How Much Compensation Do You Get for Complex Regional Pain Syndrome (CRPS) and Reflex Sympathetic Dystrophy?
A Guide to Workers Comp Claims and Settlements for CRPS
Complex regional pain syndrome (CRPS), previously called reflex sympathetic dystrophy (RSD), is a progressive medical condition that causes persistent, burning pain and dysfunction of the autonomic nervous system.
Unfortunately, CRPS is not widely known or understood by many doctors. And this results in difficulty receiving the correct diagnosis or treatment.
Combined with the permanent disability and high lifetime medical costs associated with CRPS, these factors explain why personal injury and workers compensation claims for CRPS are hard-fought by insurers but can result in high settlements and payouts.
This article explains multiple perspectives of workers comp claims and auto accident lawsuits for CRPS. The first part gives a medical overview of CRPS and how doctors’ understanding of its causation and diagnosis has developed over time. And the second part focuses on the litigation of CRPS claims, including the workers comp benefits and tort damages you may recover.
Keep reading to learn more.
And if you have questions about CRPS after an occupational injury or motor vehicle crash, contact my office for a free consultation. We have helped many people with complex regional pain syndrome negotiate personal injury and workers comp settlements that help them and their families move forward. And we want to do the same for you.
What is CRPS?
Complex regional pain syndrome (CRPS) is a painful and disabling medical condition that affects one or more of the body’s limbs but can occur anywhere in the body.
CRPS is a new name for a disorder documented by the medical community since the mid to late 1800s. Indeed, over the years, the condition now called CRPS has been named causalgia (heat pain), reflex sympathetic dystrophy (RSD), chronic traumatic edema, idiopathic neurodystrophic disorder, and sympathetically maintained pain (SMP).
It is a form of suffering as yet undescribed, and so frequent and terrible as to demand from us the fullest description. In our early experience of nerve wounds, we met with a small number of men who were suffering from a pain which they described as a ‘burning,’ or as ‘mustard red hot,’ or as ‘a red-hot file rasping the skin
The seat of burning pain is very various; but it never attacks the trunk, rarely the arm or thigh, and not often the forearm or leg. Its favorite site is the foot or hand …
The great mass of sufferers described this pain as superficial, but others said it was also in the joints, and deep in the palm. If it lasted long, it was referred finally to the skin alone.
Its intensity varies from the most trivial burning to a state of torture, which can hardly be credited, but which reacts on the whole economy, until the general health is seriously affected.
As the pain increases, the general sympathy becomes more marked. The temper changes and grows irritable, the face becomes anxious, and has a look of weariness and suffering. The sleep is restless, and the constitutional condition, reacting on the wounded limb, exasperates the hyperaesthetic state, so that the rattling of a newspaper a breath of air, another’s step across the ward, the vibrations caused by a military band, or the shock of the feet in walking, give rise to increase of pain. At last the patient grows hysterical …
The Two Types of CRPS
In the 1990s, the International Association for the Study of Pain (IASP) suggested complex regional pain syndrome to replace reflex sympathetic dystrophy (RSD) and causalgia.
It then recommended dividing CRPS into two types – CRPS I and CRPS II.
CRPS I
CRPS I replaces RSD. It refers to situations where a tissue injury triggers complex regional pain syndrome.
CRPS I is more common in personal injury and workers compensation claims.
CRPS II
CRPS II replaces causalgia. It refers to situations where a nerve injury triggers complex regional pain syndrome.
What are the Three Stages of CRPS Development?
Typically, CRPS follows three stages of development. However, there is some overlap between the stages.
Stage one begins when you are hurt or soon after. Usually, it lasts one to three months and includes severe, burning pain aggravated when you move. You may also experience muscle spasms, joint stiffness, blood vessel alterations affecting the skin, and rapid hair growth.
Stage two of CRPS lasts three to six months. You may experience more intense pain that spreads from the injury site during this period. And other symptoms involving the skin, hair, and bones progress.
If your CRPS progresses to stage three, you may have difficulty moving the affected body part. In addition, the changes in your skin and bones become irreversible.
This inability to move the affected body parts results in increased joint problems and even damage to the unaffected side of the body due to overuse and compensation for the injury.
What Causes CRPS?
Doctors do not know the exact cause and mechanism of CRPS. And this lack of understanding is one reason that complex regional pain syndrome claims lead to litigation.
Many patients with CRPS suffered trauma (injury) to an arm, leg, hand, or foot before developing the condition. But the initial injury need not have been a significant or catastrophic injury to result in CRPS. Even minor injuries can play a role in the development of CRPS.
For example, you may develop CRPS after:
- A sprain or strain involving muscles, ligaments, or tendons
- Surgical trauma (wounds or immobilization of the body for long periods)
- Electric shock
- Crush injuries
- Contusions (bruises)
- Lacerations
- Aggravation of preexisting degenerative disc disease (osteoarthritis). For example, a work-related back injury that causes or contributes to spinal stenosis or spondylosis.
- Extended immobilization of the injured body part to heal (casting, wheelchair use, etc.)
- Gunshot wounds
- Heart attacks (or cardiovascular disease)
Recent theories on CRPS causation suggest that the initial trauma impacts the pain receptors within your sympathetic nervous system, causing dysfunction.
The sympathetic nervous system regulates your body’s involuntary responses to stressful stimuli. For example, stimulation of the sympathetic nervous system can produce the “fight or flight” response characterized by an increased heart rate, sweating, dilated pupils, constriction of peripheral blood vessels, and increased alertness.
An abnormal sympathetic nervous system may produce neural signals misinterpreted as pain. In addition, a damaged sympathetic nervous system may cause permanent changes in musculature, bone, skin, and blood vessels that cause progressive symptoms limiting the ability to work.
However, roughly five to ten percent of CRPS patients do not remember an initiating event before developing pain and other neuropathic symptoms.
Which Patients are the Most at Risk of Developing CRPS After a Workplace Injury or Car Crash?
You have an increased risk of complex regional pain syndrome if:
- You sustained an injury to the upper extremities (arms, shoulders, hands). Studies show this pain disorder affects the upper extremities more than the lower extremities in adults.
- You are female. CRPS occurs in males and females, but women are more likely than men to develop the condition (two to four times more likely).
- You suffered a peripheral nerve injury.
- You have a pre-existing neurological condition such as carpal tunnel syndrome or diabetic neuropathy.
- You suffered a fracture or contusion.
- You are immobilized for weeks (or longer) because of the injury.
- You have paralysis of one side of the body (hemiplegia) from the accident.
- You are 50 years of age or older. However, younger persons (even children) can develop CRPS.
What are the Signs and Symptoms of CRPS?
Below are common symptoms and signs that injured workers and accident victims with CRPS/RSD have:
- Abnormal hair or nail growth (either too fast or slow)
- Abnormal pilomotor erection, also known as gooseflesh (when the hair stands up on your skin)
- Abnormal sensitivity to noises/sounds/vibrations
- Abnormal skin sensitivity to temperature, touch, or pressure
- Anxiety
- Changes in skin color (your skin is warmer or cooler when compared to the opposite extremity)
- Changes in skin temperature (your skin feels hot or cold to the touch)
- Changes in skin texture (your skin appears shiny, thin, or leathery)
- Changes in sweating (increased or decreased)
- Chronic fatigue
- Decreased appetite
- Difficulty sleeping
- Intense burning pain near the injured area that seems out of proportion to the objective signs
- Muscle atrophy
- Muscle spasms
- Muscle weakness
- Osteoporosis (typically confirmed by a bone scan)
- Pain spreading to other body parts that you did not hurt in the workplace accident or car crash
- Pain when moving the impacted region
- Restricted mobility (including the inability to reach, lift, handle, finger, pull, squat, kneel, crouch, or crawl)
- Stiffness in the affected area and nearby joints
- Swelling in the affected region
- Tremors
The onset of CRPS symptoms usually occurs within a few hours or days of the initial trauma. But this is not always true. Sometimes the symptoms do not develop for weeks or months, especially when there is a delay between the accident.
Insurance claim adjusters are more skeptical of a CRPS diagnosis when it occurs months after the trauma. Or, at least, they use the delay to convince the judge or jurors that you are malingering (exaggerating) your symptoms. But you can still recover compensation if you obtain supportive medical evidence on how CRPS developed as your diagnosis.
Further, not all CRPS patients have all these signs and symptoms. And your pain may vary – you may have some good days where you can complete daily living activities and some bad days where you must stay in bed. So do not let the adjuster convince you that variance in pain levels or symptoms is unusual or a sign of faking pain.
How is CRPS Diagnosed?
The earlier you receive the diagnosis of CRPS, the better your chance of recovering to the point you can return to work.
But unfortunately, diagnosing CRPS is challenging for several reasons.
First, several other medical conditions have similar symptoms.
Second, there is no diagnostic test specific for CRPS.
And third, the unrelenting pain is often out of proportion to the reported history.
Because of these problems, physicians often diagnose CRPS after excluding other injuries and diseases. And this takes time. For example, one study found that, on average, it took more than one year from developing symptoms to the official CRPS diagnosis for several patients.
The process for diagnosing CRPS typically follows this path:
- Patient history: Your medical providers should interview you and ask for a detailed medical history to determine if you have suffered a recent injury or developed an illness in the past few years.
- Physical examination: Your doctor should physically examine you, looking for a limited range of motion in the injured body part or changes in the skin. This clinical exam may include a stimulus test to provoke pain (touch, heat, pinprick, cold, etc.).
- Laboratory (blood) testing: The doctor should refer you for blood tests to exclude infections or other diseases.
- Diagnostic imaging: Your doctor may refer you for x-rays, MRI, CT scanning, or a triple-phase bone scan to see if any changes explain your symptoms.
- Other tests: Nerve conduction studies (EMG/NCS) can help identify CRPS and rule out other causes. Similarly, a quantitative sudomotor axon reflex test or Laser Doppler test may help show changes in the skin blood flow or predict how you will respond to sympathetic blocks.
How is CRPS Treated?
There is no cure for CRPS. But with an early diagnosis and aggressive treatment in the early stages of the disease, you can improve the potential outcome.
The following treatment modalities may help reduce your CRPS symptoms and prevent the condition from spreading to other parts of the body:
- Physical therapy: The first step your doctor recommends could be a physical therapy and activity program to increase mobility in the affected limb. Using the extremity is critical to stopping or reversing symptoms associated with complex regional pain syndrome. Indeed, the medical literature suggests that patients with CRPS/RSD have a better prognosis when mobility is encouraged early.
- Psychiatric care: Your doctor may recommend that you undergo a mental health evaluation and receive mental health treatment (counseling, antidepressants, etc.) after a CRPS diagnosis. Dealing with pain can take a toll on you, especially when you are involved in litigation and stressed financially. Behavioral and cognitive therapy can help you cope with the pain.
- Medications: In addition to antidepressants, your doctor may prescribe muscle relaxers, antiepileptics, anti-inflammatories, and local analgesics to treat CRPS.
- Sympathetic nerve blocks: You may get pain relief from sympathetic nerve blocks that administer medication to the spine to reduce the nerve activity.
- Surgical sympathectomy: In addition to sympathetic nerve blocks, your doctor may recommend that you undergo a surgical sympathectomy if you respond well to the initial blocks. This procedure attempts to disrupt the sympathetic innervation of the affected region permanently. In addition, it destroys a sympathetic ganglion, which is a structure that contains nerve cell bodies and may form swelling on the nerve fiber.
- Spinal cord stimulator: The placement of this electrical device next to the spinal cord can relieve pain.
- Intrathecal drug pump: This device administers medications to the spinal fluid.
What is the Prognosis (Likely Outcome) for CRPS Patients?
The long-term prognosis for CRPS patients varies. Though the condition is serious, it does not mean that you are resigned to a life of pain and suffering indefinitely. Proper treatment can improve your quality of life.
Some of you will experience remission and complete relief of your patients within 12 to 24 months.
However, many others will experience ongoing symptoms that ebb and flow, with your CRPS never going into remission.
Unfortunately, if your CRPS does not go into remission, you may experience long-term disability due to pain. Therefore, you should consider applying for long-term disability or Social Security Disability Insurance (SSDI) benefits in this situation.
Legal Considerations for CRPS Workers Comp Claims
You can recover workers compensation benefits if you suffer an injury in an accident arising from and in the course of your employment and satisfy specific procedural requirements (filing a claim for benefits within the applicable statutes of limitations, timely notice to the employer, etc.).
If, however, the cause of your medical condition and disability is due to some other disease or incident or you cannot prove where it comes from, the insurer will deny benefits.
Therefore, the first step to recovering workers comp for CRPS is to prove a specific work-related incident caused a structural change to the body. No matter how small the structural change, you must show that it occurred to build the basis for CRPS.
Then you should ask your treating doctor (primary care provider, orthopedic surgeon, neurologist, physiatrist) if the work-related injury caused or contributed to your complex regional pain syndrome.
A narrative report will help you meet your burden of proof (preponderance of the evidence) and show that the initial workplace trauma contributed to CRPS. Even a small contribution to the condition can be enough for the workers compensation board to hold the employer liable for medical care, wage loss, and permanent disability from CRPS. This is due to the compensable consequences doctrine.
But remember, the workers comp system does not provide compensation for pain and suffering damages. Therefore, the value of a workers comp settlement for CRPS may be significantly less than a CRPS lawsuit under negligence laws, which permit these damages.
What is the Average Personal Injury or Workers Comp Settlement for CRPS?
CRPS is a life-changing condition and a significant cause of disability from work. As Dr. Silas Weir Mitchell wrote: Perhaps few persons who are not physicians can realize the influence which long-continued and unendurable pain pain may have upon both body and mind … Perhaps nothing can better illustrate the extent to which these statements may be true than the cases of burning pain, or as I prefer to term it, causalgia, the most terrible of all the tortures which a nerve wound may inflict.”
Indeed, one study estimates that less than half of CRPS patients who worked before the diagnosis will return to their pre-injury job. And one study found that only 20 percent of CRPS patients returned to employment, with those who returned to work missing six months to one year before doing so.
CRPS claims are often expensive for insurers. And most claims adjusters recognize the seriousness of the conditions.
The settlement numbers reflect the seriousness of complex regional pain syndrome. For example, in my experience, the average settlement value of CRPS in a workers compensation case is $70,000.00 to $150,000.00, depending on other factors.
What are Other Workers Comp Benefits Available for CRPS/RSD?
Some workers comp cases do not settle because the parties have different views on the claim’s value or the likelihood of success at a workers compensation hearing.
If this describes your situation, you may seek the following workers comp benefits:
- A lifetime medical award that covers medical appointments, prescription medications, pain management, home modifications, and surgery needed to treat your CRPS/RSD;
- Temporary total disability benefits if you are unable to return to your pre-injury job or any other type of job because of your CRPS symptoms;
- Temporary partial disability benefits if you return to a job at a lighter exertional level because you can no longer perform your old job due to CRPS/RSD symptoms;
- After reaching maximum medical improvement (MMI), vocational rehabilitation services to find a job within your residual work capacity (even part-time work); and,
- Permanent and total incapacity benefits if your CRPS/RSD affects two or more extremities and limits your mobility significantly.
What Factors Impact the Settlement Value of a CRPS Claim (or Your Entitlement to Other Benefits)?
Several factors impact the workers comp settlement value for CRPS.
Some items to consider include:
- Your credibility. There is no objective test for pain. Therefore, your claim will have more value if the judge and claim adjuster believe your testimony.
- Your pre-injury average weekly wage. Many workers comp benefits are based on how much you earned at the initial injury. The more you make, the greater the potential CRPS settlement value.
- Recommended future medical treatment to manage your pain
- Whether you have strong reports on causation and disability for CRPS
- Whether an IME doctor has stated your CRPS is unrelated to the workplace trauma
Get High-Quality Legal Representation to Win Your CRPS Claim
You deserve fair compensation when a work-related injury or car crash results in complex regional pain syndrome and chronic pain.
But the insurance company (Travelers, Liberty Mutual, etc.) or third-party administrators such as Sedgwick CMS or Gallagher Bassett may do everything they can to prevent you from getting the financial, medical, and vocational help you need to improve your quality of life.
Contact our law firm today so that we can pursue all options under tort law. We will guide you through the workers compensation claims process to get every dollar you deserve and every medical treatment that may improve your condition. And we will evaluate your potential entitlement to other sources of compensation, such as a third-party claim based on negligence law (common after construction accidents due to unsafe working conditions) or applying for disability benefits.
We have helped many CRPS patients like yourself with litigation. And we are here for you.
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