Shoulder injuries are one of the most common workplace injuries that cause people to miss work. They result in the longest periods of temporary disability benefits, averaging around 168 days (about five and a half months).
This is much longer than the time missed for other joint injuries, such as those to the back, knee or hand.
Whether from a sudden fall or repeated heavy lifting, these severe and debilitating shoulder injuries often require surgery to repair for the worker to eventually return to their duties.
If your shoulder issue needs this type of surgical repair, the workers’ compensation claims process can seem confusing. With this guide, you will learn how to obtain workers’ comp for a shoulder injury requiring surgery. It will teach you about qualifying injuries, typical settlement amounts, how surgery impacts your workers’ comp claim and what to expect throughout the process.
Common causes of workplace shoulder injuries
Shoulder injuries can happen at any workplace, including office or desk jobs. However, they are most prevalent in physical labor roles like health care, warehouses or factories where workers face greater injury risks. A number of day-to-day work activities and hazards put strain on the shoulders and can lead to injuries over time, such as:
- Repetitive overhead motions
- Heavy or improper lifting
- Slips, trips and falls
- Accidents and struck-by incidents
- Poor ergonomics
Simple tasks like opening stuck windows or doors can also trigger injuries if you use too much force. Proper safety training, equipment and reasonable workloads help prevent these injuries.
What are the eligibility requirements for an injury?
For a shoulder injury to be eligible for workers’ compensation benefits, the incident must be directly related to performing your job. A shoulder injury alone doesn’t qualify you for workers’ comp. The incident must occur at work, with your duties directly causing the injury.
For example, injuring your shoulder from repetitive overhead lifting would likely qualify, while hurting it while playing recreational sports would not. In some cases, your employer may dispute the claim. They may argue that your shoulder injury had nothing to do with your job or that you had the problem before you started working there.
With or without disputes, you must gather strong documentation to prove your injury is work-related and, therefore, eligible for benefits. This will help link your shoulder injury directly to your work activities.
At a minimum, you’ll need:
- Detailed medical records
- Doctor’s notes on needed treatment
- Proof linking the injury to specific job tasks
- Employer incident reports
- Witness statements
Proper documentation is key for receiving a typical workers’ comp settlement for a rotator cuff or other shoulder injury sustained at work. Once you get approval, you can receive the necessary medical care without having to pay out-of-pocket costs.
How do you document the injury incident?
Beyond medical records, you’ll also need to properly document the injury incident itself by:
- Reporting the injury immediately to your employer and getting an official report
- Obtaining written statements from anyone who witnessed the injury
- Keeping records of the specific job tasks you were doing when injured
Workers submitting thorough documentation increase their chances of claim approval for surgery. Those who fail to submit the required forms and evidence risk having their claim denied. A denied claim can hurt you financially because you will need to pay out-of-pocket for anything related to your recovery. But if your workers’ comp claim for a shoulder injury is approved, you will receive proper medical care, like surgery if needed.
How long does workers’ comp approve shoulder surgery?
Once approved, the next step is getting authorization for the recommended surgical treatment. How quickly approval comes for requests like shoulder surgery or other major procedures can vary.
In general, it typically takes 2-4 weeks for the insurer to review and approve a surgical request. However, additional delays can occur if the insurer requires further documentation, such as:
- Second medical opinion
- Peer reviews by other physicians
- More details on the medical necessity
Some surgery requests may get denied outright based on the provided evidence. This can affect how quickly you can get surgical care and prolong your recovery.
What is a workers’ comp settlement?
After undergoing approved shoulder surgery, you may be eligible for a settlement later on. A settlement is a lump sum payment resolving your entire injury claim once and for all.
It’s important to note that this settlement amount goes beyond just covering the surgery’s medical expenses, which workers’ comp already paid. A settlement compensates for other damages like:
- Wages you couldn’t earn during recovery or missed work
- Any permanent disabilities, impairments or restrictions affecting you long-term
- Loss of future earning capacity in your job due to limitations
- Anticipated ongoing medical expenses for future treatment or rehabilitation
Serious shoulder injuries, such as rotator cuff or labrum tears, often result in permanent effects, even after surgical repair, like arthroscopic shoulder surgery. This is one of the reasons why arthroscopic shoulder surgery settlements tend to have higher settlement values.
Does surgery increase a workers’ comp settlement?
Yes, it does. The more disabling the injury and the greater the impact on future employment prospects, the higher the potential settlement to account for losses over a lifetime.
Surgery increases your settlement value due to higher medical costs, longer recovery time and potential permanent effects after the procedure. This applies to both arthroscopic and open shoulder surgeries.
These factors all contribute to a higher settlement calculation when surgery is involved. Injured workers who undergo surgeries receive average settlements around three times higher than those with non-surgical injuries.
For example, according to Oasis Financial, the typical workers’ comp settlement for a rotator cuff tear that requires surgery is around $70,000, compared to just $21,000 for non-surgical cases.
More complex or multiple surgeries can increase the potential settlement value even further. Consider seeking legal guidance regarding workers’ comp to help pursue a fair settlement that accounts for all damages from a shoulder injury requiring surgery.
Don’t go at it alone – consider legal counsel
Ultimately, settlement amounts get determined case-by-case based on your:
- Specific shoulder injury and surgery
- Duration of recovery and time missed from work
- Permanent impairments or disabilities
- Future income losses projected
- Overall impact on your ability to perform duties
With injuries as impactful as a rotator cuff tear or shoulder damage requiring arthroscopic surgery, you can’t risk being shortchanged on your rightful workers’ compensation benefits due to potential long-term restrictions.
So, consider seeking legal guidance when it comes to such matters. A work-related injury lawyer can help you through the complex claims process and protect your rights as an injured worker. They can calculate and negotiate maximum settlement amounts. They can also help when injuries involve expensive medical procedures and extended time away from work due to a serious on-the-job shoulder injury.