Start With the Medical Evidence
A chart-based case review is a structured analysis of medical records for a specific legal or claims question. It organizes documented facts and medical opinions so adjusters, attorneys, and injured workers can assess what the evidence supports, without promising a particular claim outcome.
Set the review’s scope and format around the issue in dispute and the claim’s current stage. Our team reviews records and prior opinions to clarify the medical evidence; case review and consultation services do not involve a new physical examination.
That distinction matters when choosing the right evaluation. A chart review analyzes existing documentation, while an independent medical examination (IME) may include a medical history and physical examination. In Defense Base Act claims, the U.S. Department of Labor’s DBA FAQ provides general claim context, but case-specific questions require attention to the applicable law and record.
Define the Review and Its Method
A medical chart reviewer analyzes claim records to summarize treatment, diagnoses, and test findings, then assesses how the evidence relates to the reported work injury or exposure. Depending on the referral, the review may address causation, treatment support, work capacity, restrictions, or impairment.
The work begins with clear referral questions and a record set organized in chronological order. The reviewer traces the reported event or exposure through medical history, examinations, tests, treatment, and response to care, while noting prior conditions and gaps in the file.
A sound analysis separates documented facts from medical opinions. It identifies inconsistencies and unanswered questions without treating missing information as proof of any particular explanation. For a practical overview of how chart findings can be connected to legal questions, see bridging the gap between medicine and law.
The written findings should cite the records that support each opinion and state what the available file cannot establish. In federal claims, the reviewer can identify documents relevant to the applicable program and claims process, but should not assume that requirements are identical across programs. The Department of Labor’s DBA FAQs describe the Defense Base Act’s relationship to the Longshore and Harbor Workers’ Compensation Act and caution that the FAQs are general information, not a substitute for case-specific legal research.
NorCal Medical Consulting conducts chart-based case reviews without a new physical examination, using existing records and prior opinions to address the questions set for review. A clear scope, requested format, and deadline help our physicians tailor the written report to the needs of the legal team, including when the file concerns a federal claim.
Connect Review Products to Claim Questions
Choose a review format to answer the claim question at hand. A chronology arranges relevant events by date, while other products compare allegations with records, summarize an issue, assess case risks, or examine charges.
Chronology. Tracks symptoms, diagnoses, visits, treatment, and outcomes in date order, with references to records or providers. It can help locate gaps or inconsistencies and compare medical events with exposure dates.
Case overview. Compares the alleged injury and related claims with the medical documentation, helping identify supported conditions, discrepancies, and missing evidence. It is particularly useful when the claim involves multiple conditions or voluminous records.
Executive summary. Presents a concise, issue-focused narrative of the medical evidence, such as treatment progression, causation questions, or claimed damages. This format distills key findings for quick reference.
Case assessment. Evaluates the apparent strengths and risks of a claim, including possible pre-existing conditions and alternative explanations, based on the available records. It provides a balanced view of the evidence to inform decision-making.
Billing analysis. Separates charges related to the alleged injury from other care and compares bills with the records to assess relevance and documented treatment. This helps identify billing discrepancies or unrelated charges.
The right deliverable depends on case complexity, litigation stage, and intended use. A chronology may help prepare for discovery or depositions; an executive summary or case assessment may support mediation, trial preparation, or settlement evaluation. NorCal Medical Consulting shapes chart-based case reviews around the medical issues and records relevant to the claim.
Whatever the format, the work product should make findings traceable to the underlying documentation. A summary or analysis can organize evidence, but it does not replace the medical records or guarantee a claim outcome. For more detail on how these formats answer distinct questions, see [the five core medical-legal review types](./legalmedical-case-review-aligning-medical-findings-with-claim-arguments-1#the-five-core-review-types).
Understand the IME’s Role
An independent medical examination (IME) is an evaluation by a physician asked to give an opinion on medical issues in a workers’ compensation claim. The physician may review records, take a history, and examine the worker. An IME is commonly requested when the parties disagree about a medical issue.
Referral questions often address diagnosis, whether work caused or aggravated a condition, the need for treatment, work capacity, or impairment. The examiner provides an assessment for the claim, not ongoing care, and the examination does not create a treating doctor–patient relationship.
The IME report is medical evidence considered alongside treating records and other claim information. It may influence decisions, but it does not by itself determine benefits or resolve a dispute. For federal claims, the applicable framework matters: the Department of Labor’s DBA FAQ describes the Defense Base Act as extending the Longshore and Harbor Workers’ Compensation Act to many overseas government-contractor employees.
An IME differs from a chart-based review because it includes an examination of the worker. Records analysis can still help frame the referral questions or prepare the physician to assess the history. NorCal Medical Consulting provides both IMEs and chart-based reviews, including evaluations for federal LHWCA and DBA claims.
For a broader explanation of the examination process and its purpose, see our guide to the role of independent medical examinations.
Prepare for and Respond to an IME
Prepare for an independent medical examination (IME) by confirming the appointment details, gathering requested materials, and planning to describe your condition accurately. Requirements about representatives or recording vary by claim and jurisdiction, so read the instructions rather than relying on assumptions.
How should an injured worker prepare for an IME?
Confirm the date and location, and check which documents to bring and whether anyone may accompany you or record the visit. Bring photo identification, a current medication list, and any records or imaging specifically requested. Do not assume the examiner has received or reviewed every treating-provider record.
Describe how the injury happened, the care you received, your current symptoms, and how they affect specific work and daily tasks. Be accurate: distinguish what you know from what you do not remember, and do not exaggerate, minimize, or guess. During physical testing, follow instructions and explain if a movement causes pain or you cannot complete it. Review IME preparation guidance before the appointment.
Can an injured worker refuse an IME?
The consequences depend on the workers’ compensation system, the authority for the request, and applicable rules. In an LHWCA claim, 33 U.S.C. § 907 addresses medical care and examinations; the notice and legal basis for a specific examination matter. The Department of Labor’s DBA FAQ explains that the Defense Base Act extends the LHWCA, but directs readers to applicable law for case-specific conclusions.
Do not ignore an appointment. Raise scheduling or medical concerns promptly with the claims representative or attorney, and seek claim-specific legal advice before refusing or missing an examination. NorCal Medical Consulting conducts independent evaluations and claim reviews, but does not determine a worker’s legal obligations.
Address Disagreement, Payment, and Records Access
When an IME and treating physician disagree, identify the precise issue and compare the reasoning and records behind each opinion. An IME does not automatically override the treating physician; examination findings, imaging, treatment history, and functional capacity information may help explain why their conclusions differ.
Ask a claims representative or attorney to consider whether the treating physician should respond to a specific point, whether relevant evidence has emerged, or whether another qualified evaluation is warranted. A chart-based review by NorCal Medical Consulting can organize the supporting records and clarify the medical reasoning. Continue care as directed and document changes in symptoms or function. See guidance on weighing conflicting medical opinions.
Who pays for an IME in a workers’ compensation or federal claim?
Payment depends on who arranged or authorized the examination and the rules that apply. In a state claim, the employer or insurer generally pays for an examination it requests or authorizes; a separately arranged evaluation may be treated differently under state law and the evaluator’s agreement.
The Defense Base Act generally incorporates provisions of the Longshore and Harbor Workers’ Compensation Act, but responsibility for an examination depends on the specific claim and applicable rules. Do not assume an examination is an OWCP-approved medical benefit simply because the claim is federal. Confirm the referral terms, authorization, and billing requirements. The Department of Labor’s DBA FAQ provides general federal-claim context, not a case-specific determination.
Can workers’ compensation insurers access medical records, and can a worker limit a release?
Insurers may obtain claim-relevant medical information when applicable law permits or requires disclosure; HIPAA does not itself block disclosures authorized by those laws. The scope depends on the jurisdiction, claim, legal basis, and any valid authorization.
A worker may ask to limit a release to specified conditions, records, or dates, but a provider may disclose information without a signed release where law allows or requires it. Review forms before signing and ask a claims representative or workers’ compensation attorney about broad requests. Refusal may affect processing when records are legally required or reasonably necessary to evaluate the claim.
Make Federal Reports Explain Their Reasoning
A useful expert medical report answers the referral questions and shows how the physician reached each opinion. It identifies the records and examination findings considered, separates documented facts from medical judgment, and addresses significant contrary evidence and limits in the available information.
The analysis should connect evidence to disputed medical issues, such as diagnosis, work-related causation, functional impairment, or the need for treatment. It should not decide legal questions outside the expert’s role. Our physicians’ federal claim evaluations focus on impartial findings and written reasoning grounded in the records and examination.
For opinions offered in federal court, Federal Rule of Evidence 702 requires the proponent to show that it is more likely than not the opinion will help the factfinder, rests on sufficient facts or data, uses reliable principles and methods, and applies them reliably to the case. Courts use the Daubert gatekeeping framework, so a report that makes its reasoning and limitations clear is easier to evaluate.
In Defense Base Act claims, the Department of Labor’s DBA FAQ provides general information about coverage and OWCP processes, but cautions that it may not be complete or current and is not an authoritative statement of agency policy. OWCP’s Division of Longshore and Harbor Workers’ Compensation administers DBA claims; unresolved disputes may proceed to a formal hearing and appeal. Those procedures provide context, not a substitute for medical analysis or case-specific legal research.
Track DBA and LHWCA Timing Separately
How long does a Defense Base Act claim take to resolve?
There is no fixed deadline for resolving a Defense Base Act (DBA) claim. A straightforward matter may resolve in months, while disputes or appeals can take years, depending on medical evidence, agreement about work-related causation and disability, and whether benefits or settlement terms are contested.
An OWCP conference, formal hearing, or appeal can add substantial time. That general Department of Labor FAQ is not a substitute for claim-specific legal research.
Overall resolution is separate from benefit-payment timing. Compensation is generally due within 14 days after the employer or carrier receives notice of disability, subject to statutory exceptions. Complete, organized records and timely filings may prevent avoidable delays, but they cannot guarantee a schedule or outcome.
For federal claims, NorCal Medical Consulting reviews medical records and prepares written reports that connect clinical findings to questions about causation and disability. A clear chronology can help parties locate relevant evidence as a claim proceeds through review or dispute.
What is the statute of limitations for a claim under the LHWCA?
Under 33 U.S.C. § 913, an employee generally must file a Longshore and Harbor Workers’ Compensation Act (LHWCA) claim within one year after injury. For an occupational disease that does not immediately cause disability, the general period is two years from when the employee knew or should have known of the relationship among the disease, disability, and employment.
Separately, 33 U.S.C. § 912 generally requires notice of injury within 30 days, with different timing for occupational diseases. Exceptions can apply, including rules involving compensation paid or required notice. The injury and awareness dates, disability history, and prior claim activity all matter, so verify the applicable deadline against the facts before relying on a filing date.
Keep the Record Traceable
A useful chart review makes relevant evidence easier to find, ties each medical opinion to its supporting record, and identifies what remains uncertain. That traceability helps attorneys, adjusters, and injured workers see what the file establishes and where additional records or clinical analysis may be needed.
NorCal Medical Consulting provides chart-based case reviews and independent medical evaluations, with written findings grounded in the available documentation. A review can inform medical and claim evaluation, but it cannot guarantee a particular decision or replace legal advice tailored to the claim.
Return to the referral questions when assessing the report. A focused, transparent analysis helps each reader distinguish documented facts from unanswered issues and decide what further review may be appropriate.
