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North Carolina workers’ compensation pays for medical expenses and lost wages for work-related injuries and illnesses. Most employers are required to provide workers’ compensation insurance for their employees. Shoulder injuries are common work-related injuries caused by trauma or repetitive motions. In this blog, our North Carolina workers’ compensation attorneys discuss shoulder injuries and when a total shoulder replacement may be necessary.
When Is a Total Shoulder Replacement Considered Work-Related and Compensable?
A shoulder injury can occur in any type of employment. However, some employees may have a higher risk of developing a shoulder injury, including in the manufacturing, construction, warehousing, auto mechanics, energy, and healthcare industries. Repetitive motions, heavy lifting, working in awkward positions, and using specific tools are all risk factors for shoulder injuries.
A total shoulder replacement must be the result of a specific workplace incident, work injury, or repetitive job duties that place you at an increased risk. Proving the cause of the shoulder injury occurred during the ordinary course of employment is essential to receive workers’ comp benefits. In some instances, a shoulder replacement may be justified if a work injury or condition aggravated a pre-existing condition.
Proving your injury occurred because of your job is only one requirement. You must prove that the shoulder replacement surgery is reasonable and necessary. Generally, proving the surgery is reasonable and necessary requires you to have medical proof that conservative treatments have failed.
Medical and Legal Documentation You’ll Need
If you sustain a work-related shoulder injury, it is crucial to take immediate steps to protect your rights. Report your injury to your employer immediately and seek medical treatment. You must provide written notice to your employer within 30 days (keep a copy for your records). You must file a Form 18 with the North Carolina Industrial Commission to begin a workers’ comp claim. Be sure to follow all deadlines to avoid your claim being denied.
You will need medical records to support your claim. Your doctor’s records will provide the history of your injury and medical treatments. It is crucial to follow the treatment plan and your doctor’s instructions. Medical records include, but are not limited to:
- Initial visit, including records from an emergency room if applicable
- Diagnostic imaging reports, including X-rays, CT scans, and MRIs
- Comprehensive treatment records, including physical therapy, pain management, and other treatments, to prove that less invasive treatments failed
- Doctor’s written opinion that your injury has not responded to treatments, and a total shoulder replacement is necessary
The workers’ compensation insurance company may require you to attend an IME (independent medical evaluation). You must attend the evaluation or risk workers compensation benefits being denied. If you have not spoken with an attorney yet, you may want to do so before the evaluation to understand your rights.
Common Challenges and Employer/Insurance Tactics to Deny Claims
Insurance companies want to avoid costly claims, including total shoulder replacement surgery. Your employer and the insurance provider may use various tactics to deny your claim. Some of the challenges you may face include:
- Questions related to the causation of the injury, including whether your shoulder injury is a pre-existing condition instead of a work injury
- Denial or delay in surgical approval
- Using IMEs to contradict or discredit the severity of the injury
- Employing surveillance to attempt to “catch you” performing actions that contradict your injury
- Disputes over maximum medical improvement (MMI) and permanent impairment ratings
A Charlotte workers’ compensation attorney understands the tactics used by insurance providers and employers. A lawyer is often critical in these types of cases to secure the full benefits a worker deserves.
How Bradford Law Helps Injured Workers with an NC Workers’ Compensation Claim
An injured shoulder can result in a life-altering impairment. Obtaining surgery may be the best alternative you have for treatment. We help injured workers by:
- Investigating their claim to establish a causal connection to work
- Gathering expert medical opinions and employment records
- Assisting you in receiving disability benefits
- Working with medical experts to obtain opinions supporting surgical remedies
- Negotiating with insurance companies to ensure complete benefit coverage
- Representing clients before the NC Industrial Commission, if needed
Early legal intervention in a workers’ comp case can improve a worker’s chances of receiving the benefits they need and deserve. Contact Bradford Law to schedule a free consultation with our North Carolina workers’ compensation attorney.
