In California workers’ compensation cases, medical evidence drives everything—from your disability rating to how much your claim is ultimately worth. One of the most powerful tools for diagnosing and proving serious work-related injuries is the MRI (Magnetic Resonance Imaging).
But MRIs are more than just diagnostic.
They can directly impact the settlement value of your claim—especially when it comes to back, neck, shoulder, or joint injuries. If you’ve had an MRI—or are fighting to get one approved—here’s what you need to know.
What an MRI Shows (and Why It Matters)
Unlike X-rays, which only show bones, MRIs provide detailed images of soft tissue, including:
- Intervertebral discs (to detect herniations or bulges)
- Nerves and spinal cord (to identify impingement)
- Tendons, ligaments, and cartilage (to show tears or degeneration)
- Muscle inflammation or soft tissue trauma
This makes MRIs the gold standard for diagnosing:
- Herniated discs (lumbar or cervical)
- Sciatica or radiculopathy
- Rotator cuff injuries
- Meniscus tears in knees
- Repetitive use syndromes like carpal tunnel
In short: the more serious the objective findings, the stronger your claim.
Legal Relevance: How MRI Results Influence Your Case
1. Establishing Causation and Injury
California law requires a work injury to be “industrial” in origin to qualify for benefits. Your employer’s insurance carrier may claim that your condition is pre-existing or due to aging.
✅ An MRI that shows acute trauma, disc extrusion, or inflammation localized to the area of injury can defeat these defenses.
💡 Example: A worker injures their back lifting at UPS. MRI shows a new L4-L5 disc herniation with nerve compression. The QME finds industrial causation, strengthening the worker’s right to treatment and compensation.
2. Increasing Your Permanent Disability (PD) Rating
The QME or AME uses the MRI to assess whether your injury resulted in permanent functional limitations. These findings influence:
- Whole Person Impairment (WPI) per the AMA Guides, 5th Edition
- PD rating based on Labor Code §4660
- Settlement range under Stipulations or C&R
A soft tissue strain might yield 0–3% WPI, but a disc protrusion or shoulder tear with surgical recommendation can produce 15–40%+ WPI.
More impairment = higher settlement value.
3. Documenting Future Medical Care Needs
MRI results also help justify:
- Surgery (discectomy, rotator cuff repair, etc.)
- Injections or nerve blocks
- Physical therapy
- Pain management
More future treatment = larger future medical award or higher C&R value.
4. Supporting Work Restrictions & Vocational Benefits
The MRI may support permanent restrictions that prevent you from:
- Lifting over a certain weight
- Repetitive motions or prolonged standing
- Returning to your former job
This can entitle you to:
- A Supplemental Job Displacement Benefit (SJDB) voucher (Labor Code §4658.7)
- Vocational retraining funds
- A 100% PD award in extreme cases
⛔ What If Your MRI Is Denied?
This is one of the most common complaints we hear from injured workers:
“My doctor requested an MRI, but workers’ comp denied it.”
Unfortunately, under California’s Utilization Review (UR) process and Medical Treatment Utilization Schedule (MTUS) guidelines, insurers often reject imaging requests as “not medically necessary”—even when obviously warranted.
If this happens, you have rights:
- Your PTP (Primary Treating Physician) can file an RFA (Request for Authorization)
- You can appeal the denial through Independent Medical Review (IMR)
- You may request an expedited hearing under CCR § 10228 if delays are causing harm
- Your attorney can push for QME evaluation to override denial
Don’t let a denied MRI stall your case.
Without imaging, insurers will argue your injuries are “minor,” lowering your rating and settlement potential.
Real-World Case Example
Claimant: Warehouse worker, age 39
Injury: Lower back pain after lifting a heavy load
Initial Diagnosis: Lumbar strain
MRI Findings: L5-S1 disc herniation with moderate nerve root compression
Treatment: Epidural injections and surgical consultation
Outcome:
- WPI increased from 3% to 22%
- Settlement offer jumped from $6,500 to $48,000
- Worker received $12,000 SJDB voucher
- Lifetime future medical approved under Stips
MRI was the key factor in changing the case value—and the course of the injured worker’s life.
Pro Tip: Save Everything
Keep the following records to strengthen your case:
- Copy of your MRI results and radiology report
- Any denial letters from the insurance carrier
- The RFA submitted by your doctor
- QME or AME reports referencing the MRI
- A journal of your symptoms before and after imaging
These documents will help your attorney advocate for the highest settlement.
EFLL Can Help You Maximize Your Settlement
If your MRI was delayed, denied, or ignored—or if the insurance doctor is downplaying your results—you need legal backup. At Employees First Labor Law, we fight to ensure:
- You receive necessary diagnostic imaging
- Your impairment is properly rated
- Your settlement reflects your real medical condition
We’ve helped thousands of California workers get what they’re owed. Let us help you.
