A broken arm can affect work differently depending on the injured side, hand dominance, fracture location, treatment, written restrictions, job demands, and recovery course. A general statement that someone could not work does not show which task changed, who imposed a restriction, what the employer did, or how earnings were affected.

A work-loss record should connect each medical restriction to the actual job duty, employer response, time entry, pay record, and later change without turning a workplace observation into a medical opinion.

Start with the medical instruction in effect

  • Provider, visit date, injured side, diagnosis wording, treatment, cast or other device, and follow-up date retained exactly as recorded
  • Restriction on lifting, carrying, pushing, pulling, gripping, reaching, driving, typing, tool use, schedule, or other activity, with effective and review dates
  • Work note, clinical note, therapy record, later clarification, revised instruction, and release compared without assuming they say the same thing
  • Question that was not answered, conflicting restriction, missing date, or unclear body side assigned for qualified follow-up

Map the restriction to the actual job

  • Job title, employer, location, ordinary schedule, essential and occasional tasks, equipment, pace, repetition, weight, reach, grip, and two-handed demand
  • Task attempted, task avoided, assistance, modified method, reduced hours, reassignment, remote work, leave, or inability to perform described by date and source
  • Written job description compared with supervisor instructions, time records, production records, coworker observations, and the person’s own account
  • Temporary change separated from a permanent conclusion, and an employer decision separated from a clinician’s medical instruction

Keep medical and employment records in separate files

45 C.F.R. § 164.524 addresses an individual’s access to protected health information in a designated record set, subject to the rule’s procedures and exceptions. Track the provider or plan, date range, requested record categories, format, request, response, fee, missing item, and correction without assuming the employer holds the same file.

The definitions in 45 C.F.R. § 160.103 exclude employment records held by a covered entity in its role as employer from protected health information. Keep provider records, authorizations, employer-held notes, leave requests, human-resources files, and claim communications labeled by custodian and purpose rather than treating them as one medical chart.

Build a pay-and-time ledger from source documents

  • Pre-event schedule, pay rate, overtime, commission, bonus, differential, tips, leave balance, second job, and ordinary pay period
  • Missed date or shift, hours lost, leave used, unpaid time, reduced schedule, modified duty, pay change, and return date
  • Pay stub, payroll register, timecard, schedule, tax document, employer statement, bank record, and benefit statement retained in its original form
  • Gross pay, net pay, benefit deduction, leave payment, disability payment, and other source kept as different fields

Preserve how each record was created

North Carolina Rule of Evidence 803(6) addresses records of regularly conducted activity and their foundation. A timecard, payroll export, supervisor email, self-created calendar, and later summary can each be useful, but they have different authors, systems, timing, and foundations. Preserve the original source and its custodian.

Rule 1006 addresses summaries of voluminous writings, recordings, or photographs and requires originals or duplicates to be available as stated in the rule. A work-loss spreadsheet should therefore point back to each underlying record and make corrections visible.

Reconcile changes without predicting claim value

  • Restriction date, employer receipt, response, worked schedule, pay period, and medical follow-up aligned on one chronology
  • Difference between reported ability, observed performance, employer policy, and qualified medical opinion stated rather than hidden
  • Prior arm condition, later event, unrelated absence, ordinary seasonal change, and other possible explanation retained for review
  • No wage total treated as proof of liability, medical causation, permanency, or the legal value of a claim

The related guide to documenting dominant-arm and one-handed activity changes focuses on personal care, driving, household work, and other functions. This page owns the narrower connection between medical restrictions, job duties, employer actions, and pay records.

Rosensteel Fleishman Car Accident & Injury Lawyers provides general information about North Carolina personal-injury claims involving broken-arm work and income records. Medical, employment, and legal questions require review of the individual sources and current law.

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