Guide to Workers Compensation Settlements for Shoulder Injuries
A Work-Related Rotator Cuff Tear, SLAP Tear, or Frozen Shoulder May Require Surgery and Cause Permanent Disability. Learn How to Get a Top-Dollar Workers Comp Settlement for Your Shoulder Injury
You ask your shoulder joint to do a lot.
As the most movable joint in the human body, your shoulder helps you lift, carry, push, pull, throw, catch, reach, and use your hands.
But these capabilities and range of motion come at a cost. Shoulder injuries, especially rotator cuff tears, are common in work-related accidents and motor vehicle crashes.
For example, you may be reading this article if you:
- Tore your rotator cuff when you put your arm out to catch yourself during a slip and fall; or
- Felt shoulder pain when you landed after a fall from a height; or
- Were hurt in a car crash when your seat belt or airbag put too much stress on your shoulder.
This article aims to discuss how to negotiate a fair workers comp settlement for shoulder injuries.
I focus on settlements for shoulder injuries such as rotator cuff tears, labrum tears, SLAP tears, shoulder girdle fractures, and the frozen shoulder (adhesive capsulitis) that often develops after surgery and limits range of motion.
In my experience, the average workers compensation settlement amount for a shoulder injury is between $25,000.00 and $175,000.00.Your claim may settle within this range – or outside of it. The value of your shoulder injury claim under workers compensation depends on many factors. These include whether you suffer a torn tendon or fractured bone requiring surgery and pain management, or a muscular injury that heals within a few months.
If you have any questions after reading this article and want to talk to a top-rated workers comp attorney or car accident lawyer, call me for a free consultation: (804) 251-1620 or (757) 810-5614. I have helped hundreds of employees obtain top dollar workers compensation settlements for rotator cuff tears and frozen shoulders. And I want to help you increase the settlement value of your shoulder injury case.
Understanding the Anatomy of the Shoulder
The workers comp claims process requires you to make both medical and legal decisions. An understanding of the basic anatomy of the shoulder and how your injury may affect you for years to come is vital to make the best decisions for you and your family.
The shoulder is a ball-and-socket joint that consists of the shoulder blade (scapula), the collarbone (clavicle), and the upper arm bone (humerus). It connects your arm to the rest of your body.
The rotator cuff, which is the name given to a group of four tendons from four muscles, connects the humerus to the scapula and provides support to your shoulder, especially during movement.
Several other muscles and ligaments provide stability and strength to your shoulder. These include your biceps, coracobrachialis, coracoclavicular ligament complex, deltoid, sternum, pectoralis major, trapezoid, and trapezoidal ligament. Because these body parts are so interconnected, it is common to suffer additional injuries to your neck, spinal cord, chest, and arm when you hurt your shoulder. It may take some time for your doctor to determine whether your pain or other symptoms are coming from your shoulder or cervical spine after an accident.
When you receive treatment for your shoulder injury after a workplace accident or car crash, your orthopedic surgeon may use many of these terms. If you are not sure what your doctor is talking about, ask him to show you a picture or diagram. Often it is easier to understand what part of your shoulder you injured and how the different parts of the joint work together visually.
Rotator Cuff Injury at Work
About 90% of the shoulder injury cases I handle involve rotator cuff tears.
Those of you who work in physically demanding jobs that require frequent use of your arms and hands are at the greatest risk of suffering a torn rotator cuff.
Many of the rotator cuff tears claims I handle involve:
- Nurses who transfer patients and deal with workplace violence;
- Construction workers, including roofers, electricians, linemen, and plumbers;
- Tractor-trailer drivers who load and unload goods; and,
- Flight attendants for airlines such as American Airlines and United Airlines exposed to turbulence and move luggage and beverage carts.
What is the Rotator Cuff?
A rotator cuff is a group of four tendons and four muscles that surround your shoulder and provide stability. The different groups are the supraspinatus, infraspinatus, subscapularis, and teres minor.
The rotator cuff has several functions.
The supraspinatus muscle and tendon help you lift and elevate your shoulder and arm. They are located between the humeral head and the acromion, attaching with the greater tuberosity portion of the humerus. The acromion is part of your scapula and connects with the clavicle to form the acromioclavicular (AC) joint.
The supraspinatus muscle and tendon are vulnerable to degenerative changes because of their location and how often they are used. These factors make a rotator cuff tear more likely.
The infraspinatus and teres minor muscles and tendons help rotate your shoulder and arm externally (outward). These tendons also attach to the greater tuberosity portion of the humerus.
The subscapularis tendon is the only rotator cuff tendon that does not attach to the greater tuberosity. Instead, it attaches to the humeral head’s lesser tuberosity, near the long head of your biceps tendon. The subscapularis muscle and tendon help you move your shoulder and arm internally (inward).
The rotator cuff muscles and tendons are supported by several nerves such as the suprascapular, axillary, and subscapular nerves, each of which come from the brachial plexus.
Multiple arteries from the axillary nerve provide the blood supply to the rotator cuff. If your work-related shoulder injury causes damage to these arteries, it may take much longer for your rotator cuff tear to heal. This delay may result in permanent impairment.
What are the Common Causes of Rotator Cuff Injury? How to Prove an Acute Shoulder Injury Caused by a Sudden and Specific Accident versus Chronic Shoulder Pain and Pre-Existing Tendinitis.
The first step to recovering workers compensation benefits or monetary damages for a torn rotator cuff is proving that a sudden accident caused the injury and that it was not the result of gradual wear and tear over time. That is because workers comp does not cover repetitive motion or cumulative trauma injuries in some states, including Virginia. Though the General Assembly recently passed a bill to research the financial effect of adding coverage for these types of injuries,
Insurance carriers know that many rotator cuff tears result from overuse of the shoulder over months or years. Studies show that those over the age of 40 and whose jobs require repetitive, overhead reaching are at the highest risk of suffering a torn rotator cuff. Often this information is used to argue that your rotator cuff tear is the result of wear and tear over many years, not a specific accident or injury.
There are several ways to prove causation in a rotator cuff injury claim:
- Offer evidence of symptoms following a specific event such as lifting a heavy object overhead or from the floor, falling on your shoulder, reaching too far or overextending your arm, or a work-related car crash. Common symptoms of a rotator cuff injury include hearing or feeling a pop in the shoulder; immediate shoulder pain; difficulty lifting the injured arm as high overhead as the non-injured arm; arm weakness; cracking or snapping in your shoulder; trouble putting your arms behind your back; or, pain that wakes you up when sleeping.
- If true, point out that you have never complained of shoulder pain or sought medical treatment for shoulder problems.
- If you have experienced shoulder pain or required rotator cuff surgery in the past, point out that your symptoms resolved, and you were able to return to work before the injury that is the subject of your claim. Under workers compensation law your employer and its insurance carrier are responsible for the payment of benefits if your work-related accident aggravates, accelerates, worsens, or flares any preexisting injury or condition affecting your shoulder such a rotator cuff tendinitis, subacromial bursitis, or degenerative joint disease.
How is a Rotator Cuff Tear Diagnosed?
The first things you should do after an accident at work are (1) report the accident and injury to your employer, and (2) seek medical treatment.
Once you report your work accident, your employer should offer a list of physicians from which to choose. Usually, this list, also called a panel, includes urgent care facilities or primary care doctors but not specialists.
Your employer and its workers’ compensation insurance carrier are responsible for the medical care given by the panel physicians. If you choose to treat with a different physician, even if you are more comfortable with or have had great results in the past, you may have to pay for that treatment out of pocket or with private health insurance if you have it.
Usually, the panel physician will refer you to an orthopedic surgeon if your shoulder symptoms do not go away within a few days or weeks of the workplace accident.
The orthopedic surgeon will ask you for a history of the accident, injury, and symptoms. Then the orthopedic doctor will order plain films (x-rays) of the shoulder area to confirm that you do not have a shoulder fracture.
X-rays rarely show rotator cuff tears. If the x-ray is negative, your orthopedic surgeon may have to undergo conservative treatment of the shoulder for a few weeks. Conservative treatment often includes resting your shoulder in a sling, taking pain medication, and performing physical therapy exercises that work on the shoulder joint’s external and internal rotation.
If you do not improve with conservative treatment, the orthopedic surgeon will know that you likely have a rotator cuff tear but have you undergo an MRI for confirmation. Many rotator cuff tears are determined by MRI, which stands for magnetic resonance imaging.
What is the Treatment for a Torn Rotator Cuff?
A rotator cuff tear cannot heal on its own. Surgery is necessary to fix it.
If you have a torn rotator cuff, you have two options: surgery or non-operative management of your symptoms.
Most of my clients with tears choose to undergo rotator cuff repair surgery. There are three types:
- Open repair of the rotator cuff, which requires partial detachment of your deltoid muscle
- Mini-open repair of the rotator cuff
- Arthroscopic repair of the rotator cuff. This may include debridement or subacromial depression (removal of part of the acromion) to reduce the likelihood of future tears..
Those of you who decide not to undergo surgery for your rotator cuff tear may try to manage your symptoms with activity modification, steroid injections, stretching, and other types of rehabilitation.
What is the Likelihood of a Full Recovery from a Rotator Cuff Injury? Understanding the Rotator Cuff Recovery Timeline When Negotiating a Workers Comp Settlement
How well you recover after suffering a rotator cuff tear depends on many factors, including the size of the tear (complete vs. partial).
There are different stages of recovery after surgery to repair a rotator cuff tear.
Initially, your arm is immobilized with the use of a sling for four to eight weeks. Then you will undergo physical therapy for six to twelve weeks.
As you regain range of motion, you will advance to more challenging exercises until your recovery is complete. Eventually, your orthopedic doctor will tell you that you have reached maximum medical improvement (MMI).
Based on what I’ve seen with my clients and my discussions with their orthopedic surgeons, it takes three to eight months to reach MMI for a torn rotator cuff. Some of you, however, may need more time to recover completely. Some of my clients suffer a recurrent tear requiring revision surgery.
Reaching MMI does not mean you are back to 100%. Instead, it means that you are as good as you are going to get. Usually, your orthopedic surgeon will refer you for a functional capacity evaluation (FCE) when you reach MMI. The FCE is used to determine your permanent work restrictions.
What is the Average Value of a Rotator Cuff Injury under Workers Comp?
The average settlement value of a workers compensation claim involving a torn rotator cuff is between $50,000.00 and $125,000.00. This amount does not include the medical or wage loss benefits the insurer may have paid before you settle. Many of my clients receive tens of thousands of dollars in workers comp benefits before negotiating a settlement for their shoulder injuries.
How Do I Calculate a Fair Workers Comp Settlement Amount for My Shoulder Injury? Understanding the Different Factors.
Several variables affect the settlement value of your shoulder injury or rotator cuff tear claim:
- Whether your employer and its workers compensation insurance carrier accept that your accident is covered under the Workers Compensation Act or have raised defenses to compensability. The law does not cover all on-the-job injuries. If you have received a Workers Comp Award Letter, then the insurer has accepted your claim. If you have not received an Award Letter, I recommend using the discovery process to prove your claim. During discovery, you can use interrogatories, requests for production of documents, and depositions to determine the basis for the insurer’s defense of your rotator cuff injury claim. Then you can analyze this information to determine the likelihood you will win your case. The higher the risk of losing on compensability, the less your case is worth. Your version of events, witness statements, and the underlying medical reports and diagnostic test results play a role in this analysis.
- The amount of money you earned at the time you were hurt. Your pre-injury average weekly wage drives the value of many of the benefits to which you will be entitled. You must use the highest number possible to increase your case’s settlement value.
- Your age. The younger you are, the higher the potential value.
- Your geographic location. Many shoulder injuries lead to permanent restrictions. If you live in a rural area with few employers, the insurance carrier will have difficulty finding a job for you. The longer it takes to find a light-duty job you can perform, the higher the value of your case.
- Your permanent impairment from the shoulder injury. When you reach MMI, your attorney will hire a doctor to evaluate you and to give you a permanent impairment rating under the AMA Guides. You are eligible for up to 200 weeks of permanent partial disability benefits for a shoulder injury, labrum tear, or torn rotator cuff. Such an injury often causes permanent impairment to your entire arm.
- Your work history. If you have a history of performing manual labor, your claim will have a greater value because it will be more difficult for you to return to your pre-injury job and the insurer or its third-party claim administrator (TPA) such as Sedgwick or Gallagher Bassett may have to pay for vocational rehabilitation.
- Your prior medical history, including any past shoulder problems or surgeries. Usually, previous shoulder injuries are only relevant if there is a dispute over causation. But sometimes the insurance carrier will argue that you are owed less in permanent partial disability benefits because of an earlier rotator cuff tear.
- The amount of workers compensation benefits paid to date, including both medical benefits and wage loss replacement benefits such as temporary total disability or temporary partial disability. A 500-week cap on wage loss and partial disability benefits applies in most cases. But there are two scenarios where you may qualify for permanent and total incapacity benefits for the rest of your life. The first is if you suffer a total amputation of the arm because of a shoulder injury. The second is if you injure both shoulders in the same work accident.
- Whether you have had shoulder surgery yet. If you have not, make sure you include the potential cost of rotator cuff repair surgery in your settlement evaluation.
- Whether an initial shoulder surgery or an additional shoulder surgery are being considered by your treating physician. If so, determine the likelihood that the Workers Compensation Commission will agree with the insurer if it issues a medical treatment denial.
- Whether you are accepting a cash buyout of future medical expenses as a term of settlement. The general rule is that you should receive more money from your shoulder injury settlement if you agree to give up your right to future medical care.
- Your projected future medical costs for the shoulder injury. Before settling your case, ask your orthopedic surgeon to address your future medical needs in a written report. The orthopedic doctor should state if you need more office visits, diagnostic imaging, steroid injections, surgery such as a total shoulder replacement, or pain medication. Shoulder replacement surgery alone can cost more than $100,000.00. If you may need a total joint replacement surgery for your work-related shoulder injury in the next ten years, make sure your settlement demand considers that.
- Whether you suffer from any other physical injuries or psychological injuries, including PTSD or depression, because of the accident. Sometimes these injuries are caused by the initial accident. But more often than not, they develop over time, either because of chronic pain associated with the injury or because of overuse of the non-injured body part. When these injuries or conditions develop over time, they are known as compensable consequences of the work injury.
- Whether a resignation is required. Some insurance companies and employers require injured workers to resign if they accept a settlement. Some of you may be ok with this, while others will not be. You must understand all the terms of the shoulder injury settlement offer. For more information on this topic, ready my article – Why is My Employer Asking Me to Resign as Part of My Workers Comp Case?
- Other sources of income. Do you qualify for Long Term Disability, Work-Related Disability through the Virginia Retirement System (VRS), or Social Security Disability (SSDI or SSI) benefits? If so, it may make sense to settle your shoulder injury case for a lower amount than you otherwise would to minimize any reduction in those benefits. For example, you can receive both SSDI and workers comp at the same time but your SSDI payment will likely be reduced until you settle the workers comp claim.
- Other sources of health coverage. For some of you, private health insurance or government-provided insurance will pay for medical treatment for your shoulder injury if your case settles on a denied and disputed basis. Ending your case with these terms and using other health insurance to treat may put more money in your pocket after a shoulder injury.
The factors I describe above are not an exhaustive list. There are even more factors that determine an appropriate settlement range for shoulder injury claims. But the general rule is that the more substantial the evidence you can present for these variables, the higher your rotator cuff injury settlement will be.
Other Types of Work-Related Shoulder Injuries
Though rotator cuff injury is the most common type of work-related shoulder injury, it is not the only type.
I also help injured employees who suffer labral tears, frozen shoulder, shoulder fractures, and shoulder impingement.
Work-Related SLAP Tear Injury
As a ball and socket joint that allows your arm to move forward, backward, sideways, in, and out, your shoulder is unstable.
The labrum, a rubbery material attached to the glenoid bone, deepens your shoulder socket and increases stability. But, like your rotator cuff, it is prone to tearing. When your labrum tears, you will feel a deep pain in the shoulder. You may also experience a painful clicking or catching in the shoulder with movement.
There are several types of labral tears. The most common is a SLAP tear or lesion, a rupture of the Superior Labrum Anterior and Posterior.
SLAP tears are common in athletes and persons whose jobs require overhead activities or throwing. There are twelve sub-types of SLAP lesions that have been identified by MRI and direct arthroscopy. I have handled many workers comp SLAP tears such as:
- Type I SLAP tears involve fraying of the superior labrum with no detachment of the biceps insertion.
- Type II SLAP tears are the most common type. They involve tearing and detachment of the superior labrum and biceps from the glenoid rim. Type II SLAP tears are divided into subtypes depending on what portion of the labrum detaches anterior, posterior, or both.
- Type III SLAP tears occur when there is a bucket-handle tear of the labrum with the biceps tendon remaining attached to the bone.
- Type V SLAP tears occur when there is a Bankart lesion that extends upward and separates the biceps tendon.
If physical therapy does not improve your symptoms, then you may require arthroscopic surgery for your SLAP tear.
A shoulder labrum repair requires several weeks in a sling and physical therapy. It will be several months before you are capable of returning to full duty, if at all. It is important that you take that into consideration when negotiating a workers comp settlement for a SLAP tear.
Work-Related Frozen Shoulder (Adhesive Capsulitis)
Frozen shoulder, formally known as adhesive capsulitis, is a medical condition that develops gradually over weeks, months, or even years.
Though its exact cause is unknown, frozen shoulder is usually the result of an acute injury or surgery to the shoulder.
There is one situation where I see a frozen shoulder develop in the injured workers I frequently represent – when the insurance company refuses to pay for treatment. A delay in treatment – such as having to wait for physical therapy until after your workers comp hearing – puts you at risk of developing a frozen shoulder.
Common symptoms of frozen shoulder include pain and stiffness that is so severe you are unable to use your arm for simple movements.
Frozen shoulder includes the following stages:
- Stage 1: The “freezing” period where you experience worsening shoulder pain reduces your range of motion. This stage lasts from two to ten months.
- Stage 2: The “frozen” stage where your pain improves but you continue to have stiffness. This stage lasts several months.
- Stage 3: The “thawing” stage where you start to heal and regain some shoulder motion. This stage lasts from several months to several years.
There are several treatments for frozen shoulder. Treatment methods range from conservative care – therapy focusing on the range of motion, prescription medication, and steroid injections – to surgery. An arthroscopic surgery called shoulder manipulation under general anesthesia is sometimes used to loosen the muscles and tendons in the shoulder joint capsule to move freely. Shoulder manipulation surgery often requires three to four months of limited arm use.
Work-Related Fractures of the Shoulder Girdle
A work-related accident or motor vehicle crash can result in a fracture of the bones that make up the shoulder joint. Common shoulder-girdle injuries include:
- Mid-Clavicle Fractures
- Fractures of the Distal Clavicle
- Scapular Body Fractures
- Acromion Fractures
- Glenoid Neck Fractures
- Intra-Articular Glenoid Fractures
- Coracoid Fractures
- Humeral Fractures
Depending on the type of extent of the fracture, you may require surgical repair. The most common type of surgery for a shoulder fracture is called an open reduction and internal fixation. With this procedure, the orthopedic surgeon will go in and visualize the fracture directly, then put it back together using hardware such as plates and screws.
Get Help Negotiating a Fair Workers Comp Settlement for Your Shoulder Injury or Rotator Cuff Tear
You are a hard worker. And you may be dismissing your shoulder pain as something you can live with and work through.
Please do not. Even if you are not ready to undergo a rotator cuff repair or shoulder manipulation, act quickly and file a workers comp claim within the limitations period. It is the only way to protect your right to lifetime medical treatment and the wage loss replacement benefits you may need.
Call today for a free consultation: (804) 251-1620 or (757) 810-5614. Whether you need help with litigation or are looking for an attorney to help you maximize your shoulder injury settlement, I’m here for you.
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