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.
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.
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:
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:
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.
Orthopedic surgeons treat many injuries that result from car crashes, slip and fall accidents, and falls from heights. These include:
Because of their familiarity with work injuries, some orthopedic surgeons also perform Independent Medical Evaluations (IMEs) for both accident victims and insurance carriers.
The treatment you receive will depend on your injury. Common medical care provided by orthopedic doctors includes:
The most common surgical procedures performed by orthopedic surgeons include:
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.
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.
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.
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:
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.
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.
To win your orthopedic injury case or increase its settlement value, I recommend asking your orthopedic doctor to write a report discussing the following:
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.