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Medical Evidence

medical professional

This information explains how to locate and present important medical evidence to support and strengthen your appeal.

Medical evidence is a form of expert evidence. Medical evidence can take many forms. It can include a doctor's clinical notes or records, and the forms a doctor completes and sends to WorkSafeBC on a regular basis. Medical evidence may also include first aid records, emergency room and hospital records, diagnostic testing results, CT/MRI/x-ray reports, and permanent functional impairment evaluations.

Medical evidence or a medical opinion could come from your doctor, a WorkSafeBC doctor, your specialist, or an independent health professional. Psychologists, chiropractors, occupational therapists, ergonomists, physiotherapists, or occupational hygienists may also provide medical evidence.

Medical literature, research, and articles are not medical evidence, but they may help us understand the medical evidence. A worker's own statement about his or her own condition is evidence, but is not expert evidence.

When You Need Medical Evidence  more ...

You may need medical evidence if the evidence already on your WorkSafeBC claim file is not sufficient or you disagree with it. For example, you might submit new medical evidence when your appeal requires additional medical evidence to fully answer questions like these:

  • What is the nature and extent of my injury or disease?
  • Did my employment cause, activate, aggravate, or accelerate the injury or disease?
  • Am I disabled from working because of the injury or disease?
  • If I am disabled from working, is the disability temporary or permanent?
  • If I was temporarily disabled, has the disability resolved or plateaued (stabilized)? When?
  • What limitations (things a worker cannot do) and/or restrictions (things a worker should not do) arise from the injury?
  • If my injury or disease is permanent, what is the nature and extent of the permanent impairment (disability)?
  • These questions may also require the evaluation of non-medical evidence, such as the physical requirements of work duties, a worker's motivation to return to work, the availability of the work, etc. They may also require the application of WorkSafeBC policy. Medical evidence does not always determine the outcome, but it is necessary that we consider it when deciding an appeal.

How to Get a Good Medical Opinion  more ...

How to get a good medical opinion depends on the medical issue. In all cases, however, you should explain the present situation and tell the medical expert what your goal is on the appeal.

You should provide the medical expert with copies of:

  • The Review Division decision under appeal
  • The WorkSafeBC decision that the Review Division reviewed
  • The medical information from the claim file that relates to the matter under appeal
  • Any opinions from WorkSafeBC doctors that relate to the matter under appeal
  • The memo of the WorkSafeBC officer who made the decision that the Review Division reviewed, giving their reasons for the decision
  • Other medical information that you may have gathered that is not on the claim file

You should consider how you are going to tell the medical expert about the non-medical facts which they may need for the medical opinion. You could:

  • Write a letter describing the matters that are relevant to the issues under appeal. For example, your letter could describe how the injury occurred, the employment activities, the physical requirements of the job, etc.
  • Give the medical expert information already on the claim file about those things. For example, the risk factors involved in the employment. If the description on the WorkSafeBC file is not accurate and/or complete, you may want to explain or clarify or provide further information.
  • Draw a picture, take a photograph(s) or a video of the work site and/or the employment activity.
  • Invite the medical expert to come and view your work site and/or employment activity.

In some cases, there is other information that you should give to the medical expert, such as:

Medical records/documents or other information from prior WorkSafeBC files and/or other treating medical professionals. WorkSafeBC policy that applies to the matter under appeal. We must apply the WorkSafeBC policies relevant to an appeal.

In all cases, ask the medical expert specific questions to fully explain the opinion you have requested them to provide.

How WCAT Weighs Medical Opinions  more ...

When a WCAT vice chair is deciding an appeal, they have to weigh all of the evidence, both medical and non-medical. In an appeal respecting the compensation of a worker, if the evidence supporting different conclusions on an issue is evenly weighted, we must decide the issue in your favour as a worker.

A vice chair weighs the evidence and makes findings of fact, including the credibility of a witness, and applies the law and WorkSafeBC policy to these findings of fact. The vice chair weighs the medical evidence along with all the other non-medical evidence when making findings of fact and deciding an appeal. The vice chair decides how much significance to give to a particular medical opinion.

When weighing a medical opinion, a vice chair considers the following factors:

  • The expertise of the person providing the opinion. This includes their training and education as well as their qualifications.
  • Whether the subject matter of the opinion is within their expertise.
  • Whether the facts behind an opinion are clearly set out, accurate, and complete, with any inconsistencies carefully explained.
  • Whether the opinion addresses the issue(s) requiring medical input, such as the likely cause of an injury.

When there is conflicting medical evidence, the vice chair might consider the following factors when deciding what medical evidence is more persuasive:

  • With respect to matters of work causation, the relative familiarities of the experts with the work duties.
  • If there is WorkSafeBC policy on the condition, such as an activity related soft tissue disorder, to what extent the opinions address the applicable guidelines.
  • With respect to the correct diagnosis of the worker's condition, the relative expertise of the experts and their knowledge of all the relevant medical information and investigations.
  • The nature and extent of the expert's reasoning for their opinion.

Workers' Compensation Appeal Tribunal. 150-4600 Jacombs Road, Richmond BC V6V 3B1 * All rights reserved.
Tel. (604) 664-7800 * Toll Free within BC 1 (800) 663-2782 * Fax (604) 664-7898