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Substantial medical evidence is a term used in workers’ compensation to describe whether a doctor’s report contains the necessary requirements for the report to be regarded as credible evidence.  The criteria to determine whether a report constitutes substantial medical evidence are as follows:

  • The report must be framed in terms of reasonable medical probability.
  • The opinions must not be speculative.
  • The opinions must be based on pertinent facts and on adequate examination and history
  • The opinions must set forth reasoning in support of its conclusions.
  • The opinions must be based on a correct interpretation or application of the law.

When looking at a doctor’s opinion after an examination takes place, it is important to ensure that the doctor has been provided with the correct facts.  Sometimes a doctor will base his/her opinions on incorrect or misinterpreted information.  Sometimes, the injured worker may provide the doctor with the incorrect facts or be unable to recall certain facts correctly during an examination. 

It is always important to determine if the doctor relied upon the appropriate facts and supported the reasoning for his conclusions.  If not, the doctor’s report can be challenged at the time of settlement or Trial and may be disregarded as evidence for settlement purposes.

If a report is found not to be substantial evidence, the parties may need to secure additional reporting from that doctor or alternatively go through the entire process again with another medical examiner.

If you have questions about your workers' compensation injury and want to talk to an attorney in Fresno, please call 559-408-7436 or fill out the form to the right.

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Law Offices of Jeremy K. Lusk, Inc.

What does substantial medical evidence mean?