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. 

Fractures

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. 

Dislocation 

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. 

Bursitis 

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

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.

Always Get A Work Note

Posted on Wednesday, February 3rd, 2021 at 3:55 pm    

Virginia and North Carolina Workers Compensation Attorney Joe Miller explains why it is so critical to your case to obtain a current work note or disability slip after each and every appointment with your primary, authorized treating physician. Failure to present valid work notes at your hearing could mean you will be unable to prove you are entitled to weekly checks.

Hand Injuries and Workers’ Compensation

Posted on Friday, January 8th, 2021 at 12:17 pm    

Hand injuries are common in many different types of jobs. Workers who do outside labor such as construction or agricultural work often suffer injuries due to the machines/tools they work with and thy types of tasks they do. Workers who work inside can suffer injuries due to repetitive use. Workers in almost every field from industrial workers to healthcare workers at some point in their career are likely to injure their hand – often severely enough that they can’t work until (and if) their hand mends.

Some of the machines that can cause severe hand injuries include saws, hammers, and assembly equipment.

Types of hand injuries

Some of the common types of hand injuries that occur during work include:

  • Carpal tunnel syndrome. This injury is a repetitive stress injury that we’ve written about before – Carpal Tunnel Syndrome and Workers Compensation (joemillerinjurylaw.com). Carpal tunnel syndrome normally affects the wrist and the hand. Many officer workers and restaurant workers (such as waitresses) are likely to develop carpal tunnel syndrome.
  • Burn injuries. Workers, such as kitchen workers and restaurant workers, are regularly exposed to flames, steam, boiling liquids, and other terms of thermal burns. Electric burns can occur when an electrical current runs through an electrician’s hand. Chemical burns can occur when industrial, construction, agricultural, or other workers handle hazardous substances which spill on or seep into the skin of the hands as the worker uses their hands to manipulate the or use the chemicals.
  • Fractures and other types of blunt trauma injuries bones. Orthopedists regularly need to provide medical care (including surgeries and setting the fractures) for workers who break a finger of any one of the 27 bones in the human hand. Breaks or crushing injuries can occur if a heavy object falls on the worker’s hands, if the worker’s hands are pinned between two objects, or due to improper use of tools and machines.
  • Lacerations. Cuts to the hand can be due to working with any type of sharp object, when glass sprays into their hands during a collision, or for many other reasons.
  • Punctures. Doctors, nurses, and anyone who works with a sharp object (such as carpenters who work with hammers and nails on a regular basis) may suffer a puncture to the skin of the hand – when the sharp object penetrates their skin.

Other hands injuries include rashes and irritations of the skin

According to MedExpress:

  • 44% of hand injuries involve lacerations and cuts – accounting for over 60,000 injuries in 2017. Many victims require stitches and other treatments.
  • “Crushes caused almost 27,000 hand injuries in 2017, making them the third most common cause of hand injuries.”
  • Fractures, sprains, and tears “accounted for 21 percent of all reported workplace hand injuries in 2017.”

Employer safety suggestions to help minimize the risk of hand injuries

There is no requirement that an injured worker prove that an employer was negligent or that the employer failed to follow federal, state, or local safety protocols. If you are injured at work, you have the right to seek work loss and medical benefits – whether the employer was at fault or wasn’t at fault.

Still, nobody wants to lose time from work and seek medical help if they can avoid it. Some of the many ways employers can help ensure the safety of their employees – when it comes to avoiding hand injuries include:

  • Providing quality safety equipment. Gloves with the proper amount of insulation (or gloves made out of the proper materials such as latex) can help reduce the risk of certain types of hand injuries – such as lacerations, punctures, and some types of burn injuries. Employers should review what types of gloves could help workers who regularly are in danger of any type of hand injury.
  • Educating the worker about safety issues. Often, education is needed for workers who work with specific types of machinery or equipment. These courses can help explain the dangers of each type of machine or tool. The courses can explain when their hands are in the most danger and what steps can be taken to reduce those risks. Workers should be taught which chemicals can cause severe burn injuries, for example, or how to properly work with certain types of sharp instruments.
  • Explaining the importance of communication. Many hand injuries could be avoided if supervisors and co-workers communicate with you – so you know when to get out of the way, when to stop working so they can work, and when other workplace factors increase the risks of hand injuries.

Workers’ Compensation for Hand Injuries

All workers who suffer hand injuries are entitled to work loss benefits if you injury you hand due to a workplace accident or due to an occupational illnesses. Your North Carolina or Virginia workers’ compensation lawyer can explain when you can file a claim for a repetitive stress injury to your hand.

Temporary work loss benefits for hand injuries generally include payment of all your medical bills and about 2/3 of your average weekly income while you can’t work.

If you can’t use your hand (or any fingers or your thumb) at all, or in part, after you’ve reached the point of maximum medical improvement (no additional medical care is likely to improve your hand) – you may be entitled to permanent disability benefits according to North Carolina or Virginia law. For example, if your hand is amputated, you can seek permanent disability benefits in both states.

An experienced work injury will work with you and your doctors to help ensure that the employer doesn’t force you back to work before you can do your job.

Virtually every worker needs functioning hands in order to do their job. Our experienced North Carolina and Virginia work injury lawyers have been fighting for employees for more than 25 years. We’ll explain your rights and fight to get you all the compensation and medical care you deserve. To reach lawyer Joe Miller, Esq., call me at 888-667-8295. or fill out my online contact form to schedule an appointment. Workers now can also complete our New Electronic Case Review. It’s a new way of communicating with clients that we’re offering – to allow workers to contact us remotely.

Workers’ Compensation Trends for 2021 – Telemedicine and Worker’s Compensation

Posted on Tuesday, December 29th, 2020 at 1:33 pm    

Today, people can connect to the Internet and with each other in many different ways – desktop computers, laptops, smartphones, and tablets. This technology is now being used to connect doctors and patients remotely – in place of in-office visits. The trend of using telemedicine in workers’ compensation cases is expected to continue through 2021 and beyond.

Electronic communications are being used for consultation, monitoring of a patient’s condition, management of chronic conditions, management of medication, and other clinical services – provided the video and audio connections are private and secure. Telemedicine usually includes a video consultation, after an injury, where the doctor can hopefully make a diagnosis of the workers’ injuries – though the worker may need to go to a lab to have certain medical tests done. The physician can then conduct follow-up examinations remotely instead of in-person. 

According to a representative from Kaiser Permanente (KP), a leader in telemedicine services, In 2015, of KP’s 110 million interactions between physicians and members, 56% were virtual, surpassing physical visits for the first time.”

The US Department of Veterans Affairs, which operates the country’s largest healthcare system, is using telemedicine for many veterans nationwide.

The use of telemedicine during the pandemic

During the pandemic, the use of remote technology has been a life-saver for many workers. Workers who use telemedicine can do so from home so they don’t need to be in contact with anyone who might have the disease – other than their own family members. Physicians and healthcare providers are using telemedicine to consult with their patients.

Advantages of telemedicine in work injury cases

There are some advantages to using telemedicine for all types of injuries. Telemedicine is useful for the following situations:

  • If an injury occurs during a night shift when most medical offices and facilities are closed, a physician can remotely begin the evaluation process
  • If an injury occurs in a rural area or an area where there aren’t many quality medical facilities
  • When accidents happen away from the company site. Here, the worker can call into the company doctor.
  • It’s generally easier to schedule appointments. Patients can wait to see the doctor in the comfort of their home instead of waiting in the doctor’s office hoping there’s an interesting magazine to read.
  • Telemedicine can be used to remotely measure a patient’s vital signs
  • Telemedicine can be used to prescribe prescription drugs remotely
  • Text alerts and messages keep the worker/patient informed of important health information

Telemedicine is useful for post-surgery care and second medical opinions. Telemedicine makes it easier to connect with specialists who may not be locally available.

According to the National Council on Compensation Insurance (NCCI), “In certain situations, where accessibility to immediate medical care may be limited, one type of telemedicine service—24/7 tele-triage—may be an invaluable resource for initial assessment and evaluation. 

Telemedicine also helps workers and employers because it saves on the time and expense of transportation to and from the doctor’s/healthcare providers’ office. Telemedicine also makes it easier to see specialists and to reduce delays in getting medical treatment.

Some of the limitations and risks of using telemedicine

Generally, telemedicine is only advisable for non-critical situations. Many workers do need to be treating in an emergency room or a doctor’s office so the physicians can properly and fully examine the patient.

There are many legal issues involved with telemedicine such as that physicians can generally only give advice to patients they’ve seen in person at least once and can only give advice to patients who live in the same state as the doctor.

Some of the downsides of using telemedicine for work injury patients include:

  • The technology isn’t always reliable. Signal or connection failures can mean missing an appointment.
  • Some workers just aren’t comfortable with any type of technology including video technology

According to NNCI, some of the other risks of telemedicine include:

  • “Lack of physician fee schedules for telemedicine services
  • Lack of regulations and policies for licensing and privacy
  • Jeopardized quality of care with potential for misdiagnosis
  • Possible high start-up technology costs
  • Cybersecurity threats; security of data.”

As telemedicine expands, medical practitioners and patients will need to develop a balance between in-person visits and the use of telemedicine.

Recent Telemedicine Legislation

States and federal agencies, such as Medicare, are working to keep current with the advances in technology. According to NNCI, “In early 2018, Texas proposed a rule that would expand injured workers’ access to telemedicine services by lifting a restriction in the Medicare-based reimbursement policy that limits the use of telemedicine to underserved areas—typically rural regions with few healthcare providers.” Other restrictions, depending on the state, require that telemedicine could only be provided to a patient in a doctor’s office, hospital, or clinic, but not at a patient’s home. 

Generally, the types of telemedicine services that are covered by workers’ compensation insurance, the provider requirements, and how reimbursement works vary from state to state. Some states require that doctors even have a special telemedicine license. 

It is likely that the use of telemedicine will expand even when the pandemic is over. Because telemedicine helps reduce costs and may improve the outcomes for the worker (because the worker has access to specialists and his/her medical care is monitored electronically), telemedicine should be advantageous for both the worker and the employer’s insurance company. In addition, as telemedicine expands, workers may find that they enjoy it even more because of the reduced need for travel while they’re not feeling well and for the other advantages that we’ve described.

Attorney Joe Miller has been a strong advocate for injured and ill workers in North Carolina and Virginia for more than 30  years. He works with your physicians and the company doctors to help ensure you are receiving the medical care you need and deserve. To discuss your North Carolina or Virginia workers’ compensation claim with an experienced and caring work injury lawyer, call attorney Joe Miller, Esq., at 888-667-8295. or use my online contact form to schedule an appointment. Workers can also use our New Electronic Case Review. It’s a new way of communicating with clients that we’re offering – to allow workers to contact us remotely.

Workers’ Compensation Trends for 2021

Posted on Monday, December 28th, 2020 at 1:33 pm    

There are many 2020 developments that will affect workers’ compensation for both employees and employers in 2021 and the coming years. Many of these developments are related to COVID-19. Other developments, according to CMR Risk & Insurance , include the use of telemedicine, the rise of mega claims, and the rise of comorbidities.

Employers across North Carolina and Virginia are required to have workers’ compensation for their employees. The insurance should cover any accidents in the workplace regardless of fault and any occupational illnesses. The insurance should pay the workers’ medical bills and a large portion of their lost wages (generally, about 2/3rds) during the time they can’t work, or in many cases, if their employer is unable to accommodate their physical restrictions due to the work injury, for a maximum of 500 weeks. In addition, the insurance should pay for any permanent partial disability, even if the injured worker is able to return to employment. In some cases, payment for vocational rehabilitation may be required.

COVID-19 and workers’ compensation

The COVID-19 pandemic has affected workers and employers in many ways. Key compensation factors are related to the nature of the business. Some professions such as healthcare and delivery services expose workers to a greater risk of contracting the disease. Other professions, such as professional services, have less risk because the professionals can usually work remotely by using the Internet.

Employers need to consider what safety precautions to take depending on the nature of their business. Employees need to understand that workers’ compensation claims for families of workers who died due to COVID-19 and claims by workers who become ill or had to quarantine due to the disease will be handled on a case- by- case basis. Some of the questions that arise in COVID-19 workers’ compensation cases include:

  • Did the illness arise out of the scope of your employment?
  • Was the illness caused by job-specific conditions – not through conditions that the general public was also exposed to?
  • Can you prove these items via your doctors to a standard of clear and convincing evidence? 

As we discussed in previous blogs, some states are enacting laws to cover workers who develop COVID-19. Some states are also creating presumptions as to what conditions indicate a worker who developed COVID-19 – developed that condition through work. Thus far, in Virginia, a bill which would have given such presumptions to health care workers, first responders, firefighters,  and teachers who develop COVID-19 was defeated in the State Legislature earlier this year. North Carolina is still wrangling with the particulars of a similar bill before the State Legislature in Raleigh. 

Meanwhile, the Virginia Workers Compensation Commission in Virginia and Industrial Commission in North Carolina are still deciding COVID-19 workers’ compensation cases on an individual basis, under the standards of an ordinary disease of life, which are difficult, but not impossible, to meet. Mega Claims

According to CMR Risk & Insurance, another new trend is that many workers are filing “mega claims” which can result in payouts (for medical bills, wages, and other expenses) of millions of dollars.These claims are usually due to workers who have severe, and often, permanent injuries. Mega claims are often due to motor vehicle accidents, accidents where the worker was struck by an object, and falls.“In some cases, however, mega claims can develop slowly—particularly when caused by minor injuries that go untreated.”

CMR reports that, according to a recent study conducted by the National Council on Compensation Insurance (NCCI), these claims have reached a 12-year high—increasing in both frequency and severity. This increase has been attributed to several possible factors, such as changes in mortality patterns, medical advances, and a rise in health care costs.”

Employers are advised to take extra safety measures to help reduce the risk workers will suffer injuries that can result in mega claims.

Presumptions for first responders

According to M Power by Mitchell (a casualty and insurance company), “states are beginning to examine presumption laws for first responders and expanding coverage to conditions such as PTSD.” The issue of presumptions raises questions as to:

  • Which injuries and illnesses should be covered?
  • Whether the injuries and illnesses are related to the risks of the job?
  • Who should be covered, if anyone, beyond first responders?

For instance, Virginia this past summer passed into law what is now VA Code 65.2-107, which provides that any first responders, fire fighters and police officers who suffer from Post Traumatic Stress Disorder (PTSD) will be compensated, provided the PTSD was caused by a “qualifying event.” 

A qualifying event is defined as an event: 

  1. Resulting in serious bodily injury or death to any person or persons;
  2. Involving a minor who has been injured, killed, abused, or exploited;
  3. Involving an immediate threat to life of the claimant or another individual;
  4. Involving mass casualties; or
  5. Responding to crime scenes for investigation.

The rise in comorbidities

“A comorbidity is the simultaneous presence of two or more medical diagnoses for an individual.”

“Comorbid conditions are typically long-term health complications that have the potential to increase the severity of other injuries or illnesses that the affected individual may experience, making it more difficult to fully recover. Common comorbid conditions include obesity, diabetes, hypertension, depression, anxiety, and substance abuse.”

CMR states that an NCCI study found that work injury claims involving comorbidities have nearly tripled since 2000. In addition, the cost of workers’ compensation claims involving comorbidities is about twice that of other claims. This is generally because workers with comorbidities need more time to heal, are more likely to develop complications, and are at more risk of having a permanent disability.

In response to the concern about comorbidities, many employers are implementing wellness initiatives – to address chronic health problems and improve their staff’s overall fitness.

Another term to describe comorbidities are “pre-existing conditions.” The good news is that in most cases, if the work injury has even the slightest bit to do with causing the current disability, then the entire claim is compensable. The bad news is that if you are only partially disabled or on light duty, and a comorbid condition causes you to become completely disabled, that could essentially end your workers compensation claim, even if you are under an Award. 

Labor trends and workers’ compensation

Many employers are hiring workers who lack experience in order to fill their labor shortages. The problem is that workers who are inexperienced are more prone to accidents in the workplace. Part of the problem of inexperienced workers can be addressed through better training. Part of the problem, though, is that there’s simply nothing like experience to do jobs in a safer manner.

“According to a recent survey conducted by the Golden Triangle Business Roundtable in Texas, employees with less than five years of experience contribute to 43% of overall workplace injuries.” 

Another labor trend that is affecting workplace accidents is that many workers are working later in life. Data from the US Bureau of Labor Statistics shows that “employees over the age of 55 in the labor force are expected to increase to nearly 25% by 2024 (up from 21.7% in 2014).” Older workers generally require more time to recover from an accident than younger workers. Older workers generally have poorer balance, hearing, and vision than younger workers. They also have slower reaction times.

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. has been fighting for injured workers for more than 25 years. He’s helped thousands of employees get just recoveries for the injuries and illnesses which are work-related. He also keeps current with the new trends and new laws. 

If you’ve been involved in any type of workplace accident or think your illness is related to work, speak with an experienced North Carolina and Virginia workers’ compensation attorney. You can reach attorney Joe Miller, Esq., at 888-667-8295. or fill out my online contact form to schedule an appointment. Workers now can also complete our New Electronic Case Review. It’s a new way of communicating with clients that we’re offering – to allow workers to contact us remotely.

When Are Workplace Injuries Not Covered by Workers’ Compensation?

Posted on Wednesday, December 16th, 2020 at 9:53 am    

Most people automatically assume if they are injured at work that they’re covered by their state’s workers’ compensation laws. And, for the most part, that’s true. If you slip and fall or suffer some other accident at work, in most cases, you should be covered. If you are loading very heavy items into a cart and wrench your back, you should be covered. If a forklift tips over or malfunctions, and you are injured, you should be covered.

In workers’ compensation cases, there is no need to prove fault. Generally, if you’re hurt while doing your job, you should be entitled to have all your medical bills paid by your employer’s insurance company and approximately 2/3rds of your wages while you are temporarily totally disabled for up to a maximum of 500 weeks, or if you become permanently or partially disabled. Permanent partial disability benefits are paid for a specific number of weeks. 

As with every rule, though, there are many exceptions. There are a few situations where your injuries will not be covered – in some cases, because your employer is not required to be insured, in other cases because of some misconduct on your part, and in others, because the injury you suffered is not considered to have arisen out of your employment.

The Employer is not Required to Carry Workers Compensation Coverage

Unless the employer has more than three employees who are regularly employed in the business, then they are not required to carry workers compensation coverage. 

The most common scenario where this issue comes up is with construction companies. The employer will actually have many more than 3 workers who regularly work for the employer, but the employer will claim that everyone is an independent contractor. Oftentimes, this is actually not the case. When you analyze the situation, you begin to realize that all of those “independent contractors” are treated no differently than an employee would be treated. They show up at a specific time every day. They are required to follow the rules and directions of the boss. They generally work nowhere else except the employer. The employer supplies all of the equipment for the job. No matter what they employer calls them, these workers are employees and must be covered. 

So what happens if the employer has no coverage? In North Carolina, unless the employer was somehow at fault, you are out of luck, unless there was a general contractor over the employer who was insured. Sometimes you can find coverage there. 

In Virginia, if there was no insurance with the general contractor, the Commonwealth of Virginia maintains something called the Uninsured Employer Fund which is designed for just such situations. They will stand in the place of the insurance company and pay the claim. Of course, after the fact, they will go after the employer and attempt to recoup their payments. 

NOTE: Just because your employer does not have more than 3 employees in the business DO NOT ASSUME that he does not have coverage. IF the employer ELECTS to purchase coverage, then even though the employer was not REQUIRED to carry coverage, that coverage will invoke all of the rights of the Workers Compensation Act and if you are hurt on such a job, you will be covered by the Act. 

We particularly tell construction workers who own their own business and do construction work themselves: Please, please buy coverage for yourself and your workers if you can find a way to afford it. We have seen too many lives ruined for failure to purchase coverage. 

Pre-existing conditions

If a pre-existing physical condition is the sole cause of your injuries and it’s the pre-existing condition that causes the injury, then you may not be covered. For example, if an employee has severe osteoarthritis, that condition can damage and cause pain in various joints such as the hands, hips, knees, and spine. If you are working and your knee buckles – even though you didn’t fall or didn’t come into contact with any object – then a physician may conclude that nothing at work caused your knee pain – your knee pain is due to your arthritis and nothing else. 

This situation is different than if you slip and fall because the floor is wet and then hurt your knee. A doctor might say that part of your pain in your knee is due to the osteoarthritis – but since the wet floor caused your fall, you can claim workers’ compensation benefits. The good news about pre-existing conditions is that it is rare that a claim will fail because of them. This is because in Virginia, so long as th the injury caused a sudden mechanical change in your body, then if any portion of your disability comes from that injury, no matter how slight, then the entire injury and treatment for it is compensable. 

Many other conditions may be caused by events at work that are personal to the worker and weren’t caused by work. In these cases, the employer will contest your right to workplace benefits.

Personal risk

There are some injuries that the workers’ compensation board or courts may consider non-compensable because they’re due to a personal risk that the employee assumes. For example, if a worker starts a fight with a co-worker, especially if it is over personal issues between them, then that worker will not be able to file a work injury claim for all the burn injuries and respiratory injuries he suffers. The victim of the assault, however, would normally have the right to file a workers’ compensation claim – provided that the reason for the fight was not personal, but work-related in some way. 

Deviations from work

Some employees who are working for their employer take time off to run personal errands. For example, a salesperson who is on the road may take time out to go shopping for something. If that worker is then injured (suffering bone fractures) by falling on the parking lot asphalt, the employee may not be able to claim worker’s compensation benefits to treat with an orthopedist to mend the broken bones– because he/she was injured while deviating from his/her work assignment. The trip to the retail store was not related to his/her work and thus would not be compensable.

Recreational injuries

Recreational activities include activities that are not generally considered part of a workers’ daily job requirements. These activities can include company softball games or outside picnics where workers mingle with other people. Injuries while playing a game or just serving food at a picnic do happen. 

Whether the injury is considered related to work often depends on a few factors such as:

  • Was the participation in the recreational activity mandatory? If everyone at work has to partake in the activity, that suggests that the employer should be responsible if you’re hurt while participating in the recreational activity.
  • Does the participation affect your employment? If the employer makes clear that participation makes you seem like a team player and that participation can help you be promoted, then those factors indicate that the activity was work-related
  • Did the employer provide the source of the recreational activity? These days, many companies offer gyms where employees can work-out. If the employer provides the ability to do the recreational activity – and encourages you to work out for your health – those factors suggest the activity is work-related.

If, on the other hand, a few workers decide to get together for a few beers after work and one worker trips and falls while carrying the beers, that would likely not be considered to be in the course of employment.

Virginia Claims: Failure to Prove the Injury Arose from a Risk Associated with Employment-No Such Requirement in North Carolina

Virginia, unlike North Carolina, has an additional requirement that the injury must be caused by a risk associated with employment. The most classic scenario is a fall down the stairs. In North Carolina, this would be considered a compensable work accident. 

In Virginia, a risk analysis is conducted. What was the employee doing at the time of the fall down the stairs that created a risk that was different from someone in the public who also fell down the stairs? If the answer is nothing, there is no risk of employment and no compensable case. On the other hand, if the employee had his or her hands full with work-related items that made it hard to see or grasp the railing? Or did the employee have some slippery substance on the bottom of his or her shoes that was from a factory floor? Were the stairs themselves somehow defective, such as worn out or missing anti-slip guards on the stairs? Those all would qualify as risks of employment.  

Another example would be someone who wrenches his or her back while performing work duties, such as picking up a light item off of a shelf, turning around and placing it in a box.  The worker is not lifting anything heavy, but suddenly feels a sharp, severe pain in the back resulting from that specific movement at work. In North Carlina, particularly with respect to back injuries, all that is required is that the injury occur as a result of a “specific traumatic incident” of the work required. Accordingly, it would likely be compensable. 

 In Virginia, such a case would not be found to be an “accident” or a result of a risk associated with employment. Anyone could lift a light item off of a shelf and suffer this same injury. It would therefore not be considered a risk of employment and therefore not a compensable accident in Virginia. 

Willful Misconduct, Intoxication and Violation of a Safety Rule

If you engaged in willful misconduct at the time of the accident such as intentionally inflicted injury, you may not recover. Also, if you were found to have been intoxicated at the time of the accident in either Virginia or North Carolina, you may not recover anything. Note that intoxication does not only mean being over the legal limit of .08 BAC in VA.  If fellow employees or supervisors testify that they smelled alcohol on your person on the day of the accident and you were exhibiting signs of intoxication, then that may be sufficient to say you were intoxicated. The intoxication must be found to have been a proximate cause of your accident. 

In North Carolina, the intoxication need only be found to have caused the employee to “lose the normal control of his or her bodily or mental faculties, or both, to such an extent that there was an appreciable impairment of either or both of these faculties at the time of the injury.” 

Insofar as violation of safety rules, to bar a claim in Virginia, the employer must show that the rule was one that was enforced across the board by the employer and that its violation was a proximate cause of the accident. So if the employer at a roofing company says you failed to follow the well-known rule about tying off with a safety rope and harness when working at heights, and yet that same morning your boss and co-workers also alighted and worked on the roof without tying off, that would be a rule that was not generally enforced. They cannot apply it for the first time to you, in order to prevent you from receiving benefits. Another commonly brought up rule is failure to wear seat belts in auto collision.  If the employer had such a rule but never informed the injured worker about it, and never enforced it, that rule may not be used selectively against an injured worker. 

In North Carolina, violation of safety rules by the injured worker will typically not bar or prevent a claim, but will reduce the weekly compensation payment to the injured worker by 10%. 

Each case is different. You should not assume that you don’t have a case. There may be good reasons why you can assert a claim. The best course of action if you are injured at work or doing anything that might be work-related is to speak with an experienced North Carolina or Virginia workers’ compensation lawyer. Often, there is a very fine line between having a viable claim and not having a claim. 

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. understands when injury accidents at or related to work are compensable. He’s helped thousands of injured and ill workers get the compensation they deserve. Attorney Joe Miller has been fighting for injured workers for more than 31  years. For help with any work injury claim, speak with an experienced North Carolina and Virginia workers’ compensation attorney. You can reach attorney Joe Miller, Esq., at 888-667-8295. or complete our  online contact form to schedule an appointment. You can also complete our New Electronic Case Review. It’s a new way of communicating with clients that we’re offering – to allow workers to contact us remotely and submit a claim for consideration, even after hours. 

What is Maximum Medical Improvement?

Posted on Tuesday, December 15th, 2020 at 9:52 am    

When you’ve been hurt at work, there comes a time when continuing to treat with your doctors doesn’t improve your medical condition. When additional medical treatments won’t improve your medical condition and the healing process is stopped – you’ve reached the point of Maximum Medical Improvement (MMI). 

This does not mean that you no longer require medical treatment such as pain management. It just means that according to the opinions of your doctors, you are unlikely to improve your permanent outlook with additional treatment. 

Workers have the right to get medical treatment for any injuries they suffer due to a workplace accident. Most workers start with a visit to an emergency room doctor or they see a physician designated by the workers compensation insurance company, or in some cases, their personal physician. Depending on the type of injury and the severity of the injury, injured workers may need surgery. They often need to see a specialist; maybe several specialists to address their work injuries.  Injured employees often treat with physical therapists, occupational therapists, and/or rehabilitation therapists. Some workers also need to see a psychologist and/or psychiatrist.

Employees who are injured at work who suffer a compensable claim have every right to try to maximize their health and minimize the consequences of their injury at work. During the time they are working to improve their health, they are entitled to have the insurance company for the employer pay their medical bills and generally, 2/3rds of their average weekly wages for the time their authorized physician holds them out of work or for a maximum of up to 500 weeks.  Some injuries completely heal with time – such as many minor fractures. Other injuries never completely heal and may require the insertion of hardware or other drastic methods of repair. 

Maximum medical improvement is an important milestone in an injured worker’s case for a number of reasons: 

  1. It enables your doctor to refer you for a Functional Capacity Examination to determine whether you have any permanent, physical restrictions due to your injuries; 
  2. It enables your doctor to refer you for a Functional Capacity Examination to determine whether you have any permanent partial impairment in any specific body parts you may have injured in your accident;
  3. It is generally a signal to all parties that a potential settlement may be on the horizon; 
  4. It is generally a signal to the defense that they may want to engage you in a program of vocational rehabilitation after the results of your FCE come in. 

MMI evaluations

When workers reach MMI, several evaluations need to take place.

  • The first evaluation is whether you have reached the point of MMI. Often employers will argue that you’ve reached MMI in order to force an early settlement or try and force you back to work or to try to cut off your right to your 2/3rds share of your average weekly wages. You have the right to challenge any claim you’ve reached MMI if you still think medical treatment can improve your health. Normally, the doctor who is treating you makes the initial determination of when you’ve reached MMI. 
  • The treating doctor, in some cases, may be a “company doctor” meaning  he/she does have some bias towards getting you back to work per the insurance company’s wishes. 
  • In North Carolina, if you disagree with a determination that you’ve reached MMI, you have the right (with the help of an experienced North Carolina compensation lawyer) request an independent medical examination (IME). The IME is a medical review done by another physician of your choice. Unfortunately, there are no such provisions in Virginia; however, if you can afford to see a different physician, you can pay for the examination yourself. 
  • After the MMI determination by your physician, the second step is usually for that physician to order a Function Capacity Examination (FCE) by a licensed physical therapist’s office equipped for such exams. This evaluation is to determine if you can return to work with workplace restrictions. A typical workplace restriction is that you can work but you can’t lift or move any objects that weigh more than 20 pounds. 
  • After the FCE occurs, some employers may decide to adjust or accommodate your work routine so you can work with these restrictions. This way, you can earn your salary; however, this accommodation does not come without risks. Note that If the employer reduces your pay because of the workplace restrictions, you should be able to continue to receive pay loss benefits – but the benefits are adjusted to reflect 2/3rds of the difference in pay between your pre-injury wages and your new wages. 
  • If the employer doesn’t have a job for you that you can do based on your work restrictions, then you can continue to receive your 2/3rds per week disability payments. In Virginia, if you are not under an Award for benefits, or if your claim in in North Carolina, if your employer cannot accommodate your restrictions, you must look for a job you can do with those restrictions. If you are under an Award in Virginia, then you are under no obligation to look for other work. The burden shifts to the employer in cases of an Award to find you work and if they choose to do so, this is done via vocational rehabilitation. 
  • Oftentimes, the FCE also includes a portion of the exam which is designed to decide whether you are eligible for permanent partial disability or permanent partial impairment (PPI) benefits. When you’ve reached MMI, the treating doctor, after reviewing this portion of the FCE report, will normally also assign an injured worker a Permanent Partial Disability (PPD) or Impairment rating (PPI). Here, the physical therapist is performing tests on your injured body part to determine if you there exists a permanent disability in the injured body part. Based on that evaluation, the physical therapist— and later your doctor– will assign a percentage rating to that disability (called an impairment rating). 

 

An example of a permanent partial disability/impairment is the loss of function of a hand. An impairment rating is an assignment of the severity of that loss of hand such as 90%. This means you’ve lost 90% of the function of your hand. If you are entitled to permanent disability benefits, the amount of the benefits (a specific number of weeks such as the maximum of 200 weeks for the hand– what North Carolina law permits) is multiplied by the impairment rating. So, if you would normally be entitled to 200 weeks for a permanent disability and you have a 90% impairment rating, you will be entitled to 90% of 200 – or 180 weeks. Note that this is NOT in addition to any weeks you remain out of work. 

  • After you have reached MMI and these evaluations occur is typically a good time to determine whether you want to consider a lump sum settlement. If you are unable to return to your former job and so far you are unable to find alternate employment or the insurance company has not been able to find any for you, then you have the potential for a maximum of 500 weeks of payments ahead of you. These potential future weeks, along with the value of the medical side of your claim can then form the basis of a lump-sum settlement demand by your attorney. 

If, on the other hand, you have returned to work at a job at or higher than your pre-injury wages, and you have been determined to have a permanent partial disability and an impairment rating, then the number of weeks as determined by that percentage, plus your future potential medical treatment would be the basis of your attorney considering and possibly negotiating a lump-sum settlement (called a clincher agreement in North Carolina). In a lump-sum settlement, you’re a negotiated portion of what potentially is due to you in the future (the 2/3rds’ wages and medical bills) in one payment to you, so you control the money. The risk, of course, is that there is no do-over if your medical bills are more than you anticipated. On the other side, the risk to the insurance company is that you will, in fact, get better, require little further treatment,  and find a good job on your own, in which case would not have ended up paying you what they paid out in settlement. 

 

An experienced work injury lawyer will advise you about the pros and cons of a lump-sum settlement in your particular circumstance. 

It’s important to understand that you are still entitled to seek medical help – after you reach MMI – and to have the employer pay for that medical care. The key requirement is that the medical care must be needed to help ensure your medical condition doesn’t worsen. Many patients, for example, who have chronic back pain due to their workplace injury need pain management or orthopedic maintenance so their back pain doesn’t get worse.

You should also understand that if you are in an accepted claim or under an Award, the burden to switch from temporary total disability benefits to permanent partial disability benefits, or from temporary total disability benefits to a termination of benefits, is on the employer.

Talk with a seasoned North Carolina and Virginia workers’ compensation lawyer today

North Carolina and Virginia workers’ compensation lawyer Joe Miller Esq. understands that many employers try to push workers to return to work before they’re healthy. He works with your doctors and independent doctors to help assess your medical difficulties and concerns. When you reach maximum medical improvement, he also works to assist your doctors in determining whether you have a permanent partial or full disability as you look to your future.  To discuss your worker’s compensation case, call attorney Joe Miller, Esq., at 888-667-8295. or fill out our online contact form to schedule an appointment. You can also fill out our New Electronic Case Review. It’s a new way we’re offering so workers can contact us remotely.

Hernia and Workers’ Compensation

Posted on Wednesday, December 9th, 2020 at 1:32 pm    

Hernias occur when a bodily organ pushes through your muscle or tissue. Muscles and tissues hold your organs in place. A common example is when a person’s intestines push through a weakening in the abdominal wall. Other common locations for hernias include the upper thigh, the groin, and the belly button. Generally, hernias don’t repair themselves with time. In severe cases, surgery may be required because the hernia can become life-threatening.

What are the different types of hernias?

According to the Cleveland Clinic, there are several types of hernias. These include:

Inguinal hernias. 

  • Inguinal hernia: “In men, the inguinal canal is a passageway for the spermatic cord and blood vessels leading to the testicles. In women, the inguinal canal contains the round ligament that gives support for the womb.” When an inguinal hernia occurs, part of the intestine or fatty tissue – pushes through the groin – at the top of the inner thigh. Men suffer from this disorder more than men.
  • Femoral hernia: This type of hernia, in which “fatty tissue or part of the intestine protrudes into the groin at the top of the inner thigh” affects women more than men.
  • Umbilical hernia: This type of hernia occurs near the belly button (navel) as the tissue or intestine pushes through the abdomen.
  • Hiatal (hiatus) hernia: Here, “part of the stomach pushes up into the chest cavity through an opening in the diaphragm (the horizontal sheet of muscle that separates the chest from the abdomen).”
  • Incisional hernia: This type of hernia is normally due to a surgery – where tissue pushes through the site of an abdominal scar “from a remote abdominal or pelvic operation.”

The strong majority of hernias are inguinal or femoral.

Other types of hernias include:

  • Epigastric hernia
  • Spigelian hernia
  • Diaphragmatic hernia

Why do hernias occur?

Some hernias are due to conditions that have existed since birth. Hernias are often caused to do aging. Repeated strains on the abdominal and groin area can also cause a hernia. These strains can be due to physical exertion, frequent coughing, constipation, obesity, and pregnancy. Surgeries can also cause hernias. 

What are the symptoms of a hernia?

According to the Cleveland Clinic, common symptoms include a noticeable lump or bulge in the groin or abdomen – that can be pushed back in. Activities such as laughing, coughing, bowel movement strains, crying, or physical activity can make the hernia noticeable. Other symptoms include:

  • Pain while lifting
  • An increase in the size of the bulge
  • Pain at the edge of the bulge
  • “A sense of feeling full or signs of bowel obstruction.”

Can hernias be work-related?

Yes. Hernias may be due to a specific incident or to cumulative trauma. A lifting accident can cause the muscle of the abdominal wall to tear. Repetitive lifting over time can also cause a hernia; however, it must be remembered that generally, a repetitive trauma that occurs as a result of lifting over time is generally held to be non-compensable. Meaning, that you must prove the hernia came from a specific, identifiable incident that occurred at a specific moment in time, for instance, attempting to lift an unusually heavy object. Hernias, as discussed, may be due to surgeries – and the surgeries may be necessitated because of a workplace accident that causes abdominal or groin injuries.

Hernias may be secondary to other types of injuries or conditions which may render the hernia non-compensable. For example:

  • Coughing and sneezing may be due to occupational illnesses or due to exposure to dust and chemicals; however, this would likely not be a compensable claim, or at least be extremely difficult to prove.
  • Constipation. People who have orthopedic surgeries such as surgery on their back may need to take medications which, in turn, can cause constipation. The straining during constipation can cause a hernia. Again, this would be very hard to prove, since the constipation is generally something the public is equally exposed to and not a condition of work; 
  • Gaining weight. Injuries such as back injuries can cause inactivity which can cause weight gain – which can then cause a hernia; however, this would also likely be very difficult to prove, since weight gain is also a result of other factors such as overeating. 

How are hernias managed?

You must report the hernia condition to your employer. Once you do, the employer will refer you to a physician (or give you a list of qualifying doctors in Virginia) who will examine you to confirm the hernia. Often a hands-on physical examination can confirm the hernia. If the physician recommends surgery, then you will be referred to a general surgeon. Early intervention for a hernia is strongly advisable.

The type of surgery required depends on your age and the type of hernia you have. The common types of hernia surgery include:

  • Open surgery. In this procedure, the surgeon makes a cut into the body at the site of the hernia. The tissue that is protruding is “set back in place and the weakened muscle wall is stitched back together.” Some hernias use mesh implants to give more support.
  • Laparoscopic surgery. The repairs are generally the same as for an open surgery hernia operation – but “instead of a cut to the outside of the abdomen or groin, tiny incisions are made to allow for the insertion of surgical tools to complete the procedure.”
  • Robotic hernia repair. This hernia operation “uses a laparoscope, and is performed with small incisions.” In a robotic surgery procedure, the surgeon handles the surgical instruments from a console. “While robotic surgery can be used for some smaller hernias, or weak areas, it can now also be used to reconstruct the abdominal wall.”

Hernia surgeries are a fairly common procedure. Some hernias do reoccur. If the original hernia was work-related, then the subsequent hernia may also be work-related.

Other treatments may include losing weight, changes in lifestyle, a better diet, and medications.

What happens if the hernia isn’t treated?

Failure to treat a hernia can cause:

  • Obstruction (incarceration): “Part of the intestine becomes stuck in the inguinal canal, causing nausea, vomiting, stomach pain, and a painful lump in the groin.”
  • Strangulation: “Part of the intestine is trapped in a way that cuts off its blood supply. In such cases, emergency surgery (within hours of occurring) is necessary to prevent tissue death.” I am personally aware of at least one person who failed to get appropriate treatment in time and died as a result of this type of hernia. Within 36 hours after he sustained this hernia, almost the entirety of his intestinal tract was necrotic, i.e. dead tissue due to the loss of blood flow to those tissues. There was nothing the surgeons could do. He died shortly thereafter.  Take this type of hernia VERY SERIOUSLY. 

 If you suffer a work-related hernia, then you should have the right to:

  • Payment for all reasonable and necessary medical expenses including the cost of a hernia surgery
  • Lost income based on your temporary work disability at 2/3rds of your average weekly wage so long as your doctor opines that you are unable to work– until you have any necessary surgeries (including time to recover). Depending on the outcome of the surgery, in some cases, you may also be entitled to permanent disability benefits.

Talk to a premier North Carolina and Virginia workers’ compensation lawyer today

North Carolina and Virginia workers’ compensation attorney Joe Miller Esq. has helped thousands of workers get the workers’ compensation benefits they deserve. He’s been fighting for injured workers for more than 31 years. He’ll work with your doctors to help verify a hernia or any other injury is work-related. To speak with an experienced North Carolina and Virginia workers’ compensation attorney, call lawyer Joe Miller, Esq., at 888-667-8295. or complete my online contact form to make an appointment. You can use complete our New Electronic Case Review. It’s a new way we’re offering workers to contact us remotely, particularly after business hours.

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