When most people hear about workers compensation injuries, they think of high-risk jobs such as construction and manufacturing. However, you can obtain an injury in the workplace regardless of your occupation. While some jobs do have a higher risk of exposure, any line of work has certain risks that workers may face when carrying out daily tasks. In particular, orthopedic injuries occur in many different types of workplaces.
A workplace orthopedic injury can occur due to awkward postures in front of a computer screen, repetitive and forceful movement of the shoulders or neck, and even prolonged exertion of force on the wrist. Simply put, an orthopedic work injury can occur more easily than you might think. These injuries also cause health complications- such as loss of muscle control, inflammation, damage to the nerves, and much more.
Workers' compensation insurance was designed to cover employees against the high costs of treatment arising from workplace injuries. It is important for all workers to know what an orthopedic injury is, how it can affect them, and how they can make a claim for compensation. Workers should also be prepared to contest any denied claims if they feel that their injury is valid and is work-related.
Workers' Compensation Claims: An Overview
There are many risks that employees face in the workplace. From slips and falls to illnesses due to chemical exposure, laws have been put in place to protect employees from suffering significant financial loss as a result of a workplace injury. In other words, workers' compensation plans provide a cushion for employees to fall back on.
But how exactly do workers' compensation plans work? The employer will typically purchase an insurance policy, where they can make a claim against the policy to cover an injured employee’s expenses. The insurance policy is essentially a fund that employers pay into. From this pool of premiums, claims can be made to compensate employees as necessary.
Your employer will typically have a workers' compensation plan that’s defined by the following variables:
- The nature of risks that employees face in the workplace
- Types of injuries (and cost of treatment) that are likely to occur to employees
- Types of injuries that are not covered by the policy (including willful misconduct or self-inflicted injuries)
- Number of employees covered
- A statute of limitations clause (durations within which a claim should have been filed)
Workers' compensation claims are primarily made to provide a timely and efficient way for injured workers to receive financial assistance. In most cases, an injured worker will have to incur costly medical bills, loss of income, temporary or permanent disability, among others. Workers' compensation plans deliver fixed payments to injured workers (along with medical coverage) while protecting the employer from being sued for negligence.
Understanding Orthopedic Work Injuries
Workers' compensation is issued to employees for many different types of injuries- and one of those is orthopedic work injuries. Orthopedic injuries are those that arise from repetitive, forceful, or prolonged movement in certain parts of the body. Such injuries can affect many different organs, including your feet, knees, elbows, hips, shoulders, and spine.
Given the expansive range of discomfort that orthopedic injuries can cause, these injuries are one of the most common in the workplace. For example, workers in manufacturing plants may experience back and wrist injuries due to frequent heavy lifting, while office workers can experience neck and shoulder injuries due to repetitive movement in front of a computer screen. Because of these reasons, orthopedic work injuries occur more often (and are more widespread) than you might think. These injuries also affect all levels of workers, from entry-level hires to more experienced personnel.
As an employee, you should remain aware of orthopedic injuries and whether you’re a victim. This knowledge will enable you to make a timely claim for compensation. Many workers' compensation plans do cover orthopedic-related injuries because of how widespread and debilitating they can be.
Many orthopedic injuries result in limited movement, frequent pain and discomfort, and even disability (in more extreme cases). As time goes by, it can be tricky to find out exactly when (or how) your injury occurred. This is why remaining aware of such injuries, and making a timely claim, is so important. Furthermore, orthopedic injuries may require specialized treatment from an orthopedic specialist- such as therapy or surgery. Such treatment can be costly and time-consuming, making compensation even more necessary for injured workers.
Types of Orthopedic Injuries you can Obtain in the Workplace
As previously mentioned, you can obtain an orthopedic injury in many different ways. From bending over awkwardly when typing to knee pain from frequent movement, various parts of your body can become strained due to orthopedic injuries. In addition, such injuries can limit your ability to work and live your normal life.
Here are some of the most common orthopedic injuries you can obtain in the workplace, and how they’re bound to affect you moving forward.
- Neck and shoulder pain
Orthopedic injuries to the neck and shoulders can occur in many different ways. For example, hauling heavy items in a warehouse can exert stress on your shoulder muscles. The soft tissues around your shoulders and neck area can also become dislocated, hyperextended, or riddled with cartilage damage.
Furthermore, such injuries could cause inflammation and nerve damage to occur over time. Also, remember that daily activities such as craning your neck or sitting in an awkward position could result in neck and shoulder pain.
- Back pain
Another common orthopedic injury is back pain. Back pain occurs whenever you exert your spine to over-activity. Such pain also occurs in the lower back area- and can be caused by frequent bending, awkward sitting positions, an accident in the workplace, and much more.
- Arm and wrist pain
Injuries along the arm and wrist mostly occur due to frequent and repetitive movements. Such movements may exert undue stress on your arms and wrist, causing stress fractures and tissue damage.
- Injuries to the knees
Your knees can also obtain an orthopedic injury. This can arise due to frequent bending, lifting heavy loads, or spraining the knee during an accident.
- Rotary cuff tears
Your rotary cuff is responsible for ensuring smooth movement of the shoulder. It also controls your entire arm and makes daily tasks (such as wearing clothes and lifting your arms in the air) possible. A torn rotary cuff is a common orthopedic injury, affecting nearly 2 million Americans every year. If you obtained a rotary cuff tear as a result of work activity, receiving adequate compensation will be an important step to take.
There are many more orthopedic injuries you can obtain, including sprained thumbs and tendonitis of the biceps.
Why Workers' Compensation for Orthopedic Claims is Important
Workers' compensation claims are widespread. These laws also vary according to your industry, size of the business, specific location, and much more. Regardless of where you are or what job you do, making a claim and receiving the compensation you deserve is important.
This is particularly true for orthopedic work injuries. Orthopedic injuries can affect your daily life, leaving you with consequences far beyond not being able to work. For example, muscular or nerve injuries may limit your movement and leave you with lingering pain.
Receiving compensation for such injuries can help you in the following ways:
- Acting as a safety net for treatment costs
Perhaps the biggest benefit of workers' compensation is that you’ll receive coverage for any costs associated with your medical condition. Whether you need orthopedic surgery or physical therapy, your compensation plan should cover all treatment costs associated with the injury that you received as a result of work. Treatment for orthopedic injuries is not only widespread, but it can also become very expensive. This is particularly true for therapy and surgeries that require lots of post-care.
If you obtained an orthopedic injury at work (or as a result of work), covering the entire cost of treatment out of pocket can be financially crippling. That is why making a timely claim is so important: it ensures that you receive the coverage you deserve so as to increase your chances of a timely recovery.
- Recover lost wages to prevent financial loss
Another important benefit of workers' compensation plans is that you can receive regular compensation for lost wages. For the duration that you’re unable to work due to injury, you will receive a replacement income to meet your daily expenses. Replacement income is important because it ensures that you remain in the same financial state that you were in before becoming injured.
Workers typically receive a replacement income along with coverage for medical expenses incurred. In this way, you get the best available treatment while not being set back financially. This coverage also facilitates a quicker recovery so you can get back to work in a timely manner.
- You can receive retraining for a new workplace position
If your orthopedic injury permanently prevents you from carrying out previous job responsibilities, workers' compensation coverage can cater for the cost of retraining. Retraining means that you can be equipped with the skills necessary for a new job position. This new position should fit what you’re currently capable of doing- both physically and mentally.
Retraining for a new position is important because it ensures that you continue to remain self-sufficient even after suffering from a certain type of injury.
- You receive compensation on a no-fault basis
Another benefit of workers' compensation is that it is awarded on a no-fault basis. As long as the injury was obtained at work (or as a result of work), you can receive compensation regardless of who was responsible for the injury itself. The no-fault system minimizes costly and time-consuming lawsuits that would otherwise become commonplace.
Making a Claim for Orthopedic Work Injuries
If you’ve obtained an orthopedic injury from work, it’s important to know how you can file a claim. Filing a timely claim makes it easier for you to gather all the documentation needed. It can also be tricky to prove that your orthopedic injury is actually work-related.
Indeed, many different daily activities can result in orthopedic related symptoms- such as the heavy lifting of furniture in your home or even playing a sport. While workers' compensation claims are issued on a no-fault basis, you still need to prepare a strong claim backed by enough evidence.
The claims process typically proceeds as follows.
- Begin by obtaining any necessary medical care
When you obtain an orthopedic injury, you should first seek treatment as soon as possible. Treatment may be in terms of emergency care or first aid for your current condition. Orthopedic injuries also tend to develop over time, and thus are more complex to pinpoint.
In the event that you suffer from an accident or excessive pain, seek medical care as soon as you can. Your medical documents will also serve as a record when officially filing your claim.
- File an official claim with your employer
The next step is to notify your employer in writing. This should be done within the deadlines set in place, and according to the workers' compensation insurance policy. Most states, including California, require you to report a workplace injury within 30 days.
A notification to the employer occurs by filling out a workers' compensation claim. The claim should include this information:
- The type of injury and how it affects your body
- When the injury occurred- date, location, and time
- How the injury in question occurred
- Any medical treatment received and how it helped
- Who was involved?
- File a claim with the workers compensation board
The next step is to fill out a form with the workers compensation board. This form, called the C-3 Form, contains information regarding you, your employer, and the nature of your injury.
Your doctor should also fill out a C-4 Form, which details the medical treatment that you received. Filing with the workers compensation board essentially creates a legal record of your claim. You, your employer, and your workers' comp insurer will all be notified of the claim and what is stipulated under the law.
- Keep records of all paperwork
After filing the claim, make sure you keep records of all paperwork. From medical records to a copy of the actual claim, these documents will come in handy should you need to provide any supporting information- or to file an appeal.
- Start receiving your benefits
After all, paperwork is processed and approved, you will start receiving your orthopedic injury benefits. Benefits are paid out as a replacement to your income, and you will receive a check or direct deposit biweekly. In addition, you may be reimbursed for all costs incurred for your treatment so far. And if you need any further medical care, the workers' compensation policy will cover these expenses as well.
During the course of receiving your benefits, regular reviews will be carried out to determine your treatment progress. Benefits will be adjusted according to how well you’re recovering from orthopedic treatment, and how much time it will take for you to get back to work.
- Seek legal representation
You should strongly consider getting a workers' compensation lawyer when filing a claim. The process of preparing, filing, and contesting a claim can be lengthy and stressful. And if you’re suffering from an injury or recovering from treatment, the burden on your health is even more significant.
A workers' compensation lawyer can help you prepare a strong claim, keep track of all paperwork, and prepare an appeal if necessary.
Are You Eligible for Compensation?
As important as orthopedic workers' compensation claims are, you should be aware that not everyone is eligible for compensation benefits. You must be eligible under terms of the policy for you to receive any income replacement, medical care coverage, or retraining. In most cases, eligibility is determined by your working status, the nature of your injury (work-related or not), and your specific line of work.
Workers' compensation claims in California cover the following people:
You must be classified as an “employee” of the company you work for to be eligible for workers' compensation. Independent contractors are typically not eligible, and they should solve any injury disputes via an arbitration process. Independent contractors include consultants, freelance workers, and seasonal workers.
There are also some categories of employees who don’t qualify for workers' compensation. These include domestic workers, agricultural workers, and undocumented workers. Employees hired through staffing agencies may need to pursue workers' comp from the staffing agency itself, rather than from the company where they work.
- Work-related injuries
Another eligibility criterion is determined by whether your injury was actually work-related. The orthopedic injury you’re suffering from must have been caused, directly or indirectly, by your line of work. You may need to establish the cause and effect relationship for your orthopedic injury so as to be eligible for compensation.
What to Do if Your Claim is Denied
If you obtained an orthopedic work injury and your claim was denied, the consequences can be devastating. Indeed, the cost of seeking treatment out of pocket, along with the number of lost wages that you may incur, can cripple you financially.
Treatment for orthopedic injuries is also different from many other illnesses and medical conditions. Because orthopedic-related injuries are mostly muscular in nature, you may require a longer recovery process. In addition, such injuries may limit your mobility and overall functionality during daily living.
If you feel that your workers' compensation claim was wrongfully denied, you should take immediate steps to appeal the decision. Appeals can be filed through California’s workers compensation board.
Common Reasons for Denied Claims
There are some common reasons why your claim may be denied. These include:
- Failure to report an injury within required timeframes
- Filing your claim late
- The injury is not determined to be work-related
- Lack of enough medical evidence
How to File an Appeal
If your initial workers' comp claim was denied, filing an appeal will be an important step to take. You should prepare to file your appeal within 30 days of being denied compensation. There are many valid grounds for filing an appeal. For example, you may have obtained additional medical evidence of your orthopedic injury, or you may have a valid reason as to why you filed your claim late.
Working with a workers' compensation lawyer will be key towards preparing a strong appeal. A lawyer will help you gather all necessary records, medical evidence, and other elements that may strengthen your appeal application.
What typically happens is that you will submit your appeal to California’s workers compensation board. The board will then schedule a hearing before an administrative law judge, who will examine all evidence and make a decision. You may be able to further appeal denials until the level of a district court.
Compensation for Disabling Injuries
Orthopedic work injuries can also become disabling. For example, a significant muscular or soft tissue injury on your leg can cause you to have limited mobility moving forward. If your orthopedic injury is determined to be temporarily disabling, you may receive compensation until your condition improves.
However, if medical professionals determine that your condition is permanently disabling, you may be entitled to receive permanent disability compensation- along with lifetime medical care. Receiving such compensation is so important (if you need it) because the overall out-of-pocket cost can become truly overwhelming.
How a Workers' Compensation Attorney Can Help with Orthopedic Work Injuries?
Orthopedic work injuries occur more often than you might think- and denials issued for such claims are also quite common. Because of the risks that orthopedic injuries pose to workers, you should be prepared to make a strong claim.
It can be challenging to prove if your orthopedic injury is actually work-related. For example, lower back pain, torn rotary cuffs, and shoulder/neck pain can occur in many different situations. This is why you should ways have a trusted Workers' Compensation Attorney by your side when filing a claim.
Find a Workers Compensation Attorney Near Me
An attorney will help you gather all necessary evidence, file your claim on time, and fight for every penny that you deserve. Don’t suffer in silence if you obtained an orthopedic work injury- get the compensation you need to restore your health as soon as possible.
Contact the Workers Compensation Attorney Law Firm today if you have a workers' compensation claim in the Los Angeles area. Call our Los Angeles Work Compensation Attorney at 310-956-4277 for a free, no-obligation consultation regarding your orthopedic work injury.