Is Sciatica Covered Under Workers Comp?
What to Know When Negotiating a Workers Compensation Settlement for Sciatica Causing Disability
A work-related back injury may affect more than your lower or mid-back. It may also cause pain and other symptoms from the back down to the buttocks, hips, and legs, going as far as the knees and feet.
Sciatica is the name of this medical condition, referring to pain and paresthesia distributed along the sciatic nerve. Your doctor may also diagnose sciatica as lumbar radiculopathy.
The sciatic nerve arises from the lumbar and sacral parts of the spinal cord, running down the back of the leg and innervating (giving sensation to) the back of the thigh, the knee flexors, and muscles below the knee, including the foot’s sole.
Sciatica affects many people, particularly employees whose jobs require heavy lifting (such as associates and stockers for Amazon, Walmart, Lowe’s, The Home Depot, and Target), physically handling patients (such as nurses or counselors in assisted living facilities), moving items in tight spaces (such as flight attendants for American Airlines or United Airlines), or driving (such as UPS delivery drivers).
Indeed, the data suggests five to ten percent of patients reporting low back pain have sciatica. Therefore, the number of Americans suffering from sciatica at any given time is significant, as millions of people (including injured workers) report back pain yearly.
Our personal injury law firm wrote this article for those with sciatica from an occupational injury. After reading the following sections, you will understand how to evaluate a workers comp settlement for sciatica. In addition, this information can help you decide whether to apply for Social Security disability benefits because of the condition.
Continue reading to learn more about sciatica workers compensation claims and settlements.
Then call us to start building your case: 804-251-1620 or 757-810-5614. With offices in Richmond, Newport News, Baltimore, Hagerstown, and Cambridge, we help disabled and injured workers with sciatica throughout Virginia and Maryland.
Medical Information You Should Know to Pursue a Workers Compensation Claim for Sciatica
This part of the article examines medical questions you may have about work-related sciatica.
What Causes Sciatica?
Nerve root compression is the leading cause of sciatica.
Often a herniated disc pressing on a lumbar or sacral nerve root is responsible for the compression resulting in sciatica. Indeed, the L3-L4, L4-L5, and L5-S1 nerve roots are most involved in sciatica diagnoses.
However, spinal stenosis (narrowing of the spinal canal), osteoarthritis, osteophytes, spondylolisthesis, piriformis syndrome, intraspinal tumors, or abscesses may also cause symptoms along the sciatic nerve.
Who is at the Greatest Risk for Sciatica?
Personal and occupational risk factors for developing sciatica include the following:
- Age (sciatica is more common in people 45 or older)
- Height (you have an increasing risk for this condition if you are taller)
- Smoking
- Other medical impairments (such as diabetes mellitus (DM) and obesity)
- Strenuous physical activity (such as lifting or carrying heavy weights, particularly while in an awkward position, such as bending over or twisting)
- Driving
- Gender (males have a higher rate of sciatica than females)
What are the Symptoms and Signs of Sciatica?
Common symptoms of sciatica include the following:
- Pain that radiates along the sciatic nerve’s course (down the buttocks and back of the leg to below the knee). This pain is often burning or stabbing.
- Numbness (loss of feeling) in one or both legs
- Tingling sensations (pins and needles feelings) in one or both legs
- Weakness of one or both legs
- Loss of bowel or bladder control (which is rare)
These sciatica symptoms may be acute (sudden), chronic, unilateral (affecting only one leg), or bilateral (affecting both legs).
How is Sciatica Diagnosed?
Medical providers typically diagnose sciatica by physical examination (clinical findings) and the patient’s reported history.
For example, your doctor may conduct these tests when diagnosing sciatica after a work accident:
- Ability to bend the foot down or inward
- Ability to walk on your toes
- Ankle jerk reflex: L5-S1 disc herniation may affect this reflex
- Knee jerk reflex: L3-L4 herniation may affect this reflex
- Straight leg raise: This test is positive in most people with sciatica; however, false positives are prevalent. Your doctor will lift and straighten your leg, flexing the hip simultaneously while you lie down. You have a positive test if this maneuver produces Lasegue’s sign, which means you have pain in the sciatic nerve’s distribution with passive flexion of the straight leg from 30 to 70 degrees. In addition, the physician may perform this test while you are seated to check the reliability of your responses to these maneuvers.
Your physician then considers these test results with your report of symptoms or neurologic deficits (including pain type, distribution, duration, and onset).
Sometimes, your physician or orthopedic surgeon will prescribe diagnostic imaging tests, such as X-rays, MRI, or CT scans. In addition, your doctor may refer you for an electrodiagnostic study (nerve conduction testing) to rule out other medical conditions that cause nerve damage and pain. However, your physician will likely not prescribe these procedures unless conservative treatment fails.
What Types of Medical Providers Treat Sciatica?
You may see several different medical providers when trying to heal from work-related sciatica:
- Primary care physician/urgent care facility: Many workers comp doctor panels include acute care facilities, such as Concentra, Patient First, or MD Express. Often, these general practitioners prescribe rest, medication, and light duty. But if this conservative treatment fails and you still have symptoms within one month of the work accident, this primary care physician will likely refer you for specialized care (such as an orthopedist).
- Orthopedic surgeon: Sometimes doctors prescribe surgery for sciatica, mainly if the procedure will heal the herniated disc that compresses the nerve roots. An orthopedic surgeon or neurosurgeon will perform this operation.
- Physical therapists: Many orthopedic doctors will prescribe physical therapy before considering surgery.
- Pain management doctor (physiatrist): If your sciatica symptoms continue for months but are not a surgical candidate, the orthopedist may refer you to a physical medicine and rehabilitation doctor to manage your pain.
- Chiropractors: Some patients find relief from sciatica after chiropractic care.
- Acupuncture: Acupuncturists provide palliative care that may relieve the pain, numbness, and tingling along the sciatic nerve’s course.
Management and Treatment of Sciatica
Your doctor may prescribe one or more of these treatments after diagnosing sciatica:
- Bed rest (usually three days or less), followed by activity as tolerated
- Nonopioid medication (NSAIDs, acetaminophen, steroids, gabapentin, low-dose tricyclic antidepressants, anticonvulsants, heat and cold therapy, etc.)
- Physical therapy
- Epidural steroid injections (ESIs)
- Traction
- Spinal manipulation
- Surgery (discectomy with laminectomy, spinal fusion if you have additional pathology)
How Likely Is It That I Will Recover Fully from Sciatica?
Some data suggests many patients with sciatica recover within one to two months of onset.
However, other studies reveal that many patients do not. Instead, sciatica becomes chronic and affects the ability to work or perform daily activities.
For example, one study revealed that nearly half of people with sciatica reported symptoms one to four years after onset. In addition, roughly 20 percent could not work one year later, and 10 percent required surgery.
Your specific prognosis depends, in part, on the underlying cause of sciatica, whether your employer provides light duty after the onset of symptoms so you can rest and heal, preexisting conditions, and psychological factors affecting your pain response.
Further, the recurrence rate is high for this condition. Therefore, those with physical jobs may have intermittent sciatica symptoms that cause frequent absenteeism from work.
These attendance problems may help you qualify for Social Security disability (SSDI or SSI) for sciatica and other musculoskeletal conditions, such as arthritis.
Specific Information About Workers Comp for Sciatica
The above sections focused on sciatica in general, explaining how doctors diagnose it, the treatment you can expect to receive, and the likely prognosis. You (or your attorney) need to know this to decide what evidence to gather to strengthen your case and eliminate weaknesses.
The following sections discuss specific questions and issues in sciatica cases.
How to Prove that a Work Accident Caused Sciatica
As the injured employee, you must prove every element of a workers compensation claim (unless the employer, insurer, or claims administrator (Gallagher Bassett, Sedgwick CMS, ESIS, Helsman, etc.) files a pleading named application to suspend or terminate benefits).
This means you must gather and present evidence that shows the following (read about workers compensation discovery to learn how to get some of this information from the employer or insurer through interrogatories, requests for production of documents, requests for admissions, and depositions):
- The employer had written notice that you were hurt at work (use this sample injury report) within 30 days of the incident.
- The state you seek benefits has jurisdiction over your claim (for example, Virginia has jurisdiction over occupational injury claims occurring within its borders, as well as those accidents happening out of state if the employer’s principal place of business is here and an employment contract does not exclude jurisdiction)
- In Virginia, you must show that a specific, identifiable workplace incident caused a structural change to your body. However, in other states, you may recover workers comp for sciatica caused by repetitive motion (cumulative trauma).
- A specific risk of employment caused the particular incident.
- You were in “the course of” employment when the incident causing symptoms occurred. Typically this means you were “on the clock” or doing something your job required.
- The medical evidence (records, reports, disability letters) shows your doctor diagnosed sciatica, and the totality of the evidence suggests the work incident caused (or at least contributed) to sciatica or the injury compressing the nerve root that results in these symptoms. Indeed, you can win your occupational injury claim if the work incident contributes to (aggravates, exacerbates, worsens, flares, or accelerates) sciatica or the underlying structural change.
- Your physician disabled you from all work (or gave you light-duty restrictions) due to sciatica.
- You have looked for work within your limitations (if applicable). This requirement is called marketing.
In addition, you must meet specific procedural requirements, such as filing a workers comp claim within the applicable statute of limitations (two years from the incident in Virginia).
What Workplace Accidents Cause Sciatica?
Any work incident that causes a lumbar strain/sprain or herniates a disc (or exacerbates pre-existing degenerative disc disease) may result in sciatica.
Everyday work-related events leading to sciatica include:
- Slip and fall (or trip and fall) accidents where you strike your lower back in a spot that inflames and irritates the sciatic nerve
- Falls from ladders, roofs, and other heights
- Machinery or equipment accidents, such as forklift crashes
- Overexertion from lifting, carrying, pushing, or pulling an object
- Twisting or bending awkwardly, such as when a nurse transfers a patient
Calculating the Value of a Sciatica Workers Comp Settlement
In our experience, the average settlement for work-related sciatica ranges from $25,000 to $80,000 (or more).
Your sciatica case’s value depends on many factors, including the following:
- The strength of the insurer’s defenses to compensability
- Whether conservative treatment relieves your symptoms or whether you require surgery
- How much time missed from work due to symptoms or treatment
- The likelihood you will have intermittent periods of disability (sciatica flareups) if you can return to work after initial treatment
- Your ability to perform your pre-injury job despite restrictions from sciatica: For example, you may find it more challenging to return to a job that requires heavy lifting or long periods of sitting (sedentary work can irritate the sciatic nerve) than other employment.
- Other injuries suffered in the workplace incident: For example, the same accident responsible for sciatica may cause a spinal cord injury resulting in paralysis or cauda equina syndrome, head trauma (a concussion), or post-traumatic stress disorder (PTSD), increasing your case’s settlement value.
- How much money you earn before the occupational injury: The amount you receive in workers comp payments depends on your pre-injury average weekly wage.
- Past medical bills (particularly if you do not have Medicare, Medicaid, or private health insurance to pay them)
- Whether you have problems using your legs because of sciatica: For example, you may have a permanent impairment (loss of use) involving the legs, such as difficulty walking, standing, jumping, kneeling, bending, or lifting. And this impairment entitles you to money for permanent partial disability.
- The likelihood you will require future medical care for sciatica or its underlying cause and this treatment’s cost
- Whether you have a Workers Compensation Award Letter or must go to an evidentiary hearing to prove entitlement to all types of workers compensation benefits you claim
- The amount of temporary total disability (TTD) or temporary partial disability benefits (TPD) you have received because these benefits count against the cap (for example, most cases stop at 500 weeks of wage loss payments in Virginia), reducing the insurer’s future liability
- Your age and geographic location if the employer cannot accommodate your restrictions and starts vocational rehabilitation: For example, the vocational counsel generally will have more trouble finding people over 50 in rural locations a job than younger workers living in urban or suburban areas with many employment options.
These factors (and others) determine a reasonable workers comp settlement demand for sciatica. And focusing on the items that strengthen your case helps you scare the insurance representative (the defense attorney and the workers comp adjuster) into offering more money.
Top-Rated Workers Comp Lawyers for Sciatica Claims
Call our law firm to determine your legal options if you have received a sciatica diagnosis after a workplace accident.
In addition to reviewing your claim for benefits under the Workers Compensation Act and taking steps to accelerate when the insurer offers to settle, our disability lawyers will evaluate your eligibility for SSDI or SSI benefits if you have trouble doing your job or being independent at home because of sciatica.
Contact us today for help with your disability or workers comp claim for sciatica.
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