Workers comp chronology sample: a left hand crush injury
Answer in brief: a workers comp chronology tracks 3 threads beside the clinical story: work status and restrictions at every visit, each treatment request matched to its decision, and the date of maximum medical improvement with the rating method quoted. This sample shows them on a 134-page synthetic file, no real patient, written to be state-neutral.
Limits: Every sample here is synthetic: no real patient, invented names and invented page numbers. Rules quoted for QME and Social Security work come from the cited regulation, read 2026-11-12; they are not legal advice, and facts about other sample libraries come from each publisher's page on that date.
The synthetic file
| Worker | Patient E, 39, machine operator at a metal stamping plant. Invented. |
|---|---|
| Injury | Left hand caught in a press on 2024-07-08 |
| Who reads it | The treating hand surgeon writing status reports, a physician doing a records review for the carrier, or an examiner rating impairment |
| File | 134 pages from 6 sources: employer incident report, emergency department, hand surgeon, occupational therapy, functional capacity evaluation, carrier and utilization review letters |
The sample workers comp chronology
12 rows. "Work status" is what the record says about work on that date. "Authorization" pairs each request with its decision.
| Date | Source | What the record says | Work status | Authorization | Page | Note |
|---|---|---|---|---|---|---|
| 2024-07-08 | Employer incident report | Left hand caught in press during die change. Supervisor notified 10:40. | n/a | 1-2 | Non-medical A1 | |
| 2024-07-08 | Riverside ED, G. Novak, MD | Swelling, laceration over dorsum. X-ray: "displaced shaft fractures of the 3rd and 4th metacarpals." Splinted, sutured. | Off work | 5-11 | Verbatim | |
| 2024-07-10 | M. Brandt, MD, hand surgery | Recommends open reduction and internal fixation. | Off work | Surgery requested 07-10 | 20-23 | A2 |
| 2024-07-11 | Carrier letter | Surgery authorized. | Approved 07-11 | 24 | Closes 07-10 request | |
| 2024-07-15 | M. Brandt, MD | Operative report: plate fixation of the 3rd and 4th metacarpals. | Off work | 26-29 | ||
| 2024-08-26 | M. Brandt, MD | X-ray: "healing, hardware intact." Start occupational therapy. | Modified: "1-handed duty, no use of left hand" | OT requested 08-26; approved 08-27 (p. 36) | 33-36 | |
| 2024-09-03 | Carrier letter | Employer has no 1-handed work available. | Remains off (no modified work) | 37 | Conflict A3 | |
| 2024-08-28 to 2024-11-20 | Lakeside Occupational Therapy | 24 visits. Left grip 12 kg to 28 kg; right 44 kg. Composite fist achieved at visit 18. | 40-88 | Series | ||
| 2024-11-25 | M. Brandt, MD | "Lift up to 20 lb with left hand, no impact tools." | Modified duty from 2024-12-02 | 90-92 | ||
| 2025-01-13 | Summit Rehab, FCE | Functional capacity evaluation: valid effort per the evaluator. Left grip 30 kg. Limits on sustained power grip. | Per FCE report | 95-110 | A4 | |
| 2025-02-03 and 2025-02-14 | M. Brandt, MD; utilization review | Requests hardware removal for tendon irritation over the plate. UR: not certified, "symptoms not documented on 2 consecutive visits." | Modified duty | Requested 02-03; denied 02-14 | 115-119 | A2 |
| 2025-03-17 | M. Brandt, MD | "Maximum medical improvement reached as of today." Impairment "8 percent upper extremity, AMA Guides 6th Edition." Permanent restriction: no impact tools. | Permanent restrictions | 125-130 | MMI A5 |
Annotations: why each row reads the way it does
- A1, the incident report sets the mechanism. The first row is not medical, but it fixes when, where and how the injury happened. Later histories are read against it.
- A2, every request gets a decision. The Authorization column pairs each request with its outcome and date. An open request with no decision is a gap in the file, and it is the first thing a claim reviewer asks about. The denied hardware removal also explains why symptoms continue after MMI.
- A3, medical status and actual status can differ. The surgeon released the worker to 1-handed duty; the employer had none. Both facts sit in the table, with the carrier letter cited, so nobody reads the time off as a medical restriction.
- A4, an FCE is its own source. The evaluator's validity statement is quoted as the evaluator's, not as the surgeon's finding. If the surgeon later adopts or rejects the FCE limits, that goes in its own row.
- A5, quote MMI and the rating method exactly. The date, the impairment figure and the edition of the AMA Guides are quoted because states differ on which edition applies and a rating under the wrong edition may need to be redone. The chronology records what was written; whether the edition is correct for the state is for the rater.
What a workers comp chronology adds to a base table
- Work status at every visit, using the record's own words for restrictions.
- The authorization trail: request, decision, date, page. Requests and decisions often sit in different parts of the file.
- Non-medical rows that change the claim: the incident report, employer letters about available work.
- The MMI row, quoted, with the rating method and any permanent restrictions or future care.
Common misses in comp chronologies
- Work status left in the note text, where it cannot be scanned across visits.
- Requests listed without decisions, or decisions without the request they answer.
- FCE results attributed to the treating doctor.
- An MMI date paraphrased as "around March", when the exact date can change benefits.
- Employer and carrier letters left out because they are "not medical records".
Questions about workers comp chronology samples
Does this sample follow a specific state's rules?
No. It is written to be state-neutral. State forms, report names and rating editions differ; add the columns your state's reports ask for. California panel work has its own sample on the QME page.
Should utilization review letters go in the chronology?
Yes. They explain why care did or did not happen, and they carry dates that matter to the claim.