Visitor Question

Compensation for Torn Bicep and Rotator Cuff?

Submitted By: Anonymous (Quincy, WA)

There was a 10″ pvc pipe at work that was plugged, and we needed to unplug it to run. I am a lead mechanic in charge of 4 other process mechanics, two of which were with me. I grabbed the pipe to move it and had no idea how heavy it was. When I tried to pull it over, so that we could clean it, I tore a bicep tendon, not in my dominant arm.

I went to the doctor twelve days later. They referred me to orthopedics 6 days later and they said “we do not do surgery on this unless you are a major league pitcher” and I had minor restrictions for two weeks. The accident happened at the end of August 19, appointment 1 was on the 31st, the second was on the 6th of September.

I mentioned something in the shoulder on the outside at the time but the doctor said that it did not affect my strength and should go away soon. In December I received a letter of closure, but I was still having some issues, so I went to Orthopedics again January 13th. After an x-ray and MRI were done, a 4th app. was made and the results showed a torn rotator cuff.

They gave me cortisone in the shoulder, another app. to occupational health, one to orthopedics, and L&I was approved 3 or so weeks later. Surgery was scheduled, and after another app. for pre-operation preparation, the operation took place on April 10th. I am now recovering.

I hope for complete healing but they did not work on the bicep. I like my job and the company I work for. So far the healing is good and I look forward to returning to work. They have offered 65% of my pay while I am off. Here are the questions:

When should I close my claim? Should there be a settlement for the bicep, and if so how much? Any other information that’s pertinent or reasonable I would love. One other thing, the company I work for is self insured through a 2nd party.

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Anonymous,

Workers in the State of Washington injured on the job are covered by the Washington State Insurance Fund. The fund is administered by the Washington State Department of Labor and Industries (L&I). However, there are also several hundred companies in the State of Washington, including your employer, who are self-insured. The Department of Labor & Industries publishes a guide for workers employed by self-insured businesses. This guide summarizes what happens when you file a claim, and how you can help make the process work smoothly for you.

It appears your surgery was successful and your rotator cuff was repaired without permanent injury to your shoulder. When an injury is not permanent, worker’s comp will pay for necessary medical treatment, reasonable out of pocket items (such as medication, crutches, slings, costs of travel to and from treatment, etc.), and a portion of the worker’s lost wages. That is usually the extent of coverage.

In your case, you may not have an option as to when to close your existing claim.  In Washington State, the worker’s compensation insurance company, whether it be the Department of Labor & Industries (L&I), or a private insurer, will close an injury claim when it is determined the injury has been effectively  treated and the worker is able to return to work.  

If you don’t agree with the decision to close your claim you have the right to request a second medical opinion. If objective medical evidence shows your injury has worsened and requires additional health-care attention, your claim may be reopened. This can apply to an exacerbation of your recent shoulder injury or to the tear in your bicep.

If you are applying for medical coverage only, you may make this request at any time. In most cases, the workers comp insurer will make a decision within 90 days. However, if you also wish to apply to reopen your claim for time-loss compensation or permanent partial disability benefits, you must make your request within seven (7) years of the date your claim was first closed.

For more information about your rights and obligations under Washington State’s Workers Compensation Laws read this guide:
 “Workers’ Compensation Benefits – A Guide for Injured Workers.”

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney. Find a local attorney to give you a free case review here , or call (888) 647-2490.

Best of luck,

Published: October 19, 2017

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