How does a medical expert act in a workplace accident?

You suffer an accident at work. You go to A&E, undergo tests, are given sick leave... and suddenly, doubts begin to creep in.

Am I being properly assessed? Have I been discharged too soon? Can I really return to work in this condition?

If you feel this way, you are not alone. And this is where a key figure comes in: the medical expert.

In this article, we explain how a medical expert acts in a workplace accident, how they relate to work disability and expert reports, and why their report can be the difference between fair compensation and further injustice.

What is a medical expert?

A medical expert is a professional with health and legal training who specialises in objectively and technically assessing a person's state of health in the context of legal or administrative proceedings.

Their work consists of:

• Assessing injuries and sequelae

• Issuing expert reports that are valid before mutual insurance companies, courts or insurers

• Determining whether there is incapacity for work and to what degree

• Defending their assessment in the event of a claim

In workplace accidents, their role is essential in defending the rights of the worker.

What is a workplace accident?

According to the General Social Security Law, a workplace accident is considered to be any bodily injury suffered by a worker during or as a direct consequence of the work they are doing.

This includes:

• Falls

• Cuts, blows or entrapments

• Injuries due to overexertion

• Accidents while travelling to work

• Exposure to hazardous substances or conditions

In all cases, there may be physical, psychological or functional repercussions that must be properly assessed.

Why is a medical assessment important after a workplace accident?

Because often the assessment made by the mutual insurance company, the company or the National Insurance does not accurately reflect the actual consequences for the worker.

Do any of these situations sound familiar?

• Premature medical discharge

• Disability denied

• Return to work without being fully recovered

• Unfair financial assessment of the consequences

• Difficulties in accessing compensation

In these cases, a medical expert report provides you with technical and legal arguments to support your claim.

How does a medical expert act in a workplace accident?

Let's take a step-by-step look at how they intervene:

1. Review of documentation

The expert analyses all the medical information related to the accident:

• Emergency reports

• Mutual insurance company reports

• Examinations and diagnostic tests

• Treatments carried out

• Clinical progress

• Medical discharge reports or disability denial reports

It is essential to provide all possible documentation so that their assessment is complete.

2. Independent medical examination

The medical expert will schedule an in-person evaluation:

• Analyses the current state of your injuries

• Assesses physical, functional or psychological sequelae

• Verifies whether or not you can perform your professional activity

• Examines whether the limitations are permanent or temporary

Unlike other reports, this analysis is objective, impartial and focused on your reality as a worker.

3. Determination of the causal link

One of the key functions of the medical expert is to demonstrate the causal link between the accident and the current injuries or consequences.

This means that the expert uses medical arguments to justify that the ailments you suffer are a direct consequence of the accident at work.

Without a causal link, the claim loses strength. That is why this point is crucial.

4. Assessment of the degree of disability

The expert assesses whether you are in a situation of:

• Temporary disability (still in the process of recovery)

• Permanent partial disability (you can work with limitations)

• Permanent total disability (you cannot practise your usual profession)

• Absolute incapacity (you cannot practise any profession)

• Severe disability (you depend on others for basic activities)

Based on this, they determine whether you are entitled to:

• Continue on sick leave

• Apply for a pension

• Claim for sequelae

• Compensation for damages

5. Drafting of the expert report

With all the information, the expert prepares a complete medical expert report, which includes:

• Description of the accident

• Medical evolution

• Diagnoses

• Current examination

• Assessment of bodily injury

• Technical conclusions

• Legal recommendations

This report can be submitted to the INSS, the court or the insurer, as appropriate.

What is the value of this report?

The medical expert report is valid and well-founded technical evidence.

It can be used to:

• Challenge a medical discharge that you consider unfair

• Support a claim for incapacity for work

• Claim compensation for sequelae

• Defend your rights before a medical or labour tribunal

• Negotiate with the insurer or company

And if necessary, the expert can ratify the report in court and defend it before a judge.

When is it essential to have a medical expert?

When you are discharged from hospital without having recovered

• If you are denied incapacity for work

• If you believe that the mutual insurance company has minimised your injuries

• If you are not satisfied with the compensation received

• If you have been dismissed on the grounds that you can return to work

What is the relationship between the expert opinion and incapacity for work?

Very direct. The medical expert report is one of the fundamental bases for requesting or challenging:

• Permanent incapacity

• Review of degree

• Claim before the INSS

• Legal appeals for denied pensions

• Assessment of compatibility between work and ailments

In short, without a medical expert report, your claim loses strength and arguments.

Conclusion

A work accident can not only leave you with an injury, but also with an uncertain professional and financial future.

And on that path, the medical expert is your key ally.

They help you demonstrate what you are going through, translate it into legal terms, and claim what you are entitled to, whether it be a pension, long-term sick leave or compensation for sequelae.

At MataSeguros, we work with medical experts specialising in workplace accidents and accompany you throughout the claims process.

Have you had a workplace accident and don't know how to claim? Contact us and we will give you a hand.