What Is Vocational Rehabilitation?

Posted on Thursday, July 1st, 2021 at 9:40 am    

Injured workers may need to consult with different types of therapists. It can be confusing to understand which therapist does what. Generally, physical therapists provide exercises and treatments to help your body recover from your injuries. Occupational therapists help injury victims learn to do everyday tasks and to work with assistive devices. Vocational therapists are supposed to work to help an injured worker return to work.

Yet there is really a huge difference between those therapists and the role of a Vocational Rehabilitation Counselor in a workers compensation case. The big difference  between the role of physical therapists and occupational therapists vs. Vocational Rehabilitation Specialists is that unlike the PT and OT folks, the vocational rehabilitation counselor (VRC) is hired directly by the workers compensation insurance company. Your doctor will not typically refer you to a vocational rehabilitation counselor. 

The reason for the hire is unfortunately really not to help you, but to ultimately reduce the value of your claim. As will be further described below, the Vocational Rehabilitation Counselor is one of what I call the “Unholy Trinity” of Defense Professionals who will usually work against you in your case. Those are 1. The insurance adjuster, 2. The Nurse Case Manager and 3. The Vocational Rehabilitation Counselor. Their primary goal is to cut off or eliminate your weekly check. The Insurance adjuster can be thought of as the “puppet master,” pulling the strings of the Nurse Case Manager to try to get you released back to your old job at Full Duty, ready or not. If that fails, the adjuster may then try another tact, which will be to try and at least reduce their weekly obligation by finding you another job within your restrictions through the Vocational Rehabilitation Counselor.  

The bottom line is that employers and insurance companies want to minimize their “exposure,” i.e. ongoing weekly payments to you. Assuming your injuries prevent you from returning to your pre-injury job, the best way to do this is to find you another job that you are able to perform within your physical restrictions. 

What does a vocational rehabilitation professional do for injured workers? 

In a perfect world, according to Vocational Training HQ some of the services that a vocational rehab professional would provide would include:

  • Assessing your current work and health situation
  • Helping understand your goals
  • Giving health advice to help the worker return to their job
  • Finding ways to help you return to work by reducing the impact of your medical condition on your job
  • Coordinating with other people such as career counselors to help you return to work
  • Career counseling
  • Analyzing your current job options
  • Continually assessing your ability to return to work
  • Helping you prepare the best resume’
  • Getting you into classes so that you can acquire more skills and return to the job market

Workers often are asked to participate in vocational rehabilitation if they are involved in an Awarded or accepted claim. This typically does not occur until the injured worker has reached maximum medical improvement (MMI). Your doctor then may conclude that you can return to light-duty work/work with restrictions. If your pre-injury job cannot accommodate those restrictions, then the insurance carrier will often set you up with vocational rehabilitation.  Common workplace restrictions include being able to rest after standing on your feet – after a specific period of time such as 5-minute breaks every hour. Another common workplace restriction is doing work that does not require that you lift or carry objects that weigh more than 20 pounds.

Vocational rehab therapists review these workplace restrictions to see how you can do your job within these workplace limitations. They may consult with various employers to see what adjustments can be made to your work.

A vocational rehabilitation professional will tell you that they will work to help you find new employment. Unfortunately, the reality is that the experience is usually not a pleasant one and further, that the VRC, having been hired directly by the workers’ compensation insurance company, is really not there to primarily help you. They are involved in your case to help the insurance company and they tend to work very closely with the adjuster. Their actions vary, but they are typically engaged in a two-pronged effort: 

  1. To find you a job to reduce or eliminate the obligation of the insurance carrier to keep paying you a weekly check. Some are quite aggressive and will require you to follow up on numerous job leads per week that are provided to you. These are not usually jobs that you have any interest in. After the initial meeting, typically held in your attorney’s office, the VRC will usually meet with you each and every week at a location near your home, often at a public library. Depending on your degree of availability via computer and your level of tech-savviness, they may meet with you via Zoom. 


  1. To trip you up and so you can be deemed non-cooperative with the vocational rehabilitation plan. This will allow the insurance carrier to file a motion to terminate your weekly check. In Virginia, that motion will result in you getting cut off immediately. They may do this by switching meetings on you, or you may simply forget about some of your meetings. If you are sufficiently non-compliant, you will be cut off of benefits immediately and it is not very easy to get them back, at all. 

What skills and certifications should a vocational rehabilitation counselor have?

Vocational rehabilitation counselors usually have a master’s degree in vocational rehabilitation or some comparable field such as “counseling psychology.” In Virginia, they must be “certified” in accordance with regulations at 18 VAC 115-40-10, et. seq. and in North Carolina they actually must be an approved VR Professional through the NC Industrial Commission in accordance with N.C.G.S. 97-32.2

For the most part, an injured or ill worker works directly with the vocational rehab counselor. If you have an attorney, he or she will typically attend the initial meeting, and at your subsequent meetings, you meet alone with the counselor, although the VRC should be including your attorney in all correspondence and formal communication with you. 

Vocational Training HQ recommends that when you speak with your vocational rehab counselor that you should:

  • “Always be honest about your condition, abilities, restrictions, and desires so they can help you as much as possible.
  • Respect their decisions in regards to your next steps towards employment since they know what they are doing.
  • Communicate frequently with them about any problems or concerns you are having so small problems can be solved while they’re still small.”

It’s important that you and your rehab counselor get along as much as possible. Being rude or walking out on meeting is a sure way to get cut off of benefits and ruin the value of your case. It is simply a fact that some counselors engage in conduct that is inappropriate, such as failing to pre-screen job leads or requiring you to apply for jobs you are completely unqualified for. Others will actually go out of their way to aggravate you, hoping to get you to walk out of the meeting. Don’t fall for it. If you do, you have handed the workers’ compensation insurance company a victory. 

Fortunately, there are guidelines that the VRC’s are required to follow. In Virginia, the VRC Guidelines discuss the duties of each party to the relationship and what is appropriate and inappropriate. If the VRC continually violates these standards, then your workers compensation lawyer will file an appropriate motion to eject the VRC from the case and bring in another vocational rehabilitation professional. In North Carolina, they must follow the Rules for Vocational Rehabilitation Services. 

A few FAQs about Vocational Rehabilitation

What Should I Bring to My First Meeting with a Vocational Rehabilitation Counselor?

If you have an attorney, you should bring nothing. Your attorney and either the defense attorney and/or adjuster for the insurance company should already be in possession of most, if not all of your relevant medical records at this point. This is because in a workers’ compensation case, you essentially give up your right to privacy to the insurance company paying for your treatment as well as those who work for them. They therefore are entitled to all of your medical records and should have already obtained them. If your attorney feels the VRC needs to see something he or she does not have, your lawyer will provide a copy to them at the initial meeting. The most important thing for the VRC to see pertains to your current work restrictions. This is typically found at this point in connection with the records of your Functional Capacity Exam.  This can be absolutely key to making sure the VRC does not exceed his or her boundaries. 

For instance, in a recent case, we had a client with a very severe injury to his left leg and foot. In one small corner of the FCE, it was mentioned that he should not operate any controls with his left foot, including a clutch. The client had a manual transmission vehicle. This meant he was really unable to drive and this ended up having a huge effect on the VRC’s ability to find the client other employment. Therefore, the clients’ weekly checks continued. 

What do you need to do to be in compliance with the vocational rehab requirements?

When you work with a vocational rehabilitation counselor, you will need to do everything you can to  follow his or her instructions.  This means you need to keep any appointments including your weekly meetings, and follow up on all the job leads you are given. If you obtain interviews for any of the jobs, you should be on time and not attempt to “sabotage” the interview by dressing or acting inappropriately. If class attendance is required, you’ll need to attend and keep up with the class instruction. 

What will your counselor do for an injured worker?

At the initial meeting, the counselor will thoroughly review with you your work and educational history  to determine what types of transferrable skills you possess. That history, together with familiarity of your physical work restrictions, will help him or her identify the types of jobs that meet your skills and work experience. 

After the initial meeting, the vocational rehabilitation counselor will typically devise an overall plan for you based on your previous work experience and physical limitations. Sometimes, because of your lack of experience in anything that does not involve intense physical labor, combined with physical restrictions that severely limit you, the only immediate thing that can be done is to get you into some type of training such as computer classes. In other situations, the VR may be able to find you send you leads of jobs that do not require a great deal of training, or where you can essentially train on the job. And in still other situations, the VRC may determine that you are simply not a candidate for vocational rehabilitation.  

What is the employer’s role in vocational rehabilitation?

Your employer’s insurance company will  pay for the cost of the services and you should continue to receive your weekly checks at 2/3rds of your average weekly wage– provided you continue to follow the instructions of the VRC. As noted previously, the insurance company will seek to terminate benefits if you are not cooperating with the VRC.  When and if new work is found by the VRC, if it is at the same or greater pay rate as your pre-injury wage, you will no longer receive your workers compensation checks. 

If the new job’s  pay rate is less than your pre-injury pay rate, then you will still be entitled to two-thirds of the difference between the new job and your pre-injury average weekly wage. This is called temporary partial disability. (TPD). For instance, let’s assume you were earning $1000.00 per week on average, pre-injury. That would mean your normal temporary total disability (TTD) compensation rate would be 2/3rds of that, or $666.67. 

If the VRC finds you a new job paying $400.00, then the difference between the new job and the pre-injury work is $600.00. Two-thirds of that is $400.00. Therefore, even after you get the new job, you are still going to be entitled to ongoing payments of $400.00 per weeks, in addition to your pay in the new job. 

Your attorney’s job is to make sure the vocational rehabilitation professional is acting in accordance with the rules. 

Our skilled North Carolina and Virginia worker’s compensation attorneys have helped thousands of injured and ill workers obtain just recoveries. We fight to get you all the benefits you deserve including payment for your medical bills and your rightful share or your lost income. To discuss all aspects of your work injury claim, call lawyer Joe Miller, Esq., at 888-667-8295. or complete my online contact form.

Injured or ill workers in North Carolina and Virginia can also use our New Electronic Case Review. The link is a convenient way of telling us about your case without having to pick up the phone. You can input the information at any hour night or day, and someone should be back to you by the next business day. 

Physical Therapy and Workers’ Compensation?

Posted on Wednesday, June 30th, 2021 at 9:38 am    

Many workers who have physical injuries such as broken bones, back pain, an amputation, disc damage, or muscle pain spend a number of sessions with a physical therapist. Workplace victims often treat with a specialist such as an orthopedist or other surgeon before treating with a physical therapist. The victims may have surgery though many people in North Carolina and Virginia who treat with a physical therapist have not had surgery.

What Is a Physical Therapist?

A physical therapist must be licensed and must have met specific education requirements in order to qualify for their job. Physical therapists are also known as PTs or physiotherapists.

According to the American Physical Therapy Association (APTA), a physical therapist must earn a “doctor of physical therapy degree from a Commission on Accreditation in Physical Therapy Education-accredited physical therapist education program and pass a state licensure exam.” It normally takes about three years to earn a Doctor of Physical Therapy (DPT) degree. Courses generally include: “biology/anatomy, cellular histology, physiology, exercise physiology, biomechanics, kinesiology, neuroscience, pharmacology, pathology, behavioral sciences, communication, ethics/values, management sciences, finance, sociology, clinical reasoning, evidence-based practice, cardiovascular and pulmonary, endocrine and metabolic, and musculoskeletal” studies.

Most of the work is in the classroom. About 20% of the educational program is achieved through clinical education.

After a physical therapist is licensed, they can decide to pursue a residency or fellowship program. A physical therapist can also work to become a board-certified clinical specialist – through the American Board of Physical Therapy Specialties

What does a physical therapist do?

A physical therapist helps develop a plan of hands-on treatments and exercises to help your body adjust to any injuries that you have. The treatments and exercises often aim to improve your muscles, joints, and other parts of your anatomy near the injured area – so these healthy parts of your body can support the injured parts.

An experienced North Carolina and Virginia workers’ compensation lawyer can explain if you can see your physical therapist directly or if you need a referral from your treating physician. As with all healthcare providers, workers must choose from a list of health care providers that the employer provides. Normally, it’s advisable to coordinate your PT care with your doctor. PTs often have assistants who help with some of the physical treatments.

Physical therapy aims to:

  • Relive your pain
  • Improve your mobility
  • Help you recover from an injury
  • Help you recover from a surgery
  • Improve your balance
  • Manage a chronic injury
  • Adjust to a prosthesis
  • Learn to use canes, wheelchairs, walkers, and other assistive devices
  • Control your bladder and bowels

Normally, a PT will start by discussing your pain and additional symptoms. He/she will ask about your ability to perform everyday tasks including sleeping. The PT will conduct a series of tests to determine what you can and can’t do. These tests include:

  • Examining how well you can reach, grasp, bend, and move
  • Seeing if you can climb stairs without difficulty
  • Monitoring your heartbeat or pulse while you’re active
  • Determining how good your balance and posture are

Treatments may include:

  • Specific exercises and stretches targeted to help support the injured part of your body  
  • Cold and heat therapy, warm water therapy, ultrasound, and massage. These therapies are designed to help with muscle pain
  • Rehabilitation if you need to use an artificial limb
  • Using a cane or a walker

The physical therapist will also recommend exercises for you to do at home in between sessions with the PT. The physical therapist should monitor your progress during your treatments.

Where do injured workers get physical therapy?

Physical therapy is often available at outpatient clinics. PT may also be available at your physician’s office, a hospital, a sports center, rehab centers, schools, and even at work sites. Some doctors have their own, “in-house” facility, while others will refer you out to stand-alone PT facilities. 

What problems may arise regarding physical therapy and my workers’ compensation claim?

Workers who are injured at work are entitled to have all their reasonable medical bills paid. Physical therapy is generally covered if the therapy is recommended by a physician or the PT you choose is approved by your employer.

In most work injury cases, one of the issues that sometimes comes up regarding physical therapy is that the insurance company for the employer may seek to terminate your PT treatments after you’ve treated with your physical therapist for a while. The insurance company’s argument will be that after a certain period of time, the PT treatments aren’t improving your health. The insurance company will often get one of their company doctors to state that for the type of injuries you have, PT after a certain point in time is unnecessary.

Workers have the right to contest the termination if the continued physical therapy is helping, because ultimately, it is up to your authorized treating physician, NOT your nurse case manager or the insurance company as to whether additional PT will help you. Your lawyer will either work with your treating doctor to verify the necessity of the physical therapy treatments and possibly engage in an appropriate motion if the insurance company is not being responsive. 

We have found that in most cases, the main problem is that over time, the injured worker may be perceived as not fully participating in physical therapy, either by missing too many appointments or not performing the exercises they are required to perform either in PT or at home. In some cases, this can result in a Motion from the defense to terminate benefits based on your failure to follow the treatment plan. In Virginia, even without a hearing, this would result in an immediate loss of ongoing benefits. Therefore, it is imperative that you should take your physical therapy very seriously and treat each appointment as seriously as you would any doctor’s appointment. When performing exercises, give it your maximum effort, short of causing any injury to yourself. 

Functional Capacity Examinations (FCE) 

We’ve discussed these elsewhere, but many physical therapists and physical therapy facilities are set up to perform an FCE. A Functional Capacity Examination is typically ordered by your doctor once he or she has determined that you have reached maximum medical improvement. The main purpose of the FCE is to determine your physical capabilities that remain after you have recovered to the fullest extent you are able from your work injuries. The test can last for up to 6 hours, sometimes longer. After the doctor signs off on the FCE results, these become your permanent restrictions. Your attorney will obtain a copy of your FCE and review it thoroughly. This can be quite critical if and when the insurance company decides to engage in vocational rehabilitation

Often, there is also a second part to the FCE, designed to determine whether there is any permanent partial impairment in a specific, injured body part such as your lower extremity (leg) or upper extremity (arm). The results of that examination typically produce a percentage impairment rating, which, after being adopted by your physician, may result in additional money for you. 

Our skilled North Carolina and Virginia worker’s compensation lawyers have been fighting for injured employees for more than 30 years. We have a strong track record of success obtaining just recoveries for our clients. We help you obtain the physical therapy you need. We work with physicians who understand when employers are trying to cut off your physical therapy treatments because the employer’s insurance company wants to save money – even when you need the physical therapy treatments to fully recover. 

If you were injured in any workplace accident, there’s no need to prove fault to file a workers’ compensation claim. To assert your right to medical and wage loss benefits, call lawyer Joe Miller, Esq., at 888-667-8295. or fill out my online contact form. To schedule an appointment.

Injured or ill workers in North Carolina and Virginia can also use our New Electronic Case Review. The link is an easy way to get an answer on the facts of your case, without ever having to pick up the phone. 

Fingertip, Finger, and Hand Injuries in Workers’ Compensation Cases

Posted on Tuesday, June 22nd, 2021 at 12:04 pm    

Finger and hand injuries are all too common in the workplace. According to Occupational Health and Safety and data from the US Bureau of Labor – “Of the 286,810 non-fatal occupational injuries to upper extremities in 2018 involving days away from work in private industry, 123,990 involved hands, which is more than 43 percent.”  Human hands have 27 bones and 30 muscles – so there’s a lot that can go wrong. 

According to Industrial Safety and Hygiene News, almost 30% of workplace injuries are due to cuts and lacerations – and about 12% of those injuries involve the hands. While hand injuries may not be as life-threatening as other injuries like head trauma, hand injuries require a lot of medical care and often require that workers take substantial time off from work to treat their injuries. In the most severe cases, even young injured workers will be prevented from returning to their occupation due to severe hand injuries. 

As of the 2012-2013 fiscal year, claims for hand, finger, and wrist injuries (according to the National Safety Council) averaged $22,384 per claim. This figure includes payments for missed days, the medical bills, and the time a business is shut down for OSHA investigations or local safety bureau investigations.

ISHN states that about 70% of injuries are due to workers not wearing gloves that are right for the type of work being done. For example, electricians should consider gloves that reduce resistance, are resistant to punctures, “protect from arc flash,” and still allow the electrician to manipulate small parts. Construction workers might want to focus on “back-of-hand protection and vibration-dampening palm padding.” Employers should provide the correct gloves for their workers.

Common types of finger injuries

Finger and hand injuries that can result in lost time from work include:

  • Lacerations. While many cuts are minor and heal in a short time, some cuts may become infected. Some cuts may damage the nerves, tendons, or other parts of the anatomy. In severe cases, surgeries may be required.
  • Fractured bones. If one or more of the 27 bones in the hand break, they normally require immobilization. If the fractures are compounded or there are other complications, surgery may be needed.
  • Injured nerves. Nerves can be damaged due to cuts, breaks, or crushing accidents. Injured nerves, even with surgery, may never fully heal. Some workers live with chronic hand or finger pain.
  • Amputation. In the worst cases, a finger, part of the finger, or more than one finger/thumb may need to be amputated which can directly affect the worker’s ability to return to work – since most jobs require some type of input from the hand or fingers.

According to Chesapeake Hand and Shoulder, tendon injuries are a common hand injury. Tendons are tissue that attach the muscles to the bones. Examples of tendon injuries to the hand include:

  • Tendonitis. This is an inflammation or irritation of the tendon. It’s often due to repetitive movements.
  • Extensor tendon injuries. These happen when the tendons at the rear of your fingers and thumb are “torn, cut, or detached.” These tendons allow your fingers and thumbs to straighten and perform movements but can become injured due to trauma or arthritis. 
  • Flexor tendon injuries. These injuries happen “when the flexor tendons attached at the palm side of your fingers and thumb get cut or ruptured. These tendons allow your finger and thumb joints to bend, grasp, and perform fine coordinated movements.”
  • De Quervain’s syndrome. This is a common type of overuse injury that can restrict your function and mobility. Unfortunately, with only a couple of exceptions,  injuries that result from overuse are generally not compensable as workers compensation claims in Virginia or North Carolina. 
  • Trigger Finger/Trigger Thumb. This injury happens when the “tendons in the thumb or fingers do not glide smoothly. It causes the tendons to catch or get trapped when the fingers or thumb bend, making it difficult to straighten them back out.”

Burn injuries to fingers and hands are also quite common. Other types of finger and hand injuries include bruises, strains, dislocations, sprains, and carpal tunnel syndrome.

What are the causes of fingertip, finger, and hand injuries?

Injuries to the fingers and hands can happen in almost every type of work that requires repetitive movements. Finger and hand injuries are quite common when workers work with any type of machinery (especially moving machinery) or work with sharp objects such as knives, needles, and syringes.  Picking up any type of hot object, working with stoves or other heat devices, and being near hot liquids are also dangerous for your fingers and hands.

Some of the professions where finger and hand injuries are common include:

  • Industrial workers
  • Construction workers
  • Electrical workers
  • Restaurant workers
  • Workers in the medical profession
  • Agricultural workers
  • Autoworkers including auto mechanics

Treatments for fingertip, finger, and hand injuries

The treatments depend on the type of injury and the severity of the injury. Injured workers may require surgery which is often performed either by a hand specialist or an orthopedic surgeon. After surgery or instead of surgery, workers often need to treat with physical therapists and pain management doctors. Cortisone steroid shots may be provided. Medications such as anti-inflammatory medicines may help. Workers may need to use a brace or some method to stabilize the fingers and protect the hand during the healing process. Workers may need to learn to use voice-activation on their computer if they can’t type.

Compensation for fingertip, finger, and hand injuries.

In addition to normal compensation under workers compensation for time that the injured worker is out of work at the rate of 2/3rds of the average weekly wage, plus medical expenses, if the injured worker suffers permanent impairment to these body parts, then even if he or she should return to work, some additional compensation may be available. This is known as permanent partial impairment and is typically compensated by way of the authorized doctor’s opinion as to the percentage of impairment in that particular body part. This opinion cannot occur until the injured worker is deemed to have reached maximum medical improvement by his or her physician.  It should be noted that if, because of the severity of the hand injury, the injured worker is unable to return to his or her occupation, then these partial impairments may become less relevant, because then compensation is based on the maximum number of potential weeks of compensation, namely, 500 weeks. 

The maximum amounts for these recoveries for finger and hand injuries for permanent partial impairment in Virginia are set forth at VA Code 65.2-503 and are as follows:

Loss Compensation Period
1. Thumb 60 weeks.
2. First finger (index finger) 35 weeks.
3. Second finger 30 weeks.
4. Third finger 20 weeks.
5. Fourth finger (little finger) 15 weeks.
6. First phalanx of the thumb or any finger

7. Hand

one-half compensation for loss of entire thumb or finger.

150 weeks.

The loss of more than one phalanx of a thumb or finger is deemed the loss of the entire thumb or finger. Amounts received for loss of more than one finger shall not exceed compensation provided for the loss of a hand.


So if we take an example, if the authorized doctor was of the opinion that the hand had suffered a permanent impairment of 20%, and the injured worker’s compensation rate (2/3rds of the average weekly wage) was $600.00, that would be 20% of 150 weeks, or 30 weeks, multiplied by the compensation rate of $600.00, or $18,000.00. Sometimes the insurance carrier will pay that amount in lump sum, other times they will do it over the 30 weeks. 


Our skilled North Carolina and Virginia worker’s compensation lawyers have been strong advocates for injured employees for more than 30 years. We work with your medical team to fully understand your injuries, what treatments you need, how long you need for the treatments, and what functional use of your fingers and hands you’ll have (or won’t have) when the treatments are complete. We demand compensation for your rightful share of lost wages and payment for all your medical expenses. If you have a permanent disability, we demand additional compensation. To make an appointment, call lawyer Joe Miller, Esq., at 888-667-8295. or fill out my online contact form or our free electronic case evaluation

Workers Compensation For Benefits When You Hurt Your Back

Posted on Wednesday, May 19th, 2021 at 4:14 pm    

One of the most common types of injuries for workers is back pain. Back pain can occur in almost every profession. Any worker who does physical labor such as construction work, agricultural work, or industrial work is relying on their back almost constantly. Workers who stand most of the days such as waitresses, nurses, and other workers often develop back pain. Even if you sit all day using the computer or doing clerical work, you’re likely to develop back pain.

Back pain can occur due to a specific accident – such as when you lift, pull, carry, or move an object – and you wrench, twist, or bend your back. Back pain can also develop over time – and that one extra motion or force can launch you into a lifetime of chronic pain. Some workers with back pain can return to work after extensive physical therapy and other treatments. Some workers may be able to return to work but only if they shift to lighter duty work or even clerical work. And some workers find back pain intolerable to the point that they have a permanent injury and are no longer able to work.

According to Spine-Health, back pain can come and go, flare up on occasion, or be a constant source of agony.

What are the causes of back pain?

According to the May Clinic, some of the common causes of back pain are:

  • Strained muscles or ligaments. This back injury is often caused by repeated lifting of heavy objects or a “sudden awkward movement” that can strain the muscles and ligaments. Workers who constantly use their back are at risk of a muscle or ligament strain.
  • Disks that bulge or rupture. The disks act like cushions – “between the bones (vertebrae) in your spine. The “soft material inside a disk can bulge or rupture and press on a nerve.” 
  • Osteoporosis. As you age, the vertebrae of your spine can become brittle and porous which can cause fractures that are painful.
  • Arthritis. “In some cases, arthritis in the spine can lead to a narrowing of the space around the spinal cord, a condition called spinal stenosis.”
  • The facet joints that connect the vertebrae along your spine may become damaged.

How is back pain classified?

According to Spine-Health, back pain is normally classified in one of the following three ways:

  • Axial pain. This type of back pain is also called mechanical pain. Axial pain usually confines itself to one part of the body. Workers who have back pain often state that the pain is “sharp or dull, comes and goes, constant, or [is] throbbing. Axial pain can be caused by a strained muscle, annular disc tears, or due to facet joints.
  • Referred pain. Injured workers describe this type of back pain as – “dull and achy.” Referred pain generally moves around the body and can vary in intensity. “As an example in the lower back, degenerative disc disease may cause referred pain to the hips and posterior thighs.”
  • Radicular pain. Radicular pain is also called “sciatica’ or “radiculopathy (when accompanied by weakness and/or numbness).” Injured workers describe radicular pain as “electric shock-like or searing.” This type of pain “follows the path of the spinal nerve as it exits the spinal canal. “Common causes of radicular pain include compression and/or inflammation of a nerve root of the spine. If radicular pain occurs in the lower back, the pain can expand into your leg. Causes of radicular pain include spinal stenosis, a herniated disk, or spondylolisthesis. 

How do doctors diagnose back pain?

Back pain can be difficult to diagnose. For example, Spine-Health states that “a torn or herniated disc may feel similar to an arthritic facet joint due to their close proximity. In some cases, the same nerve root can be compressed or irritated by different structures, such as a disc or bone spur.”

Common diagnostic tests for back pain, according to the Mayo Clinic, are:

  • X-ray. This test is used to examine your back for broken bones, arthritis, and shifts in the alignment of your bones.
  • MRIs and CT scans. These imaging tests “can reveal herniated disks or problems with bones, muscles, tissue, tendons, nerves, ligaments and blood vessels.”
  • Blood tests. These tests may disclose if an infection or other problem is causing your back pain.
  • Bone scan. This test can reveal if you have a bone tumor or whether osteoporosis is causing a compression fracture.
  • Electromyography (EMG). This test studies your nerves and looks for how your muscles respond, spinal stenosis, and whether a herniated disk is causing compression of a nerve. If the signal between two leads is proceeding slower than normal, that could indicate that the nerve is being compressed by a herniated disc. 

For some injured workers, determining the cause of your back pain can still be difficult to find.

What are the treatments for back pain?

The possible treatments for back pain include:

  • Over-the-counter drugs such as Nonsteroidal anti-inflammatory drugs (NSAIDs) may help. Examples include – ibuprofen (Advil, Motrin IB) or naproxen sodium (Aleve).
  • Muscle relaxants which require a doctor’s prescription such as Flexeril or Tizanidine; 
  • Prescription NSAIDs such as Meloxicam or Diclofenac can be effective;
  • Prescription drugs which tend to reduce nerve pain due to sciatica such as Neurontin (Gabapentin) or Lyrica (Pregabalin); 
  • Topical pain relievers – creams, ointments, and patches such as Lidocaine; 
  • Narcotics. Drugs containing opioids, such as oxycodone or hydrocodone, may be used for a short time with close supervision by your doctor. Opioids don’t work well for chronic pain, so your prescription will usually provide less than a week’s worth of pills.”
  • Your doctor may also prescribe antidepressants.
  • Physical therapy. These are exercises “to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture.”
  • TENS units which provide muscle stimulation and may reduce pain. Cheaper versions can be found over-the-counter, or your doctor may prescribe a more professional unit

In some cases, if those less invasive things do not help, surgical and other procedures may be required. These can include:

  • Cortisone injections
  • Epidural steroid injections
  • Radiofrequency neurotomy This procedure uses essentially microwaves transmitted by a probe inserted into a spinal disc to heat up and deaden the nerves that are the source of pain; 
  • Implanted nerve stimulators, also known as spinal cord nerve stimulators or an SCS. These include a battery-operated device and controller with which you can adjust the nerve stimulation to decrease your pain;
  • Surgery – usually for structural problems such as a narrowing of the spine, or to trim or pull out a severely herniated disc. This can include either a laminectomy, where part of your spinal bone at the rear of your spine called the lamina is removed to make more room for the disc and spinal cord, or a diskectomy,  where the disc is simply trimmed back so it is no longer pressing on the spinal cord, or a more involved surgery such as a spinal fusion, where hardware is implanted to stabilize the spine after a complete disc removal. The fusion can be at one or sometimes multiple levels of the spine.  In those cases of a spinal fusion, typically some bone from your hip or a cadaver is harvested to fill in the space after the disc is removed. The idea is to “fuse” the two spinal bones together so that they form one, larger spinal bone. Although there are no guarantees, patients who have been suffering from severe sciatica often report immediate relief from those symptoms after these surgeries. 

Are there any Special Rules or Benefits for Back or Lumbar Spine Injuries in Workers Compensation? 

Yes, back injuries entail some special consideration in both Virginia and North Carolina. The strange thing is that the laws differ significantly as to the treatment of back injuries in a workers compensation case in each State in some respects. 

So one thing that is clear is that in both Virginia and North Carolina, one cannot recover at all for a purely “wear and tear” injury to the spine, or just about any other body part, for that matter. There must have been, as is stated in Virginia, a “sudden anatomical change” resulting from a traumatic event, or there is no “accident,” and therefore no recovery. In other words, saying that your job is hard and caused you to have back injuries over many years is not something you can recover money for under Workers Compensation Law. For that, you may have to look to Social Security Disability Law. 

The main way in which VA and NC treat back injuries differently is with respect to permanent partial impairment. This is a potential benefit that is sometimes available, after the injured employee reaches maximum medical improvement. Testing is performed and if permanent impairment is found in the body part tested, then a permanency rating is assigned, which could entitled the injured worker to additional money. 

But in Virginia, there ARE NO PERMANENCY RATINGS permitted for the back or any part of the spine under Virginia’s workers’ compensation laws. If an injured worker is unable to return to work due to a spinal injury, then the claim may be negotiated to settlement for the remainder of the 500 maximum weeks available plus possible future medical bills. But if a Virginia worker suffers a spine injury and then returns to work, there are no permanent partial ratings benefits available to that worker under Virginia Law. The only exception might be if the sciatica down legs or arms is so severe that it creates permanent partial impairment in any of those extremities. That would be compensable. 

Contrast this with North Carolina, where any injury to the “back” (which under NC Law means any part of the spine) has the HIGHEST available number of potential weeks for permanent partial impairment of any body part—up to 300 weeks

Why the stark difference between the two states on this issue? I leave that to legal scholars to discuss. 

One more important point with respect to back injuries. In North Carlina, one must typically have suffered a “slip, trip, or fall” in order to recover for a work accident. A sudden pain, such as a “pop” or “crack” while lifting something heavy would not be sufficient to recover—UNLESS that injury is to the spine. In those cases, NC has carved out an exception to the “slip, trip or fall” rule, and, very similar to Virginia, only require a “specific traumatic event” in order to recover for spinal injuries suffered at work. Therefore, in our example above, an injured worker who suffered a sudden “pop” in his or her spine due to heavy lifting at work would be able to recover under NC Workers Comp Law. 

North Carolina and Virginia workers’ compensation attorney Joe Miller has helped many back injury victims get the workers’ compensation benefits they deserve. He works with your treating doctors and independent doctors when permitted to fully analyze just how serious your work injury is. He fights to try to ensure the employer doesn’t force you back to work before you’re healthy. To discuss your back injury claim with an experienced workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888-667-8295. or fill out my online contact form to schedule an appointment. 

North Carolina and Virginia employees can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Workers Compensation For Benefits When You Injure Your Arm

Posted on Tuesday, May 18th, 2021 at 4:14 pm    

There are very few jobs a worker can do if his/her arm is injured. Your arm is also known as your “upper extremity” in workers’ compensation terms. Workers need their arms to serve food, treat patients, drive, operate machinery, do construction work, or type at a computer. Arm injuries-which often  include shoulder injuries – are due to either an acute or chronic injury. Acute injuries are normally injuries due to a specific event such as a workplace accident. Chronic injuries are typically wear and tear injuries where the deterioration just becomes too difficult to work with. Unfortunately, under most circumstances, “wear and tear” injuries are not compensable unless they are made symptomatic by a specific, identifiable, traumatic event such as a slip, trip or fall. In Virginia, a sudden, severe pain, accompanied by a “pop” or some other clear indication of a single event—even without a slip, trip or fall— may be sufficient, so long as it was caused by a risk associated with your employment. 

Experienced North Carolina and Virginia workers’ compensation lawyers work with your doctors to fully understand why you can’t use your arm, what your injury is, what treatments you need, and what your medical diagnosis is. We fight to help you obtain all the work benefits you deserve including:

  • Payment for all your medical bills including the cost of any surgeries, diagnostic tests,  braces and medications
  • Your share of wage loss benefits (generally about 2/3rds of your salary)
  • Payment of any permanent impairment in one or both of your arms

We also fight to ensure that you are not forced back to work before you can work or that the workplace restrictions (such as limiting the weight of objects you can carry) are clear.

What are the common types of arm injuries

Workplace accidents include:

  • Repetitive stress injuries such as:
    • Carpal tunnel syndrome. Pressure on the nerves in the wrist area.
    • Bursitis. According to the University of Michigan Health department, this arm injury is “pain and swelling of the sac of fluid that cushions and lubricates the joint area between one bone and another bone, a tendon, or the skin.”
    • Tendinitis. “Pain and swelling of the tough, ropey fibers that connect muscles to bones.”
    • Stress fractures. These are hairline cracks in the bones of the arm.
    • Sprains and strains.
    • Rotator Cuff Tears- a tear in the tissues connecting the muscle to bone (tendons) around the shoulder joint. This can come from either repeated stresses or a single incident. 
  • Fractures. Broken arms are often due to falls or some type of forceful impact such as a crushing injury or having your arm pinned.
  • Arm and should injuries due to excessive pushing, pulling, or lifting.
  • An arm amputation. This injury can be caused by a vehicle accident, when an arm is pinned, a machinery failure, or getting your arm caught in a machine such as an electric saw or any cutting device.
  • Bruises or contusions. This type of injury occurs due to falls, bumps, or other causes. These injuries occur when there is a tear or rupture of the blood vessels under the skin. The blood seeps into the tissue cause discoloration – such as yellow, red, or purple bruises.
  • Dislocations. This injury occurs when the bones in the arm push or pull their way out of their normal position in relation to other arm bones. 
  • Ruptures. The arm muscles (such as the biceps are triceps) may rupture.
  • Strains. These are pulled muscles.
  • Burn injuries. When toxic chemicals spill or when workers work with hazardous products, their arms are often affected because workers use their arms to work and because their arms often aren’t covered by clothing. 
  • Shoulder injuries such as rotator cuff tears- a tear in the tissues connecting the muscle to bone (tendons) around the shoulder joint. This can come from either repeated stresses or a single incident.
  • Elbow injuries- weakened or fatigues muscles or injuries to the ulnar nerve, which passes around the end of the upper arm bone. 

There are three bones in the arm – the humerus, radius, and ulna. The arms also contain muscles, joints, tendons, and tissue

Acute arm injuries may be due to a direct forceful blow, a fall, or a penetrating injury. Acute arm injuries may also be due to an abnormal movement or bending of the arm

What are the treatments for arm injuries?

Workers with arm injuries may start their medical review by seeing an emergency room doctor or their family doctor. In many work injury cases, the workers will see an orthopedic doctor – especially ones who focuses on arm injuries.

Generally, workers in North Carolina and Virginia must see physicians that are on a list approved by their employer, although if you must undergo emergency surgery immediately after your arm injury, then the surgeon will usually stay on as your authorized treating physician. 

We are all familiar with folks who break their arm and end up in a cast, but many upper extremity injuries can be far more severe. If the fractures in any of the bones of the arm are severe, then an Open Reduction Internal Fixation surgery may be required to fixate the bones into position so they can heal. If there are nerve injuries, frequently in the wrist or elbow, then the nerves may need to be decompressed via surgery. If the shoulder is injured, then arthroscopic surgery may need to be performed such as a rotator cuff repair. If the damage is too extensive or severe, you may even require a reverse shoulder replacement. 

Some of the diagnostic tests your health providers will use include:

  • X-Rays. This imaging test is used to determine if you have a bone fracture or a fractured joint. 
  • MRIs. A magnetic resonance imaging test may be used. This test, among other uses, can help assess if you have a tear in your arm or shoulder. 
  • EMG/NCS (Electromyogram/Nerve Conduction Studies). Your physician may use this test to see if you have a compressed nerve.

When can workers with arm injuries return to work?

The answer to this question depends on different factors such as the type of injury, the severity of the injury, the functional use of your am, the type of work you do, and the amount of pain you have.

Generally, you are not required to return to work at full capacity until you have reached the point of maximum medical improvement (MMI). MMI is when it is clear that additional medical treatment won’t improve the health of your arm. Once your arm is at the point of maximum medical improvement, your doctor will evaluate whether you have a permanent injury, whether you can return to work with restrictions, or whether you can return to work without any restrictions.

The insurance company for the employer may request an independent medical examination be conducted at some point in your recovery if the treating doctors think you haven’t reached the MMI stage or the treating doctors think you have a permanent arm injury.

In addition, you will typically undergo a Functional Capacity Exam (FCE) which will evaluate your work capabilities. In addition to the “work capability” FCE, you may also undergo a separate FCE for the purposes of determining whether you have any permanent partial impairment in the arm. This may result in an impairment rating, which could entitle you to additional funds. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller represents workers who suffer any type of workplace accident or occupational illness. For more than 30 years, he’s helped thousands of employees obtain just work injury recoveries. He has the experience and resources to help you get justice and to help ensure you get the medical care you deserve for an arm injury or any other injury. To discuss your workers’ compensation claim, call lawyer Joe Miller, Esq., at 888-667-8295. or use my online contact form to schedule an appointment. 

North Carolina and Virginia workers now also fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Pain Scale Tests – Part Two

Posted on Friday, May 7th, 2021 at 12:12 pm    

This is the second part of our discussion on the use of pain scale tests in North Carolina and Virginia workers’ compensation cases. As a reminder, pain scales are a way that doctors and others interested in your workers’ compensation case try to measure your pain. The results of pain scales test can affect your right to continued treatment and other work injury rights, such as pain management treatment.  

Pain scale tests are “self-reporting.” This means they’re easy to administer and are generally clerical in nature. Most patients just use a pen or marker and respond to questions on a written sheet of paper. The scales can confirm a worker’s injuries. The scales can also help show if a worker isn’t credible. 

The results may be compared to objective tests. The results may also be compared to prior pain scale tests which means workers need to be extra-careful to given honest answers. The doctors and your employer will look for inconsistent answers.

We discussed many of the pain scale tests in part one of this discussion. Here are a few more common pain scale tests.

The McGill Pain Questionnaire

According to Pain Scale, the McGill Pain Questionnaire (MPQ):

  • Is a subjective test that attempts to measure the quality and intensity of your pain.
  • There are three general categories:
    • Sensory. This part of the MPQ focuses on how you feel at this moment – the moment you answer the question. Different descriptors can be used. Points are awarded depending on which descriptor you select.
    • Affective. “Affective descriptors are used to understand how an individual’s pain changes with time.” “The MPQ asks about how alcohol, stimulants, depressants, exercise, and weather affect an individual’s pain levels. It also goes more in-depth to decipher if distraction lessens the pain.”
    • Evaluative. There are six questions such as “What word describes your pain right now?” or “Which word describes your pain at its worst?”. Workers/patients who say mild get one point. Workers who say their pain causes discomfort are assigned two points – and so on.
  • Uses 78 words to describe your pain. Different point values are given to different words.
  • The questions are divided into 20 different categories including:
    • Temporal
    • Spatial
    • Constrictive pressure
    • Thermal
    • Brightness
    • Dullness
    • Tension
    • Autonomic
  • Is used to treat and monitor pain – and for other reason.
  • Was developed at McGill University in Montreal, Canada.

Pain, Enjoyment and General Activity Scale (PEG)

Another common pain scale test is the Pain, Enjoyment and General Activity Scale (PEG). Pain scales are used to help assess the severity of your pain, whether treatments are working, and what types of other treatments may be needed. Pain scales such as the PEG scale are sometimes used to help determine whether you have a permanent impairment and/or whether and how your pain should be categorized according to American Medical Association guidelines.

How does the PEG scale work?

There are three pain-related questions:

  1. What number (a range is given from 0 to 10) describes the intensity of your pain – during the prior week? If you answer 10, you’re stating that you experienced a lot of pain during the period week. A 5 indicates a moderate amount of pain. A 0 means you didn’t experience any pain.
  2. What number describes how much your pain (during the prior week) interfered with your ability to enjoy your life. A high number indicates that the pain prevented you from doing the things you enjoyed such as walking and enjoying your family. A low number indicates minimal or no interference.
  3. What number (again with reference to the prior week) describes how your pain impacted your “general activity.” General activity suggests doing the things you enjoy and also the things you have to do (like taking out the trash or other errands) even if you don’t enjoy them. General activity can also include essential activities like eating and sleeping. Again, 0 indicates no impact while a 10 indicates a major impact.

The test is graded by finding the average – adding up the three numbers and then dividing by three.

The PEG test can be answered in your doctor’s office. The test can also be answered on the phone or at your home. The test can be used at different intervals in your recovery. It can also be used for different types of pain. For example, it can be used to determine how well your physical therapy is going. The PEG test can also be used to help your doctor understand how well any prescribed medications are working.

If the numbers aren’t improving, that suggests the rehabilitation isn’t working. So be careful, the employer will look to see if your physical therapy is helping. If therapy isn’t helping, the employer (or the insurance carrier for the employer) may seek to terminate the therapy.

The pain scores should improve after you take the medication and stay stable as you continue to take the prescribed medications.

North Carolina and Virginia workers’ compensation lawyer Joe Miller has been fighting for injured workers for more than 30 years. He works to verify your medical injuries. He fights to ensure the employer doesn’t terminate your right to medical treatment or work loss benefits before you’re healthy enough to return to work. To speak with an experienced workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888-667-8295 or fill out my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Pain Scale Tests – Part One

Posted on Monday, May 3rd, 2021 at 12:08 pm    

One of the difficulties in workers’ compensation cases is trying to measure the worker’s pain. Many parts of a medical diagnosis are objective. Disorders can be seen on X-Rays, CT scans, and MRIs. Diseases and other medical problems can be seen when doctors read blood test and other lab test results like stress tests. Medical problems can be confirmed when doctors perform surgeries.

Still, for many types of pain such as chronic pain, the medical disorder is very subjective. In other words, no one except you knows the level of pain that you are feeling on a day-to-day basis. One person may be able to return to work with a severe injury while an employee with a similar injury may need continuing medical rehabilitation or pain management

To try to fine-tune how much pain a worker is in, physicians and health care providers often use questionnaires and surveys to analyze the degree of pain a worker has. Workers should review with experienced North Carolina and Virginia work injury lawyers how to prepare for and respond to some of these surveys. 

There are different pain scales for different parts of the body. There are also different pain scales for different injuries and different symptoms. 

What are the types of pain scales?

According to Pain Scale, there are two kinds of pain scales – unidimensional and multidimensional. Some of the common types of scales include the following. These pain scales help when an analysis of pain by objective tests isn’t complete and when pain is expected to vary from patient to patient or worker to worker.

Unidimensional pain scales. These scales focus on the intensity of your pain.

  • The Visual Analog Pain Scale (VAPS) and the Numeric Rating Scale (NRS) are discussed later (or in the second part of this topic).
  • A categorical pain scale uses visual or verbal descriptors to help workers and patients focus on the level and degree of their pain.
    • Verbal pain scale. The descriptors use words such as “mild,” “moderate,” “severe,” “discomforting,” “distressing” and excruciating,” to describe pain levels. A worker who takes this type of test chooses the adjective/word that best corresponds to the intensity of their pain.
    • Visual pain scale. Here the workers/patients respond to faces that show the level of pain. While they’re often used for children, adults can use them too.

Multidimensional pain scales. These pain scales are less common but often provide a more complete analysis of your pain. We discuss the McGill pain questionnaire in more detail later. The two other types of multidimensional pain scales are:

  • Initial pain assessment tool. This survey shows a diagram of the human body. The patient marks where their pain is on the diagram, and then answers “a series of questions regarding the characteristics of their pain, the expressions of their pain, and the effects of their pain on everyday life.”
  • Brief pain inventory. This test examines the intensity of pain you felt or experienced over the past 24 hours.

What is the Visual Analog Pain Scale Test?

VAPS is used for workers and other categories of adults. It tries to measure your level of pain. 

The VAPS test, and many other similar tests, usually use a scale from 0 or 1 to 10 or 100. If you have no pain, you enter the lowest number (0 or 1). If your pain is unbearable, you enter the highest number (10 or 100 – depending on the scale). The VAPS scale is displayed on the written page with a horizontal line for the full scale and vertical lines that correspond to the numbers on the scales. 

The VAPS test is simple. There’s just one question and one answer. Workers can either enter a number or just mark the spot on the scale the fits with their amount of pain. For example, if your pain is right in the middle, you’ll answer with a 50 on a 0-100 scale or mark the midpoint of a graph that has the 0 at one end and the highest number at the other end.

What does the score mean?

The VAPS score uses these general guidelines for analyzing the severity of your pain:

  • 0-4. No pain.
  • 5-44. Mild pain.
  • 45-74. Moderate pain.
  • 75-100. Severe pain.

These classifications make a difference. They can be used to determine:

  • What type of medical treatment you require;
  • How long you might reasonably need the treatment
  • Whether you can return to work
  • Whether you have a permanent disability.

Some of the issues involved with the VAPS scale and other pain scale tests

Workers need to understand that their answer doesn’t exist in a vacuum. Your medical provider will know the results of your imaging tests, lab tests, and any other tests. The doctor will have conducted a physical and oral examination.

If your answer as to your level of pain is not consistent with other tests and reviews, your answer affects your perceived credibility. On the other hand, everyone has different levels at which they respond to pain. The objective tests are generally given much more weight than the answers to surveys and questionnaires.

Patients need to understand issues such as:

  • Am I answering how much pain I have – when I’m medicated or when I’m not medicated?
  • Am I answering the question – just after I’ve had physical therapy or when I haven’t had physical therapy yet?
  • Am I answering these questions relative to other types of injuries or just this injury?

Of course, if your doctor has not ordered the proper kinds of diagnostic testing, then there is no way to match the symptoms to the findings. 

For example, if you should have had a lumbar MRI, but your doctor never ordered one, then your doctor may be unaware that you have a severely herniated disc in your lumbar spine from your work injury. This may lead the therapist or Functional Capacity Evaluator to assume you are exaggerating your symptoms (in other words lying to make yourself look worse) and say so in his or her report. We once had this situation. 

In this particular case, the Functional Capacity Exam evaluator assumed the client was faking when she said she had severe shooting pains as well as numbness down her leg, and severe back pain. He of course stated there was “no objective testing” to support these severe symptoms, resulting in an opinion that she was “malingering,” (i.e. faking), which in turn, lead to a very unfavorable report. 

Fortunately, the client had health insurance which allowed her to “work around” her treating doctor and go to a different physician, who ordered a lumbar MRI, which revealed a herniated disc which required surgery. The client was vindicated, underwent surgery and we ended up obtaining a very good settlement for her. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller has helped thousands of injured workers through the work injury claims process. He does more than assert your legal rights and document your injuries. He guides workers through the tests and strategies that insurance companies  and employers may use to try to limit or deny your claim. To discuss any questions you have about the workers’ compensation process and to speak with a strong advocate, call lawyer Joe Miller, Esq., at 888-667-8295. or use my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Types of Knee Injuries

Posted on Thursday, March 11th, 2021 at 12:21 pm    

Knee injuries happen at work for many different reasons. Workers may be injured in a car accident, they may be hurt if something falls on their leg, they slip and fall, or they may be hurt through for many different reasons such as twisting, pulling, or moving their leg in the wrong direction at the wrong time. Knee injuries may be due to chronic issues or they may be due to an acute injury. 

The knees have four primary components: bones, cartilage, ligaments, and tendons. The femur, called the thighbone, is located at the top of the knee joint. The shinbone, the tibia, is at the bottom of the knee joint. The patella, kneecap, is the part of the anatomy that covers the point between the femur and tibia meeting point. Cartledge is the tissue that helps cushion the knee joint bones. Ligaments protect the bones from impact. 

According to Medical News Today, the ligaments act like ropes holding the bones together and stabilizing the knee joint. The “tendons connect the muscles that support the knee joint to bones in the upper and lower leg.”

Some of the many types of knee injuries that workers need treatment for include the following. 


The bone in the knee joint that is most commonly broken is the patella. Other bones in the joint may break too. Breaks are usually due to some type of forceful trauma. Surgery may be required to treat the fracture. 

Anterior cruciate ligament (ACL) injuries

These injuries are fairly common for athletes.  They can also make life very difficult for employees. The ACL provides stability for the knee joint. Injuries often require surgery which can take months or even up to a year to properly heal and that’s only with extensive physical therapy.  A grade one ACL sprain is a mild injury. A grade three ACL is a complete tear. 


A knee dislocation occurs when the knee bones are not properly aligned. For example, a bone slips out of place. Falls in construction accidents and car accidents are common causes of knee dislocations.

Meniscus tear

This refers to torn cartilage in the knee. Cartilage helps provide a cushion between the bones such as the thighbone and the shinbone. Usually, when there is a sudden meniscus tear, the worker will hear or feel a pop followed by pain, tightness, and swelling. 


The bursae are “small fluid-filled sacs that cushion the knee joints and allow the tendons and ligaments to slide easily over the joint.” When the sacs swell and become inflamed, that condition is known as bursitis. 

In general, bursitis can be treated with self-help-care. In some cases, an antibiotic is required. In some cases, a procedure to withdraw the excess fluid, called an aspiration, is required. 


Tendonitis (inflammation) is called patellar tendonitis when it affects the knee. The knee-tendon connects the shinbone to the kneecap. A properly functioning patellar tendon allows the worker to perform physical activities including running and jumping. For that reason, tendonitis is also called jumper’s knee. While it affects athletes, it can also affect any active person including employees. 

Tears of the tendon 

Tears or overstretching of the tendon may occur when a worker falls or is struck by an object in or around the knee.

Collateral ligament injuries 

Collateral ligaments connect the shinbone to the thighbone. While they are also a common athletic injury, collateral ligament injuries can occur at work. 

Posterior cruciate ligament injuries

The posterior cruciate ligament is located at the back of the knee. It is one of the many ligaments that connect the thighbone to the shinbone. This ligament keeps the shinbone from moving too far backward.” This type of injury occurs when there is a forceful impact while the knee is bent.

Knee injury treatments

Medical News Today recommends seeking medical care for any knee injury as soon as possible. While you’re waiting -the RICE method of rest, ice, gentle compression, and elevation is suggested. You should especially seek medical care if:

  • You can’t move your knee
  • You have a limp
  • You hear a popping noise when your knee gives out
  • You have terrible pain in the knee

Some of the many types of treatments for knee injuries that workers need, according to Orthoinfo, include the following. 

  • Nonsurgical treatments. Nonsurgical treatments vary depending on the severity of the injury and your general health condition. Sample treatments include:
    • Physical therapy. This treatment generally consists of exercises to help strengthen the knee and the muscles around the knee. You may need to immobilize your knee with a brace or a cast. You may also need to learn how to use crutches so you don’t put weight on the injured knee. 
    • Drugs like aspirin, ibuprofen, and other nonsteroidal anti-inflammatory medications or in some cases, narcotic medications may provide some relief. 


  • Surgical treatment for knee injuries. Many knee injuries require surgeries. Some are done arthroscopically, meaning the surgeon typically makes three small holes in the knee through which instruments, including a camera, are inserted to conduct the surgery. This is advantageous as it is minimally invasive compared to open knee surgery. 
  • Should more conservative treatments and surgeries fail, ultimately what may be required is a partial or total knee replacement. Knee replacements are essentially artificial joints comprised of titanium and plastic parts that are surgically inserted to take the place of the knee portions being replaced. Many of our clients report good pain relief as well as restored function after recovery from such surgeries. The disadvantage is that it is irreversible. Once your natural knee parts are cut out and removed, there is no putting them back. 

The time to recover from a knee injury can range from a few weeks to a few months depending on the severity of the injuries. Some workers never suffer a permanent injury because they never regain the full use of their knee.

North Carolina and Virginia workers’ compensation lawyer Joe Miller has been fighting for injured workers for 32 years. He works with your physicians to fully document and verify your medical condition and the types of treatment you need. He’s helped thousands of employees obtain full recoveries including payment of their medical expenses includes visits with physical therapists and other therapists. He fights to get you all the lost income benefits the law allows. To discuss your knee injury workers’ compensation case with a seasoned workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888667-8295 or complete my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Types of Shoulder Injuries

Posted on Wednesday, March 10th, 2021 at 12:17 pm    

Workers are constantly using their shoulders in many jobs such as industrial work, construction work, and agricultural work. Nurses, waitresses, and many other employees also regularly use their shoulders at work. Injuries to the shoulders generally happen either through some sort of acute incident such as a fall, tear, a forceful blow to the shoulder, or another immediate event. Shoulders can also be damaged over time through constant wear and tear. That one extra movement at work can affect a weak shoulder by causing a lifetime of chronic pain. 

The different kinds of shoulder injuries that are work-related

The shoulder consists of a ball and socket joint. There are many different types of injuries that can happen according to the Mayo Clinic. Some of these types of injuries are the following: 

    • A broken clavicle or collarbone. The clavicle bone connects your shoulder blade to the upper part of your breastbone. Fractured collarbones can take months to heal after they are properly set by your physician. In some cases, surgery is required to repair the fracture. 
    • Brachial plexus injury. A brachial plexus injury. According to the Mayo Clinic, this injury happens when the shoulder nerves are compressed, stretched, or there is a tear from the spinal cord. 
  • A shoulder dislocation. This painful injury happens when the “upper arm bone pops out of the cup-shaped socket that’s part of your shoulder blade.” With prompt medical treatment, many workers do recover from a shoulder dislocation. However, once a shoulder is dislocated it becomes likely that the employee may suffer subsequent dislocations. 
  • Tears of the rotator cuff. This part of the shoulder is composed of muscles and tendons. Rotator cuff injuries may require surgery. Workers generally need to take a fair amount of time off to work with physical therapists to manage the continual pain. Workers who have a rotator cuff injury will have difficulty lifting objects and using their shoulder in any way until the rotator cuff injury is repaired. 
  • A separation of the shoulder. The ligaments effectively hold the shoulder blade and the collarbone together. There are different types of separated shoulder injuries that are graded based on their severity. The least severe separated shoulder injury consists of stretched ligaments. The most severe type of separated shoulder injury is when the ligaments are torn. A common self-help treatment is rest, ice, and the use of pain relievers. 


Another common type of shoulder injury that may occur through work is called a tear of the labrum, fibrous tissue.  Other types of shoulder injuries include impingement syndrome, otherwise known as frozen shoulder and avascular necrosis (death of bone tissue due to limited blood flow), and sprains.

Treatments for shoulder injuries 

Employees who suffer any type of shoulder injury should save seek medical help. If an accident causes the shoulder injury, then workers should go to their nearest emergency room to obtain a diagnosis and an initial treatment plan. Some of the doctors that employees with shoulder injuries treat with after the initial review at the emergency room are the following: 

  • Orthopedic surgeons. These physicians diagnose injuries to bones, muscles, ligaments, and other parts of the shoulder. They repair fractures and tears, treat dislocations and separated shoulders, and provide medical help for the full range of shoulder injuries. 
  • Pain management doctors. Workers who suffer shoulder injuries may also seek help from pain management physicians to treat their pain, typically after the surgeon has done everything he or she can do, but there remains residual pain. 
  • Physical therapists. Most workers who have a shoulder injury, whether or not they’ve had surgery, will normally need to spend numerous sessions with a physical therapist. The therapist provides exercises that helped to strengthen the shoulder and the muscles around the area of the injury. Treatments can take weeks or months before the worker is able to return to his/her job. In some cases, workers may need to trade for a longer period of time. 

Workers with any type of shoulder injury will often have difficulty performing routine personal tasks such as eating, sleeping, brushing their hair, driving, or any type of household activity. The same thought applies for their ability to do their work. Most workers who have a shoulder injury need to stop working until their pain and shoulder injury are properly treated. Even when workers do return to work, they may need to work subject to physical restrictions such as not lifting objects that weigh more than 20 pounds.

Some shoulder injuries, particularly in older workers, may not be amenable to repair, or the repairs may not provide sufficient relief or restoration of function, and accordingly may require what is known as a reverse shoulder replacement

Workers who suffer shoulder injuries are generally entitled to the following benefits in North Carolina and in Virginia:

  • Payment for all reasonable and necessary medical bills;
  • 2/3rds of their average weekly wages until their injury reaches the stage of maximum medical improvement (MMI);
  • Workers who return to work with restrictions are normally entitled to 2/3rds of the difference between their average weekly wage before their injury and a lower wage after they return to work – that they may be paid because of their job restrictions, otherwise known as temporary partial disability payments;
  • If there is a permanent injury, there may be additional possible benefits the injured work may be entitled to for permanent partial impairment to the injured body part, which insofar as the shoulder would be called either the  right or left upper extremity. 

As a recent case shows, attorney Miller fights aggressively for his clients. This fight includes efforts by the physicians hired by the employer’s insurance company who may argue your shoulder injury is due to a pre-existing condition.

North Carolina and Virginia workers’ compensation lawyer Joe Miller has helped thousands of injured workers obtain just recoveries. He understands just how life-altering a serious shoulder injury can be. He works with your physicians to ensure that you get the medical help you need – and that your employer does not force you back to work before your injuries have been treated and healed. To review your shoulder injury claim or any other work injury claim with a seasoned workers’ compensation lawyer, call lawyer Joe Miller, Esq., at 888-667-8295. or use my online contact form to schedule an appointment. 

Employees in North Carolina and Virginia can also now fill out our New Electronic Case Review. The link is a new way of communicating with clients that we’re offering – to allow workers to contact us remotely during the pandemic.

Reasons Workers Treat with Orthopedists

Posted on Wednesday, February 17th, 2021 at 11:06 am    

Orthopedists are medical specialists who help to correct bone and muscle deformities such as fractures. They treat the musculoskeletal system. Orthopedists are surgeons who also provide a range of non-surgical medical care. Workers often need the help of orthopedists when they fall, when a body part is crushed (such as in a forklift accident), when something drops on them such as tools from a scaffold, or due to a host of other reasons. In some cases, there is some overlap as between orthopedists and neurosurgeons, most typically in the case of spinal injuries. This is because in addition to bones, the spinal processes that make up the spinal column contain, surround, and protect the spinal cord, which is the main “trunk” or nerve which provides the body with feeling and function. Then again, there are orthopedists who specialize in spinal surgery. 

In any event, some of the common reasons workers need orthopedic care include the following:

  • Carpal tunnel syndrome. According to the Mayo Clinic, “the carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling, and weakness in the hand and arm.”
  • Dislocated shoulder. A shoulder dislocation is called a subluxation. While rare, shoulder dislocations do occur. Surgery may be required in severe cases.
  • Osteoarthritis and bursitis. Osteoarthritis happens when your cartilage wears down as you age. Bursitis involves the part of your body that cushions your muscles, and other body parts – near your joints. Bursitis is the inflammation of these cushions (called bursae). Despite the fact that these conditions may exist without any trauma, in the context of a workers’ compensation case, it is often a trauma that aggravates these dormant or asymptomatic conditions that are now very painful. 
  • Plantar fasciitis. The Mayo Clinic defines plantar fasciitis as heel pain which “involves inflammation of a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes (plantar fascia).”
  • Sprains. Most people sprain some part of their body during their lifetime. Standard treatments include rest, ice, and compression. 
  • Stress fractures. These breaks usually aren’t as painful as traditional bone breaks. They normally occur through wear, tear, and stress instead of due to a single accident. The most common parts of the body that suffers stress fractures are the ankle and feet.
  • Tennis elbow. This injury is normally due to repetitive motions that damage the tendons near the elbow. Unfortunately, unless aggravated by a trauma, other than carpal tunnel syndrome, repetitive stress injuries are generally not covered by workers compensation. 
  • Torn ligaments and the meniscus in the knee. These injuries, which are common to athletes, also happen to workers. According to the Mayo Clinic, a torn meniscus can be due to any activity that causes a worker to forcefully rotate or twist a knee. The anterior cruciate ligament (ACL) may tear requiring surgery an extensive rehabilitation. The meniscus is the cartilage around your knee. A healthy meniscus allows your knee to move freely. If the knee does not respond to less invasive surgeries, depending on your age and the condition of the knee, a total or partial knee replacement may be an option. 
  • Torn rotator cuff. This injury involves the tendons and muscles near the shoulder joint. The rotator cuff keeps “the head of your upper arm bone firmly within the shallow socket of the shoulder”
  • Ankle Injuries/fractures. During falls from heights, these injuries can be severe and debilitating. One of the worst is known as a pylon fracture, where essentially the leg bone smashes down into the foot bones and almost completely destroys them. Usually, an orthopedic doctor who specializes in foot and ankle surgery will perform an internal fixation surgery with plates and screws. Fortunately, medical technology has improved in recent years to the point that many foot and ankle specialists are now doing ankle replacements. 

Fractures that happen due to workplace accidents

The human body has more than 200 bones. The human hand, alone, has 27 bones. 

Bone fractures, such as leg fractures, are generally categorized in the following ways according to the Mayo Clinic:

  • Open (compound) fracture. Here, the broken bone pierces the skin. Surgery is normally required for several reasons including reducing the risk of an infection.
  • Closed (simple) fracture. Here, the broken bone does not penetrate the skin.
  • Incomplete fracture. “This term means that the bone is cracked, but it isn’t separated into two parts.”
  • Complete fracture. Here, the broken bone snaps “into two or more parts.”
  • Displaced fracture. “In this type of fracture, the bone fragments on each side of the break are not aligned. A displaced fracture may require surgery to realign the bones properly.”

Another type of fracture, called a greenstick fracture, is more common in children who are less likely to be employees. With this type of fracture, “the bone cracks but doesn’t break all the way through.”

What are the treatments for fractures?

Doctors will normally conduct an oral and physical examination if they suspect a fracture. They’ll use X-Rays to locate where the break is, the type of break, and the severity of the break. In some cases, an orthopedist may order a CT scan or an MRI.

The treatments vary depending on the type and severity of the break. A common initial step, according to the Mayo Clinic, is to use a splint to immobilize the leg. If a worker has a displaced fracture, the orthopedist may need to “manipulate the pieces back into their proper positions before applying a splint — a process called reduction. Some fractures are splinted for a day to allow swelling to subside before they are casted.”

A splint or cast helps to immobilize the broken bone. Broken bones, such as broken legs, may require six to eight weeks to heal. During this time, the worker may need to work with a physical therapist to learn how to use a cane or crutches. It’s important not to put any weight on the broken bone and to restrict the movement of the bone so the bone can heal properly.

An orthopedist may recommend over-the-counter pain medications, “such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a combination of the two. If you’re experiencing severe pain, your doctor might prescribe stronger pain medications.”

Depending on the location of the break, the type of break, and the severity of the break; workers will likely need physical therapy after the cast or splint is removed. The full rehab process can take months or longer.

Possible surgery for broken bones

Orthopedists may need to use rods, screws, plates, or other devices to ensure the bones stay in the proper position while the fracture heals. Usually, this type of surgery is known as an “Open Reduction Internal Fixation” (ORIF) surgery. Many of our clients undergo these types of surgeries. The recovery period after these surgeries can be long. These devices, according to the Mayo Clinic, are generally used for:

  • “Multiple fractures
  • An unstable or displaced fracture
  • Loose bone fragments that could enter a joint
  • Damage to the surrounding ligaments
  • Fractures that extend into a joint
  • A fracture that is the result of a crushing accident
  • A fracture in particular areas of your leg, such as your thighbone”

Joe Miller Esq. has been fighting for injured workers for more than a quarter of a century. He works with and reviews detailed medical records experienced orthopedists, physical therapists, and other healthcare provides to properly assess your workplace injuries, the need for surgeries or other medical care, and the time and treatments you’ll need to return to good health. To discuss y our North Carolina or Virginia work injury case, call me at 888-667-8295. or fill out my online contact form to make an appointment. 

Workers can also complete our New Electronic Case Review. It’s a new type of communication method for our clients that we’re offering – to allow workers to reach us remotely.

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