If you want to win your workers' compensation case, one of the things you will need is good, solid evidence of your injuries, the pain they have caused you, and the treatment you have had to undergo. Keeping your own records of your injury and recovery process is a great way to ensure the evidence is solid and contains everything you need. But how do you keep good medical records for yourself? Here are a few tips.

1. Keep physical and digital records

Both physical records and digital records have their flaws. Physical records can go missing or become damaged if there is a fire or a flood. Digital records can become corrupted, and what happens if you somehow lose the password to access them? The best approach is to keep both physical and digital records. This gives you a backup, and it also gives you options when you need to send the records to someone. You can make and mail a physical copy, or you can email an attachment.

2. Start at the beginning

Even if you have to think back in order to do it, start your records with an account of how the injury occurred. Include as many details as you can remember as you write down exactly what happened, what treatment you immediately sought, and the symptoms that developed. If there is anyone who was present when you injured yourself, include their name and contact information at this point. This enables anyone reading the records to contact someone and verify your claims if needed.

Keep the records in chronological order as you go. Try to make entries every other day, if not daily, so that information does not get skipped.

3. Keep track of what treatments you try

Many workers' comp claims get denied because the person making the claim did not follow up with treatment as recommended by the doctor. If you don't keep up with your treatment, the insurance company will be able to argue that your ongoing pain is your fault and due to a lack of treatment. To ensure this argument is never made against you, be very thorough in your descriptions of treatments in your medical records.

For instance, do not just say "took ibuprofen." Say "took 2 ibuprofen at 9:00 pm for moderate leg pain." Also record your doctor's treatment instructions after any medical appointment that you have. This way, someone reading the journal can refer back to the treatment instructions and see that, according to your records, you followed them.

4. Include your receipts

One of the hardest parts of making a workers' comp claim is trying to gather compensation for any medical expenses you paid for out of your own pocket. You don't want to be left calling doctors and pharmacies, trying to regather records of what you spent. Instead, include copies of all receipts in your medical records book. Scan the receipts so you have digital copies.

5. Have your doctor sign the records

When you visit a doctor, bring your medical records book with you. Ask them to read through it and offer their signature. Usually, as long as your doctor agrees that everything is accurate, they will be happy to sign. Their signature adds credibility to your medical records. They can also give you copies of your official medical reports that you can add to your files.

To learn more about keeping good medical records related to your workers' comp case, speak with a workers' compensation attorney like David Helfand PA. An attorney can let you know if there are specific things to include related to your unique injuries and accident circumstances. 

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