing upon the Injured Worker.   Other times, the Evaluators will contact the Insurance Company to get the approval for the testing.

Is Diagnostic Testing Important?

Yes. Diagnostic Testing is very important. For example, for the purposes of obtaining Permanent Disability, Diagnostic Testing can be used to assign the most accurate assessment of the Injured Worker’s Whole Person Impairment.  Therefore, an Injured Worker can lose money if they do not receive the proper testing.  Additionally, Diagnostic Testing can provide the basis for an Injured Worker getting proper medical treatment. In the AMA Guides for Evaluation of Permanent Impairment, 5th Edition, certain diagnostic study results are the basis for finding Permanent Whole Person Impairment. This Whole Person Impairment will be used to generate a Permanent Disability percentage.

What If I Need Advice?

If you would like a free consultation regarding your workers’ compensation claim, please contact the Law Offices of Edward J. Singer, a Professional Law Corporation. They have been helping people in Central and Southern California deal with their worker’s compensation cases for 26 years. Contact us today for more information.

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