Torn ACL Workers Comp Settlement – Valuing ACL Tear Claims

ACL Injuries: Workers Comp Claims and Settlements

 

Learn How to Increase the Settlement Value in ACL Injury Claims

 

You are doing your job when you move your leg and hear a loud pop in your knee. You try to put pressure on the leg, but you feel a sudden pain, and your knee buckles when you do. You call for help.

 

What just happened?

 

You suffered an anterior cruciate ligament (ACL) tear on the job, a painful and debilitating knee injury. Now what?

 

Your knee has four primary ligaments: strong bands of tissue connecting bone to bone. They are: 

 

• The anterior cruciate ligament; 

 

• The medial collateral ligament (MCL); 

 

• The lateral collateral ligament (LCL); and,

 

• The posterior cruciate ligament (PCL)

 

Injuries to the ACL are the most common, impacting more than 150,000 people in the United States each year. And many of these ACL tears and sprains happen at work and coincide with meniscal tears.  

 

This article discusses what to expect if you hurt your ACL on the job. After reading it, I hope you understand the average workers comp settlement value of ACL injuries and what you can do to get even more. 

 

Keep reading to learn more. 

 

If you have questions about workplace injury litigation or would like a consultation with a top-rated workers comp lawyer, contact my firm today. We help injured employees negotiate fair and reasonable work injury settlements. And we are ready to fight for you. 

 

What is the Anterior Cruciate Ligament (ACL)?

 

Ligaments connect bones to other bones.

 

There are four main ligaments in your knee, one of which is the anterior cruciate ligament, or ACL for short.

 

Your ACL connects your thigh bone (femur) to your shin bone (tibia) and provides stability to your knee joint. It also helps you bend your knee forward and stop and change directions suddenly.

 

Understanding the Mechanism of an ACL Injury: What are the Most Common Causes of Anterior Cruciate Ligament Sprains and Tears?

 

ACL injuries are often considered sports injuries, probably because so many football, basketball, and soccer players suffer ACL tears.

 

But all of us, no matter our occupation, can suffer an injury to the anterior cruciate ligament.

 

For example, I have represented teachers, police officers, firefighters, nurses, semi-truck drivers, delivery drivers for UPS and FedEx, flight attendants for airlines such as American Airlines and United Airlines, construction workers who fell from ladders and other heights, and warehouse employees for Amazon, Wal-Mart, Kroger, and Target who suffered ACL injuries caused by:

 

• A direct blow to the knee in a motor vehicle crash or when attacked by a patient or customer during a workplace assault or struck by a beverage cart or other object

 

• Landing awkwardly when going down the stairs or when jumping from one level to another

 

• Stopping suddenly

 

• Twisting suddenly

 

• Pivoting with the leg planted in the ground

 

• Changing direction suddenly

 

• Hyper-tending the knee

 

• Squatting with too much weight

 

• A slip and fall accident, such as when the floor is slippery or wet

 

• Poor conditioning

 

• Inadequate footwear

 

• Tripping over workplace hazards

 

• Moving quickly to meet a production quota

 

• Inadequate safety training

 

What are the Types of ACL Injuries? Common Signs and Symptoms

 

There are varying degrees of ACL injuries, ranging from mild to severe in the effect they have on your ability to work or complete activities of daily living. These include:

 

ACL Sprains

 

You suffer a sprain when the fibers of your anterior cruciate ligament are stretched, partially torn, or completely torn. ACL sprains are classified as:

 

Grade 1 ACL Sprain

 

A Grade 1 sprain is the mildest type of ACL injury.

 

You have a Grade 1 sprain when the fibers of your anterior cruciate ligament are stretched but not torn and your ACL can keep the knee joint stable.

 

Common symptoms include swelling, moderate knee pain, some reduction in mobility, and, tenderness to touch.

 

Usually you do not need surgery for a Grade 1 ACL sprain. Rest, anti-inflammatory medications, and restrictions limiting you to sedentary work or limited periods of walking or standing are prescribed.

 

Grade 2 ACL Sprain

 

You have a Grade 2 ACL sprain when you have an incomplete tear of the fibers of the ligament. This type of ACL injury is rare. Usually you have either no tear or a complete tear.

 

The symptoms of a Grade 2 ACL sprain are similar to those of a Grade 1 ACL sprain, only more severe. You may also experience instability in the knee joint, with it sometimes giving out or buckling during activity.

 

If you experience instability your orthopedic surgeon may recommend that you undergo reconstruction of the ACL.

 

Grade 3 ACL Sprain

 

Known as a complete ACL tear or rupture, a Grade 3 ACL sprain is the most common type of ACL injury among athletes.

 

When you suffer a complete ACL tear, the ligament is torn apart into two or more sections. Often this results in swelling, stiffness, inability to extend the leg fully or to put weight on it, and instability. In fact, an unstable knee is the strongest sign of a complete ACL tear.

 

ACL reconstruction surgery is usually recommended once your pain decreases and your swelling goes down.

 

ACL Avulsion Fracture

 

An ACL avulsion fracture, also called a tibial eminence avulsion fracture, occurs when your ACL tears and breaks a piece of bone from where it attaches. Usually there is a separation of the tibial attachment of the anterior cruciate ligament (where the tibia attaches to the shin bone). A separation at the femoral attachment is rare.

 

ACL avulsion fractures are more common in children than adults; however, it is possible for an adult to suffer this type of injury if there is a direct blow over the distal end of the femur when the knee is flexed.

 

Multi-Ligament Knee Injury

 

Some of you may suffer not only a work-related ACL injury but also an injury to other parts of the knee, such as the meniscus. In my experience, many employees suffer injuries to the meniscus and anterior cruciate ligament at the same time.

 

An injury to multiple ligaments or to the ACL and patella is considered a catastrophic injury that can result in permanent disability. Multi-ligament reconstructive surgery is often required.

How is an ACL Injury Diagnosed?

 

After you report your work accident and knee injury to your employer, you will likely be asked to choose a workers compensation doctor from a list. This list, called a workers comp panel, is created by your employer or its insurer or third-party claim administrator. Usually it consists of three or more primary care providers or urgent care facilities.

 

In my experience, the first doctor you see will ask you to describe how you were hurt. This is called a patient history, and many doctors can predict the type of knee injury you have based solely on your patient history.

 

That doctor will then perform a physical examination of your knee, focusing on your range of motion and stability. This is often followed by plain radiographs, also called x-rays. The x-ray will show if you have any fractures that require treatment. An avulsion fracture is often evidence that you have suffered a ligament injury.

 

If you do not have a fracture, the doctor will probably recommend conservative treatment such as rest, light duty restrictions, ice, elevation, or even physical therapy. If this conservative treatment does not take away your symptoms, the doctor will probably refer you to an orthopedic surgeon.

 

An orthopedic surgeon is a doctor that specializes in treating injuries and conditions involving your bones, joints, and ligaments. At your first visit with the orthopedic surgeon, he or she will take another patient history and ask if conservative treatment has helped at all. If the orthopedic surgeon suspects an anterior cruciate ligament injury based on the history you give and the symptoms you are experiencing, they may suggest that you undergo magnetic resonance imaging (MRI) of the knee.

 

Studies show that MRI is able to detect both meniscal and ligament injury with greater than 90% accuracy. Your orthopedic surgeon will review the MRI films and the radiologist’s report to make an official diagnosis.

 

If MRI does not show a ligament injury but your orthopedic surgeon still suspects a partial or complete ACL tear , they may recommend that you undergo an arthroscopy as a diagnostic tool. An arthroscopy is even more accurate than diagnostic imaging but is usually suggested only if you are active and in decent shape. Even though it’s diagnostic in nature, it’s still a surgery.

 

Treatment of ACL Injuries: Is an ACL Reconstruction Appropriate for You?

 

The key decision for most of you with complete or partial ACL tears is whether nonoperative or operative management is appropriate.

 

For some of you, physical therapy and rehabilitation, bracing, and work and activity modifications will be all you need to improve after suffering an ACL injury.

 

Others of you, however, may require surgical intervention in the form of an anterior cruciate ligament reconstruction. If you undergo this type of surgery your orthopedic surgeon will rebuild your ACL using either an autograft tendon harvested tendon from your own hamstrings, patellar tendon, or other body part or an allograft tendon from a cadaver.

 

Many of my clients require ACL surgery, which is consistent with statistics on the number of people who suffer an ACL tear and require operative management. Whether your doctor recommends that you undergo an ACL reconstruction depends on many factors, including:

 

• Whether you suffered a partial tear or complete tear of the ACL

 

• Your pre-injury activity level

 

• Your pre-injury job requirements

 

• Your expected post-injury activity level

 

• Your age

 

• Whether you have multi-plane instability in your knee

 

• Whether you suffered injuries to any other knee ligaments or structures in the workplace accident or motor vehicle crash

 

• Your post-surgery expectations

 

Do not be surprised if your doctor recommends that you undergo additional rehabilitation before the ACL reconstruction to strengthen your knee and improve its range of motion. This is helpful in reducing the likelihood of complications post-surgery.

 

After the surgery your doctor will likely recommend pain medication and intensive physical and occupational therapy.

 

How Much Does an ACL Reconstruction Cost?

 

Unfortunately there is not much transparency with health care costs.

 

In my experience, an ACL reconstruction surgery and the follow up care needed to recover costs anywhere from $15,000 to $75,000 without insurance. This amount includes facility fees (hospital operating room), doctor fees (anesthesiologist, surgeon, assistants), medical equipment fees (graft), prescription drugs, therapy, follow-up appointments, and additional diagnostic testing.

 

If the workers compensation insurance carrier is responsible for covering the ACL reconstruction surgery, it will likely pay from $7,500 to $14,000 for the operation under the current medical fee schedule. This does not include costs associated with follow-up care.

 

What is My Likely Prognosis and Outcome After ACL Reconstruction Surgery?

 

I have seen a wide range of outcomes following ACL tears and surgery.

 

Many ACL tears require at least six months to recover. During this time your orthopaedic doctor may take you out of all work or give you light duty restrictions with limited lifting, kneeling, climbing, walking, and standing.

 

Depending on your restrictions and normal job responsibilities, you may be entitled to temporary total disability (TTD) benefits if you are out of work completely or temporary partial disability (TPD) benefits if your employer can accommodate your restrictions or you find a modified duty job.

 

So long as the workers comp insurance carrier does not issue a medical treatment denial and you are able to complete your post-surgery therapy program without delay, you have a high likelihood of regaining most of your pre-injury functional abilities after an ACL tear.

 

Even with a good outcome, however, your doctor will likely recommend some activity modifications.

 

If you have complications from arthroscopic reconstruction of your anterior cruciate ligament, then your post-injury outcome is more difficult to predict. Potential complications include:

 

• Fracture of the patella

 

• Muscle weakness or atrophy, especially if you did not rehabilitate your leg before and after surgery

 

• Post-traumatic arthritis

 

• Patellar tendon rupture

 

• Infection such as MRSA

 

• Loss of graft fixation

 

• Inappropriate graft placement

 

Any of these complications may require additional surgery or antibiotic treatment, especially if you have an aggressive infection.

 

I recommend discussing the likelihood of surgical success with your doctor and asking for a referral for a second opinion if you are hesitant to undergo the ACL reconstruction.

 

What Factors Determine the Settlement Value of a Work-Related ACL Tear?

 

When your employer’s workers compensation insurance carrier or third-party claim administrator (TPA) makes a settlement offer in your ACL injury case, you should consider not only the factors discussed earlier in this article but also:

 

Is there any dispute that you suffered an injury by accident to your ACL?

 

The first step in recovering workers comp benefits for an ACL injury is to prove that you suffered an injury by accident to the ligament.

 

To prove an injury by accident under the Workers Compensation Act you must prove: (1) an identifiable incident; (2) that occurs at some reasonably definite time; (3) an obvious sudden mechanical or structural change in the body; and, (4) a causal connection between the incident and the bodily change.

 

Because some ACL tears are chronic or pre-existing, the insurance carrier may defend your workers comp claim by alleging that your workplace accident or auto crash did not cause an actual change to your anterior cruciate ligament. This is especially true if you have been diagnosed with arthritis before the work accident. You can overcome this defense by asking your primary care physician or orthopedic surgeon to state that your accident was the main cause, or a contributing cause, of your ACL tear.

 

Is there any dispute that your anterior cruciate ligament injury was caused by your work-related accident?

 

You are not eligible for workers compensation benefits if your ACL injury was caused by the simple act of walking, turning, bending, squatting, or going up and down stairs – unless you can prove that the movement was awkward or there were other contributing factors.

 

Do not be surprised if the insurance carrier or a TPA such as Sedgwick or Gallagher Bassett denies your claim, alleging that your ACL injury did not arise out of a specific risk of your employment, and forces you to present your case at a workers comp hearing.

 

I have helped many employees receive medical coverage, wage loss replacement benefits, and settlements for ACL injuries that were initially denied by the insurance carrier by developing facts showing how the injury was caused by an unusual movement or the employer’s requirement that the employee rush or hurry to complete a task.

 

Who has paid for medical treatment for your ACL injury so far?

 

If the insurance carrier denies your claim, you may have to use your private health insurance to pay for treatment for your work injury or pay out of pocket or on a lien basis.

 

Make sure you include the amount of medical bills paid by other sources (you, Medicare, Medicaid, or private health insurance) or that are outstanding when determining a fair settlement amount for your ACL injury.

 

If the workers comp insurer has paid for medical treatment for your anterior cruciate ligament tear, do not include the amount paid already when calculating a fair settlement range.

 

Is an ACL reconstruction being discussed by your orthopedic surgeon?

 

As I discussed above, an ACL reconstruction surgery is expensive.

 

If you have not undergone surgery but it is being discussed, make sure you include the amount of money you would have to pay without insurance in your settlement demand.

 

Have you reached maximum medical improvement (MMI) for your anterior cruciate ligament injury and, if so, are you capable of performing your pre-injury job?

 

When you reach MMI for your ACL injury, your orthopedic surgeon may refer you for a functional capacity evaluation (FCE) and impairment rating.

 

The FCE is used by your doctor to determine your permanent restrictions from the anterior cruciate ligament injury and whether you are capable of performing your pre-injury job, while the impairment rating is used to determine the amount of permanent partial disability (PPD) benefits you are entitled to through workers comp.

 

If you are unable to perform your pre-injury job with the permanent restrictions you are given, your ACL injury claim should settle for more money, all other factors remaining equal. Just make sure you look for work within your modified duty restrictions until you receive a Workers Compensation Award Letter.

 

Are you at risk of suffering post-traumatic arthritis that may require a total knee replacement?

 

A work-related ACL injury may put you at risk of developing post traumatic osteoarthritis of your knee or, if you already have arthritis, aggravating, accelerating, exacerbating, or worsening it.

 

Your employer or its workers compensation insurance carrier may be responsible for wage loss or medical care resulting from the development of arthritis after your ACL injury or the worsening of pre-existing arthritis. Even if you have been told that you will need a knee replacement surgery in the past, your employer or its workers comp insurer may still have to pay for it if the workplace ACL injury caused you to need the joint replacement surgery sooner than you otherwise would have.

 

Discuss with your orthopedic surgeon whether you have developed or may develop osteoarthritis because of your anterior cruciate ligament and what medical treatment, such as a total knee replacement, osteotomy, or pain management, you may need in the future. Then include medical expenses for this treatment in your settlement.

 

How much did you earn before the anterior cruciate ligament injury?

 

The more money you made before your ACL injury, the greater the potential settlement value of your claim. This is true in every workers comp claim.

 

If there is conflicting medical evidence, how supportive and credible is your orthopedic surgeon?

 

The three most important people in your claim are you, your attorney, and your orthopedic surgeon.

 

Choosing an orthopedic surgeon that is not only skilled and respected by the Workers Compensation Commission but also willing to cooperate with you and your lawyer if the insurance carrier fights your claim by hiring an IME doctor to dispute your treating orthopedic surgeon’s opinions is important.

 

This is an area where I can help you. I know what orthopedic doctors are more likely to help you during litigation, including staying strong during deposition. If your orthopedic surgeon is supportive, you have a better chance of recovering more money through settlement because the insurer knows you may win at trial.

 

Get Help with Your Claim for an Anterior Cruciate Ligament Injury

 

An ACL tear can affect you for the rest of your life.

 

Depending on the severity of your ACL injury, the level of permanent impairment it caused to your leg, and the physical requirements of your occupation, you may have to change careers, impacting your family’s finances for a long time.

 

Don’t try to navigate the workers comp claims process on your own. Let me help you get the highest settlement possible for your anterior cruciate ligament injury by working with you, your treating orthopedic surgeon, and other fact and medical witnesses to develop a strong case.

 

Call now to get started: (804) 251-1620 or (757) 810-5614. From start to finish, I’m here for you.