Getting Orthopedic Treatment After a Work Injury or Auto Accident
If You Suffered an Orthopedic Injury On-the-Job or in a Car Crash, Your Orthopedic Surgeon Can Not Only Help You Heal But Also Help You Get a Fair Settlement under Workers Compensation or Tort Law
Orthopedic injuries are the most common type of injury suffered in motor vehicle crashes and work-related accidents. No matter what body part is injured, you will probably need to see an orthopedic surgeon within a few days or weeks of your injury.
Your orthopedic surgeon will have an important role not only in determining what type of treatment you receive and in helping you heal physically but also in determining what workers compensation benefits or monetary damages you recover through litigation. If you file a workers comp claim, seek monetary damages under negligence and tort law, or apply for Social Security Disability because of your injury, your orthopedic doctor may be the most important expert witness at trial.
The purpose of this article is to discuss the orthopedic surgeon’s role in workers compensation, car accident, and Social Security Disability claims. Because my law practice focuses on these areas, I have gotten to know many of the orthopedic surgeons in Virginia and have a good idea of what type of witnesses they make at deposition or trial, whether they tend to support their patients when pressured by the workers comp insurer, claim adjuster, nurse case manager, third party claim administrator (TPA), or auto insurance company, and whether they are conservative or liberal in terms of causation, disability and work status, and future medical expenses.
Keep reading to learn more.
If you have any questions about getting orthopedic treatment after a work injury or auto accident, or what supportive information and documentation you need from your orthopedic surgeon to increase the likelihood of negotiating a fair personal injury or workers compensation settlement, call me for a free consultation: (804) 251-1620 or (757) 810-5614. Come see why my colleagues and past clients have voted me one of the best workers compensation lawyers in Virginia.
What is Orthopedics?
Orthopedics, also spelled orthopaedics, is the medical specialty that diagnoses and treats injuries, diseases, and conditions that affect the musculoskeletal system.
Your musculoskeletal system includes your bones, muscles, ligaments, and nerves.
What is an Orthopedic Surgeon?
An orthopedic surgeon is a doctor that specializes in treating injuries and conditions affecting the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat trauma and other disorders.
To become an orthopedic surgeon certified by the American Board of Orthopaedic Surgery (ABOS), a person must:
- Graduate from medical school (either traditional or osteopathic medical school)
- Complete a five year residency program
- Pass a written test and oral examination
After completing their residency training, many orthopedic surgeons complete fellowship training in an orthopedic sub-specialty. These fellowships often last one to two years.
Common orthopedic sub-specialties include:
- Foot and Ankle Surgery
- Hand and Upper Extremity
- Orthopedic Oncology
- Orthopedic Trauma
- Pediatric Orthopedics
- Shoulder and Elbow
- Spine Surgery
- Sports Medicine
- Total Joint Reconstruction/Replacement (Arthroplasty)
Orthopedic surgeons who specialize in hand surgery or orthopedic sports medicine may obtain a Certificate of Added Qualifications (CAQ) in addition to their board certification if they pass a standardized test.
What Types of Injuries Do Orthopedic Surgeons Treat?
Orthopedic surgeons treat many injuries that result from car crashes, slip and fall accidents, and falls from heights. These include:
- Amputations
- Back Injuries
- Broken Bones
- Carpal Tunnel Syndrome
- Clavicle Fractures
- Hand Injuries
- Herniated Discs
- Hip Fractures
- Knee Injuries such as torn menisci, ACL tears, and patellar fractures.
- Muscle Injuries
- Neck Injuries
- Pelvic Fractures
- Shoulder Injuries including Rotator Cuff Tears
- Soft Tissue Injuries
- Spinal Cord Injury
- Whiplash
- Wrist Fractures
Because of their familiarity with work injuries, some orthopedic surgeons also perform Independent Medical Evaluations (IMEs) for both accident victims and insurance carriers.
What Types of Procedures Do Orthopedic Surgeons Perform?
The treatment you receive will depend on your injury. Common medical care provided by orthopedic doctors includes:
- Prescription Medications
- Steroid Injections
- Physical Therapy
- Work Hardening
- Diagnostic Imaging
- Surgery
The most common surgical procedures performed by orthopedic surgeons include:
- Carpal Tunnel Release
- Cervical Spinal Fusion
- Debridement of Skin, Muscle, or Bone
- Hip Replacement
- Incise Tendon Finger Sheath
- Knee Arthroscopy and Anterior Cruciate Ligament Reconstruction
- Knee Arthroscopy and Chondroplasty
- Knee Arthroscopy and Meniscectomy
- Knee Replacement
- Laminectomy
- Low Back Intervertebral Disc Surgery
- Lumbar Spinal Fusion
- Removal of Hardware/Support Implant
- Repair of Ankle Fracture (Fibula or Bimalleolar)
- Repair of Distal Part of Radius
- Repair of Femoral Neck Fracture
- Repair of Radius/Ulna Fracture
- Repair of Rotator Cuff Tendon
- Repair of Trochanteric Fracture
- Shoulder Arthroscopy and Debridement
- Shoulder Arthroscopy and Decompression
- Shoulder Arthroscopy with Distal Clavicle Excision
When Will I First See an Orthopedic Surgeon?
Those of you who suffered catastrophic injuries requiring emergency medical treatment after your motor vehicle crash or work-related accident likely saw an orthopedic surgeon in the hospital’s Emergency Room (ER). The ER physician or hospitalist will contact the orthopaedic doctor on call if immediate care is necessary.
If you did not go to the ER after your injury and instead went to your primary care physician or chose a doctor from a workers comp panel of physicians, you will likely be referred to an orthopedic surgeon if conservative treatment such as rest and physical therapy does not resolve your symptoms.
How Do I Choose an Orthopedic Surgeon?
It is important that you choose an orthopaedic doctor who is not only good at what they do but also willing to help if litigation is necessary to get the workers comp payments you deserve or a fair auto accident settlement. Finding the best orthopedic doctor among your available options is one reason to hire an attorney after you’re hurt.
The amount of freedom you have to choose your orthopedic surgeon depends on whether you have a personal injury or workers comp claim.
Choosing an Orthopedic Surgeon in Personal Injury Cases
If you suffer injuries in a motor vehicle crash caused by another’s negligence, you have the right to choose any orthopedic surgeon you want. I recommend selecting an “in-network” orthopedic doctor if you have private health insurance or coverage through Medicare, Medicaid, or Tricare or, if you do not have private insurance coverage, selecting an orthopaedist that will treat you on a lien basis. Read my article, Paying for Medical Treatment After an Auto Accident, for more information on this topic.
You should also check to see if you have Medical Payments Coverage (Med Pay) through your bodily injury insurance policy. You can use Med Pay to cover orthopedic treatment after a car crash.
Choosing an Orthopedic Surgeon in Workers Comp Claims
Selecting an orthopedic doctor for your work injury works differently.
If you have a Workers Compensation Award Letter that provides lifetime medical coverage for your occupational injuries, your employer or its insurance carrier must pay for you to see an orthopedic doctor if that treatment is reasonable, necessary, and causally related to your work accident.
The insurance carrier, however, has some control over what orthopedic doctor you see. It can force you to choose from a list of three orthopedic surgeons. If you decide to treat with another orthopaedist who is not on the list, you may have to pay for that treatment out of your own pocket. But there are some exceptions to this rule.
For example, you can choose your own orthopedic surgeon if:
- The insurance carrier denies your workers comp claim initially and refuses to offer a panel of orthopaedists until weeks or months after you need one. In this situation I recommend using your private health insurance to treat for your work injury (if you have it), then filing a claim asking the Workers Compensation Commission to order the employer to pay reimburse your private health insurance.
- Your authorized treating physician decides to refer you to an orthopedic surgeon and asks who you want to see. The employer and its workers comp insurer must pay for referrals from your treating physician.
- The orthopedic doctors on the panel offered to you do not treat your type of orthopedic injury or condition. I have seen some insurance carriers include back surgeons on panels offered to employees who suffered hand injuries. This is not a valid panel and you may be allowed to choose your own orthopedic surgeon if the insurer does not offer a new panel.
- You move out of state after your claim is accepted and the workers comp insurer does not give you a new panel of physicians.
Can I Change My Orthopedic Doctor?
If you have a personal injury claim, yes.
If you have a workers comp claim, maybe.
It is common for accident victims to get frustrated with their orthopedic doctors, especially if you are not improving or you feel like your orthopaedist is not spending enough time with you at examinations. When that happens, you may need a change in doctor to get better.
Those of you with personal injury claims based on someone else’s negligence do not need the auto insurance company’s permission to change orthopedic doctors. You are free to switch orthopaedists at any time. But if you change doctors too many times the claim adjuster and insurance defense attorney will argue that you are doctor shopping, meaning you are more interested in finding a doctor who will help you recover more money than in actually getting better.
Those of you with workers compensation claims may be able to change orthopedic doctors if you follow the Rules of the Commission, file a change in condition application, and satisfy your burden of proof.
For more information on this topic, read my articles on how to change doctors in a workers comp case and how to get a second opinion.
What Do I Do When My Orthopedic Surgeon Releases Me from Care?
There are two situations where your orthopedic surgeon may release you from care.
The first situation occurs when your orthopedic surgeon determines that you are not a surgical candidate. Usually this is determined after the orthopaedist reviews your MRI or CT imaging.
The second situation occurs when you reach maximum medical improvement (MMI) for your orthopedic injuries. This means that further surgical treatment is unnecessary though palliative treatment may help relieve your symptoms.
When you reach MMI, your orthopedic surgeon will likely refer you to an occupational therapist for a functional capacity evaluation (FCE). The FCE, which consists of a series of physical tests conducted over several hours, is used by the orthopaedist to determine your permanent work restrictions.
Your orthopedic surgeon may also suggest that you receive a permanent impairment rating, especially if the surgeon knows that you are involved in personal injury or workers comp litigation. The permanent impairment rating is used to determine the severity of the loss of function and use of the injured body part, which is then used to determine the amount of monetary damages and permanent partial disability (PPD) benefits you receive.
If you continue to have symptoms such as pain or numbness when you are released from care, your orthopedic doctor will likely refer you to a physiatrist or chiropractor for chronic pain management.
When you are orthopedic doctor releases you from care or tells you that you only need to treat on an “as needed basis,” you should consider negotiating a buyout of your future medical expenses.
What Information Do I Need from My Orthopedic Doctor to Win My Workers Comp or Car Accident Case?
To win your orthopedic injury case or increase its settlement value, I recommend asking your orthopedic doctor to write a report discussing the following:
- The Nature of Your Orthopedic Injury: Your doctor should identify each injury you suffered on-the-job or in the car crash and how the injury happened.
- Causation: Usually there is no dispute that your workplace accident or auto accident caused your injury. You were fine before the accident and now you are hurt. But the insurance carrier may argue that your ongoing symptoms are related to a prior injury or a preexisting condition such as degenerative disc disease or arthritis. Ask your orthopedic doctor to state that your accident caused the diagnosed injuries or worsened or accelerated any preexisting condition you may have had at the time you were hurt.
- Medical Necessity of Treatment: The insurance company may admit that you were injured but argue that you did not need all the medical treatment you received for your orthopedic injury and that it is not responsible for payment of that treatment. This is a rare argument for the insurance company to make if you underwent surgery based on objective diagnostic findings but is common if your orthopedic doctor recommends conservative treatment or palliative care (chiropractic, acupuncture, water therapy, etc).
- Reasonableness of Bills: In Virginia orthopedic treatment for work injuries is subject to a Medical Fee Schedule. A statute determines the amount of money the workers comp insurer must pay and that your orthopaedist must accept for specific treatment, unless your doctor and the insurer have a contract. On the other hand, you can use your orthopedic surgeon’s bills, which are often much higher than the amount the doctor will accept from the insurance carrier after a contractual reduction, to prove damages in a personal injury claim. This results in insurer’s arguing that the actual bills are unreasonable and do not reflect the actual cost.
- Current Work Status and Disability: To receive temporary total disability or temporary partial disability benefits under workers comp you need your orthopedic doctor to state that you are disabled from all work or that you have light duty restrictions. I recommend asking your orthopaedist for a “work status” note after each appointment. Personal injury cases do not require these types of notes on a regular basis but I still recommend asking your orthopaedist to address your disability status every three months with a focus on the difficulties you have performing your pre-injury job because of the accident.
- Anticipated Future Medical Expenses: Any fair settlement or jury verdict should take into consideration future medical expenses. Ask your orthopedic doctor to state what medical care you will likely need for your injuries over the next twenty years so that you can get a report from a life care planner stating the expected costs.
- Effect on Life (Activities of Daily Living) and Ability to Work: Your orthopedic doctor is in a good position to state what problems you have performing specific physical actions such as sitting, standing, walking, lifting, carrying, pushing, pulling, handling, manipulating, kneeling, squatting, bending, and reaching because of instability or reduced range of motion from your injury.
Need Help Getting Orthopedic Treatment as Part of Your Workers Compensation or Personal Injury Claim?
This website offers a number of articles on workers comp and personal injury law, including how to get the medical care you deserve and what to do if the insurance carrier denies medical treatment in your workers comp case.
Check out these articles. Then call me for a free consultation if you have any questions: (804) 251-1620 or (757) 810-5614. Whether you’re trying to negotiate a settlement or need help winning your case at trial or a workers comp hearing, I’m here to help.
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