The shoulder does a lot. It helps you lift, carry, push, pull, throw, catch, reach, and use your hands and fingers.
However, our reliance on the shoulder at work and in completing daily living activities comes at a cost. The features that make the shoulder joint so valuable – mobility and flexibility – also make it prone to instability and weakness when overexerted or put in an awkward position, which can lead to an occupational injury.
Thus, tens of thousands of employees seek workers compensation benefits and lump sum settlements for a shoulder injury that results in missed time. Indeed, data from the U.S. Bureau of Labor Statistics (BLS) shows that employees reported approximately 120,000 traumatic shoulder injuries at work that caused missed time in a recent year. That number almost doubles (to over 228,000) when you add work-related shoulder injuries that result in light-duty restrictions and the need for employment accommodations. Further, the Virginia Workers Compensation Commission reported that 36 percent of last year’s workers comp claims involved the upper extremity, which includes the shoulder.
This article analyzes the factors to consider when seeking workers compensation for a shoulder injury such as a rotator cuff tear, SLAP tear, AC joint disease, fracture, impingement syndrome, or adhesive capsulitis (frozen shoulder). The data and insight below come from my experience litigating and negotiating hundreds of workers comp settlements for torn rotator cuffs, labrum (SLAP) tears, and shoulder injuries requiring arthroscopic surgery or shoulder arthroplasty.
After reading this article, you will have the information or know what evidence to obtain to decide a fair settlement amount for a workers comp shoulder injury, whether it requires surgery or not.
So, read on.
Then call (804) 251-1620 or complete this contact form if you have workers comp questions.
You must prove that a specific work incident caused your shoulder injury to receive workers comp. The law does not cover shoulder conditions from gradual wear and tear (repetitive motion/cumulative trauma injuries).
Therefore, I recommend you include the exact mechanism of the shoulder pain when describing the injury to your doctors, submitting pleadings (the claim for benefits form), and answering discovery requests (interrogatories, requests for production, depositions).
For example, common work-related causes of shoulder injuries include the following:
The evidence from the National Safety Council shows you have a higher likelihood of hurting your shoulder at work if you fall into one or more of these categories:
These findings are consistent with the shoulder injury settlements I have negotiated for injured employees like you, whose jobs require heavy lifting and the frequent use of your arms and hands.
For example, many of the shoulder injury cases I have settled involved:
Do not see your job on this list?
Do not worry. You can still receive workers comp for a shoulder injury.
The medical and legal decisions you make after a work-related shoulder injury may affect your health, job options, and finances for years.
As you will see below, the shoulder includes the region from the mid-humerus to the scapulothoracic region, including all bone, joint, ligament, tendon, and soft tissue structures. An occupational injury that causes shoulder pain may involve structural damage to one or more of the shoulder’s muscles, ligaments, or tendons. Indeed, the American Medical Association’s (AMA’s) Guides to the Evaluation of Permanent Impairment, Section 15.2e, at 390, says: “In the shoulder, it is not uncommon for rotator cuff tears, a superior labrum from anterior to posterior (SLAP) lesion or other labral lesions, and biceps tendon pathology to all be present simultaneously.“
In addition, injuries to other body parts, such as the cervical spine/neck, may cause shoulder pain. For example, a spinal cord injury may cause cervical radiculopathy, which often affects the shoulder, arm, hand, and fingers.
Therefore, understanding the specific nature, treatment, and permanent restrictions for your type of shoulder injury is critical to calculating a fair lump sum payment.
This section summarizes the average workers comp settlement amounts for a shoulder injury in distinct categories: rotator cuff tear, injuries with surgery, injuries without surgery, and frozen shoulder.
The article’s later sections offer details on how specific shoulder injuries are diagnosed and treated and what permanent restrictions or impairment you may have. I recommend you read those sections to get more than a bird’s-eye view on workers compensation for shoulder problems.
$35,000 to $175,000 is the typical settlement range for a workers comp shoulder injury.
Where you fall in this range depends on the type of shoulder injury, whether you need arthroscopic shoulder surgery or total shoulder replacements, the permanent restrictions you receive from your doctor, after reaching maximum medical improvement (MMI), and what complications develop.
For example, in my experience, $50,000 to $75,000 is the starting point for a work-related rotator cuff tear settlement. This settlement range increases to $75,000 to $145,000 or more if you need shoulder surgery and have complications from a rotator cuff repair or also hurt your biceps tendon or neck in the same workplace accident.
Your case’s value increases if you need shoulder surgery.
For example, a work-related shoulder injury requiring arthroscopic surgery is often worth more than $65,000.
And a shoulder injury requiring more in-depth surgery, such as arthroplasty or a reverse total shoulder replacement, is often worth $85,000 or more.
Indeed, medical expenses for workers comp shoulder cases requiring surgery can range from $25,000 to $100,000 or more.
In addition, undergoing shoulder surgery increases the likelihood that your doctor will prescribe permanent restrictions and a high permanent impairment rating.
Shoulder injury settlements for employees who do not need or refuse to undergo surgery are often lower, from $50,000 to $75,000.
This lower range does not mean your injury is less severe or has not affected you.
Instead, the lower range reflects that conservative medical treatment for shoulder injuries often costs less than surgery, and employees can continue to work and earn money if their injury is nonoperative, potentially lowering the insurance company’s financial exposure
Few workers compensation cases involve only a frozen shoulder.
Instead, you likely suffered trauma to another part of the shoulder.
Therefore, I recommend evaluating a fair workers compensation settlement for a frozen shoulder using the same factors as deciding the average amount for the first work-related shoulder injury.
But with this modifier. You should seek the high end of the settlement range for your shoulder injury when you develop a frozen shoulder because this complication increases the likelihood of days award from work and permanent impairment.
This section explains six questions to answer before deciding a fair workers compensation settlement amount for a torn rotator cuff or other shoulder injury.
A frequent argument in shoulder injury claims is whether the employee suffered an acute or chronic injury.
Insurance companies and claim administrators (Sedgwick, ESIS, Corvel, Gallagher Bassett, etc.) know that many rotator cuff injuries and SLAP tears result from overuse of the shoulder over months or years. Indeed, medical studies show that those over the age of 40 whose jobs require repetitive overhead reaching are at the highest risk of suffering a torn rotator cuff.
With this knowledge, insurers may argue that your shoulder injury comes from wear and tear over years, not a specific incident.
Fortunately, you can overcome this defense and prove causation between the industrial accident and the shoulder diagnosis.
I recommend you offer evidence of symptoms following a specific event to combat this. Common symptoms of a shoulder 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, upper extremity weakness, cracking or snapping in your shoulder, trouble putting your arms behind your back, or pain that wakes you up when sleeping.
In addition, provide testimony about your ability to work before the injury versus afterward to show that even if you had a preexisting condition, this work trauma aggravated, exacerbated, or flared your shoulder.
Other factors kept equal, a torn rotator cuff or shoulder injury on the dominant side is more likely to lead to a higher settlement because it will be more difficult to return to work if you cannot use your dominant arm.
Your traumatic shoulder injury may require surgery. Indeed, orthopedic surgeons regularly use arthroscopy to diagnose shoulder injuries and determine the extent of the damage to the rotator cuff and other structures.
Further, shoulder symptoms are prone to recur when you try to use the arm, increasing the risk that you will need more treatment or surgery.
For example, I have represented injured employees who require a reverse total shoulder replacement when arthroscopic surgery did not relieve their symptoms.
Here is a list of the most common shoulder surgeries in workers comp cases:
Needing surgery for a torn rotator cuff or degenerative joint disease (DJD/osteoarthritis) of the shoulder increases the potential settlement value in two ways.
First, surgery is expensive.
As I said earlier, the medical costs for shoulder injuries requiring surgery range can easily exceed $25,000 or more. In a recent case where the employee underwent arthroscopic surgery and a reverse total shoulder replacement, the insurer spent approximately $110,000 for medical treatment (including the surgeries and follow-up care) by the time we settled.
Second, the data shows workers compensation patients are susceptible to poor outcomes after primary rotator cuff repair, even with small tears. Poor outcomes result in more time out of work, permanent restrictions that prevent a return to your pre-injury job, or the need for revision surgery.
Include all potential surgery and medical expenses in your workers comp demand letter that seeks a settlement.
The length of time your doctor disables you from all work or restricts you to modified duty influences the amount of wage loss benefits you receive.
In my experience, nonsurgical shoulder injuries often require up to two months of total disability, followed by up to four months of light duty.
In contrast, shoulder injuries needing surgery can lead to up to six months of total disability, then another three to six months of work restrictions at the sedentary or light physical exertion levels before receiving permanent limits or a full-duty release after a functional capacity evaluation (FCE).
Physically demanding jobs often lead to more extended periods of wage loss owed, increasing the lump sum payment for the shoulder injury.
For example, my experience representing injured employees with torn rotator cuffs is consistent with one study I reviewed. The study involved primarily middle-aged men with a history of rotator cuff tear in occupations involving manual labor. Nearly half never returned to full-duty work after a torn rotator cuff. And those who returned to work took more than six months (on average).
You may qualify for temporary partial or temporary total disability (TTD) benefits if your employer cannot accommodate restrictions from the shoulder injury or rotator cuff tear. This failure to provide light duty is common when the pre-injury job involves heavy, physically demanding work. Few employers will find a lighter job for you to transition into because of permanent restrictions from a shoulder injury.
Your employer’s inability to find a job you can do will increase your case’s settlement value.
Under most states’ workers compensation laws, you can receive compensation for permanent loss of use of an arm (upper extremity) from a shoulder injury.
Two substantive rules apply to claims for permanent partial disability, the name given to this benefit.
First, you must reach MMI for the shoulder injury. It can take anywhere from eight weeks to an entire year or more to reach MMI for shoulder injuries, depending on whether you need surgery.
Second, you must obtain evidence that quantifies your level of permanent impairment.
In Virginia, the insurer must pay for the permanent impairment evaluation that calculates the disability rating as a percentage loss of use.
Then you multiply the percentage impairment by your compensation rate and the number of weeks of PPD benefits available for the upper extremity (200 weeks in Virginia) to calculate the PPD payment for the shoulder injury.
Your shoulder accounts for more than half of your upper extremity function.
Any injuries and resulting complications discussed in this article can reduce shoulder joint motion, immobilizing the arm.
The list below gives typical impairment rating ranges for specific shoulder injuries.
A shoulder injury increases the chances of developing post-traumatic arthritis, adhesive capsulitis, osteoporosis of the humerus, impingement syndrome, complex regional pain syndrome (CRPS) of the upper extremity, glenohumeral arthritis, or acromioclavicular arthritis.
Each of these medical impairments requires treatment and can limit your capabilities. Therefore, you should include money for treatment and disability for these shoulder conditions in your settlement demand.
The following sections explain the medicine behind six common shoulder injuries in workers comp: rotator cuff tear, frozen shoulder, SLAP tear, broken clavicle, shoulder dislocation, and shoulder fracture (a broken proximal humerus). My law firm has won and settled hundreds of workers comp cases for employees with these job-related shoulder injuries.
Rotator cuff injury (including torn rotator cuff, impingement syndrome, and rotator cuff tendinitis) is the most common shoulder injury in workers compensation. About 80% of the shoulder claims I handle for injured employees involve rotator cuff tears.
The frequency of work-related rotator cuff injuries is not surprising, given their prevalence in the public. Over two million Americans annually seek medical help for a rotator cuff problem.
The rotator cuff includes four muscles (and their tendons) that wrap over the upper arm and engulf it.
Your rotator cuff stabilizes the humeral head during arm motions and helps lift and move the shoulder and arm.
Referred to by the mnemonic “SITS,” the four muscles forming the rotator cuff include the following:
The supraspinatus is a muscle in the upper back that helps with shoulder abduction (lifting the arm up and out) and prevents the head of the humerus from slipping lower. Indeed, this muscle controls the first 15 degrees of shoulder abduction motion, and then the deltoid takes over.
Its tendon passes under the acromion’s cover and attaches to the greater tubercle of the humerus.
Many rotator cuff injuries involve the supraspinatus. Its location, under vascularization, and frequent use make it vulnerable to degenerative changes, impingement, and tearing.
The infraspinatus is a thick muscle shaped like a triangle that helps rotate the arm laterally (externally). Its tendon attaches to the middle part of the humerus’s great tubercle.
The teres minor is a narrow muscle covered by the deltoid. Like the infraspinatus, the teres minor helps the arm rotate laterally.
The subscapularis muscle rotates the arm inward (medial rotation). Its tendon is the only rotator cuff tendon that does not attach to the greater tuberosity of the humerus. Instead, it attaches to the humeral head’s lesser tuberosity near the long head of your biceps tendon.
Multiple arteries from the axillary nerve provide the blood supply to the rotator cuff:
Your rotator cuff injury will take longer to heal if the occupational trauma damages these arteries, increasing the likelihood you will suffer permanent impairment to the upper extremity and miss time from work.
Several nerves carry messages between the rotator cuff and the central nervous system (spinal cord and brain).:
You can learn more about nerve damage from occupational injury here.
The rotator cuff muscles and their tendon attachments experience stress whenever you lift, rotate, or move your arm.
Degeneration, repetitive movement, or overexertion (tension overload) may irritate a muscle or tendon, causing inflammation or tearing.
The most common rotator cuff injuries include the following:
My law firm has negotiated workers comp settlements for rotator cuff injury of every type.
The type of rotator cuff tear you have will affect the settlement value of your workers compensation case in two ways.
First, the extent of the tear is crucial in predicting if you are a candidate for rotator cuff repair surgery or may suffer a retear if you return to work.
Second, whether you have an acute or chronic rotator cuff tear affects the strength of the insurer’s compensability defense.
The orthopedic surgeon will diagnose your rotator cuff tear as partial thickness or complete.
Partial tears do not go through the entire rotator cuff. Types of partial rotator cuff tears include:
In contrast, full-thickness rotator cuff tears puncture a hole in the entire cuff. Some full-thickness tears are called massive rotator cuff tears because of the surface area affected.
A confirmed diagnosis of a partial-thickness tear instead of a full-thickness tear does not mean your rotator cuff injury is worth less money. Many partial-thickness tears cause as much (or more) pain and disability from work as complete tears.
In addition to classifying the tear as partial or complete, the orthopedic doctor will diagnose you as having a chronic or acute rotator cuff tear.
An acute rotator cuff tear diagnosis will make qualifying for workers compensation benefits easier because it proves the tear resulted from a specific, discrete event—a requirement in states like Virginia.
In contrast, repetitive use causes chronic tears. And the use of this word signals a rotator cuff tear present before your occupational injury.
You can still recover benefits or negotiate a workers comp settlement for a rotator cuff tear that is chronic; however, you will likely need a doctor to write a disability letter on causation to show that the work injury aggravated, exacerbated, or flared the chronic tear or accelerated the need for surgery for the torn rotator cuff.
For example, a partial tear of one tendon or muscle from overuse can develop into a full-thickness rotator cuff tear affecting multiple muscles or tendons.
With this evidence, you can avoid losing at trial based on a finding that the tear resulted from repetitive movement.
Confirming the diagnosis of a rotator cuff tear involves three parts: patient history, clinical examination, and diagnostic imaging.
The first workers comp doctor you see will ask for a history of the accident and what symptoms you felt.
Most employees with acute rotator cuff tears describe sudden pain in the shoulder or neck when lifting an object overhead or breaking a fall from a height or floor level, followed by discomfort, stiffness, upper extremity weakness, and swelling. Overhead activities worsen the pain.
Employees with chronic rotator cuff tears may describe similar symptoms, including increased pain and arm weakness after a work-related task.
No matter the type of tear, you may also have increased shoulder pain at night that disrupts sleep.
Your age and description of the work accident are the two most critical factors in diagnosing a rotator cuff injury.
Clinical tests that gauge your pain and reaction when the doctor places your arm in different ranges of shoulder motion or offers resistance predict if you have a torn rotator cuff.
Standard tests to assess work-related rotator cuff injury include the following:
Many orthopedic surgeons can diagnose a torn rotator cuff based on the physical examination and range of motion testing.
However, you will likely undergo one or more imaging tests to confirm the diagnosis and exclude other injuries.
In addition, your doctor may perform a diagnostic arthroscopy to evaluate the rotator cuff and other shoulder structures after an acute occupational injury.
A rotator cuff tear cannot heal on its own.
Those with partial-thickness tears will likely start with conservative treatment.
Conservative treatment includes rest, ice, high-dose nonsteroidal inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections into the subacromial space. Your doctor should avoid injecting the rotator cuff tendon directly, as this may cause weakness or rupture.
Conservative treatment and rehabilitation aim to decrease pain and reduce stress on the tendon or muscle to prevent further tearing or degeneration.
If conservative treatment does not relieve your pain and improve function, or if you have a complete tear, you may need shoulder surgery to repair the rotator cuff.
Common rotator cuff surgeries include:
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.
The time it takes for your torn rotator cuff to stabilize and treatment to plateau orthopedically depends on the size of the tear, your pre-injury general health, and complications.
Generally, reaching MMI for rotator cuff injuries treated conservatively will take three to six months.
If you need surgery for a torn rotator cuff, the time to reach MMI often extends to 10 to 15 months.
You may avoid using the arm for days after hurting your shoulder at work or undergoing surgery, keeping the limb still by your side.
But now the shoulder feels stuck — like it is frozen.
Frozen shoulder is a medical condition that may develop when you suffer a work-related shoulder injury or a hand or wrist injury that causes you to guard the arm.
A risk anytime you must immobilize the arm after injury, a frozen shoulder frequently develops in injured employees who receive initial claim denials from the insurance company or experience delays in medical treatment authorizations. Waiting for approval for doctor appointments, surgery, or physical therapy increases the likelihood of developing adhesive capsulitis.
A frozen shoulder refers to stiffness and limitations in arm use that develop gradually over weeks, months, or even years.
Typically, these restrictions on active and passive shoulder movement stem from inflammation of the shoulder joint, which causes scarring of the glenohumeral joint. Eventually, the joint capsule shrinks from this chronic inflammation, restricting arm movement.
Doctors divide frozen shoulder into two classes: primary and secondary adhesive capsulitis.
Patients with primary adhesive capsulitis cannot remember trauma to the shoulder or a potential cause of their problems.
In contrast, many injured workers suffer secondary adhesive capsulitis, meaning you remember an event or cause before your symptoms began. For example, rotator cuff tears, posttraumatic arthritis, broken clavicles (collarbone), arm and wrist fractures, sling wearing, or shoulder surgery immobilizing the arm for an extended period may lead to a frozen shoulder.
Common symptoms of adhesive capsulitis include:
You have a greater risk of developing a work-related frozen shoulder if one or more of these factors apply to you:
Bottom line: If you want to avoid a frozen shoulder after a work injury, do not hold your arm still unless the orthopedic surgeon tells you to.
Frozen shoulder usually has three stages:
During the first stage of adhesive capsulitis, shoulder pain worsens until it restricts your range of motion.
In my experience, injured workers spend one to ten months in this first phase.
In stage two of adhesive capsulitis, you have been diagnosed with a frozen shoulder and begin to receive treatment for it. This treatment reduces pain, but you continue to have a decreased range of motion that makes working difficult.
This stage lasts from three to twelve months.
You start to heal and regain shoulder motion during this recovery phase.
This stage lasts from a few months to two years or more.
Your doctor may try several treatment methods to heal a frozen shoulder.
Standard medical care includes the following:
Probably.
The compensable consequence doctrine requires insurers and claim administrators to pay for medical treatment for any condition that naturally flows from a compensable injury by accident to the shoulder.
Therefore, you can receive treatment under your lifetime medical award if you have an Award Letter showing a covered accident and your doctor writes a letter explaining the causation between that accident and a frozen shoulder.
Your superior glenoid labrum is a ring of cartilage that surrounds the otherwise shallow shoulder socket. It stabilizes the joint.
A SLAP tear or lesion is an injury to this part of the shoulder.
Professional sports fans and former athletes may have heard of this diagnosis. SLAP lesions often affect athletes who have to throw or reach overhead.
But other occupations suffer SLAP tears, too. These shoulder injuries are significant causes of disability and missed time from work.
SLAP Tear Types
Doctors recognize multiple types of SLAP tears, such as the following:
When considering a workers compensation settlement for a SLAP tear, I recommend including the possibility that you will have permanent impairment from the surgery and may require additional procedures. A high percentage of injured employees I have represented with SLAP tears have needed two or more SLAP repair surgeries.
You have likely heard of children suffering from broken collar bones (officially called a clavicle fracture).
But these injuries also affect employees. Indeed, I have negotiated shoulder injury settlements for employees who fractured their clavicle in a workplace fall.
Doctors divide clavicle fractures into three categories (A, B, and C).
Class C clavicle fractures cause the most significant disability because the force required to break the collar bone near your body’s center means you likely suffered injuries to other shoulder structures and body parts.
If you fall on an outstretched arm at work, you may suffer a proximal humeral fracture near the shoulder joint.
Often, you can avoid surgery for a shoulder fracture. Indeed, the rotator cuff may hold the break together.
However, if you injure two or more of these parts of the proximal humerus – greater tuberosity, lesser tuberosity, surgical neck, or anatomic neck – arthroscopic surgery, an ORIF procedure (open reduction internal fixation), or shoulder replacement may be needed.
Shoulder dislocations are some of the most common major joint dislocations.
The most common type is an anterior shoulder dislocation. Your doctor may stabilize the shoulder using the Hennepin technique, scapular manipulation, or the Cunningham technique.
You may also suffer a posterior (common after electric shock) or an inferior shoulder dislocation.
I recommend asking your doctor to check for other shoulder injuries if you receive a diagnosis of a dislocated shoulder. An industrial accident or car crash capable of dislocating your shoulder can damage the rotator cuff and other structures.
You work hard. 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 shoulder surgery, you must act quickly and file a workers comp claim within the limitations period. It is the only way to protect your right to benefits.
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 rotator cuff tear or shoulder injury settlement under the Workers Compensation Act, I am here for you.