Learn how workers’ compensation shoulder injury settlements are calculated. We give average settlement amounts and discuss example calculations.
No matter what kind of work you do, you’re at risk of injuring your shoulder on the job.
Most injured workers’ claims fall under their state’s workers’ compensation laws. Depending on the facts of your injury, your prognosis, and your job, the compensation you can get for a shoulder injury at work will vary.
This article will look at common kinds of shoulder injuries in the workplace. We’ll also estimate different workers’ comp shoulder injury settlements. Finally, we’ll go over factors that can limit your settlement compensation.
Average Workers’ Comp Shoulder Injury Settlements
Injuries that can be treated without surgery are going to settle for less — between $10,000 and $20,000. Partial disability injuries that need surgery, but don’t prevent you from working, see a significant jump in value — $30,000 to $60,000.
The injuries that cause full disability for any length of time, in addition to requiring surgery, are going to command the highest values. Those settlements can easily go over $50,000 and may even reach six figures.
Those who work in factories and warehouses can easily injure their shoulders. Lifting heavy objects and twisting commonly cause injuries. Constant movement and shifting weight can put a heavy strain on your shoulders.
However they happen, accidents that impact the shoulder can cause many different injuries. Some common types of shoulder injuries are discussed below, along with examples of potential workers’ compensation settlements for each type of injury.
Shoulder Impingement Injuries
Shoulder impingement is a very common cause of shoulder pain, particularly in middle-aged adults and seniors. Unlike rotator cuff injuries, which involve tearing of tendons and/or muscles, impingement happens when the bones of your shoulder rub against the tendons or against the bursa (fluid-filled sacs designed to reduce friction) in your shoulder.
Age-related degeneration can combine with a slip and fall or other impact to create radiating pain and an inability to use your shoulder for even simple physical tasks, like putting on clothes. Treatment for impingement is usually nonsurgical, consisting of steroid shots and physical therapy.
If your doctor believes that surgery is warranted, they need to explain to the workers’ compensation insurance company why your impingement needs such an extraordinary remedy. (This is especially so considering the demonstrated relationship between impingement and the aging process.)
Depending on whether the injury is repaired with arthroscopic surgery or open revision, the cost of operating is between $8,000 and $18,000. Full recovery usually takes about six months.
Example: Shoulder Impingement Settlement
Dorothy is a middle-aged administrative assistant at a high-end commercial litigation law firm. She makes $25 per hour. When she is in the office kitchen making lunch for herself, another co-worker spills some water on the floor. Dorothy steps backward, slips and lands on her shoulder.
After getting an X-ray in the hospital, Dorothy learns that she didn’t break any bones or tear her rotator cuff. She does, however, have radiating pain in her shoulder that refuses to go away. After some more investigation, the doctor determines that the impact of her fall, combined with her age, has caused her shoulder to rub against the bursa and tendons.
Dorothy misses six weeks of work while her shoulder pain gets to a manageable level. Her doctor determines that she does not need surgery. After a month of physical therapy, Dorothy achieves full recovery with four cortisone shots in her shoulder per year.
In cases where the injury victim is prevented from working, workers’ comp wage benefits are typically two-thirds of average pre-injury income. Therefore, we’ll multiply Dorothy’s wages by 0.67 to get her estimated wage benefit.
Past medical bills (hospital, doctors and X-ray): $3,000
Lost wages benefit ($1,000/week x 6 weeks x 0.67): $4,000
Cortisone shots (4 per year for 40 years at $100 each): $16,000
Physical therapy (2 times/week for 4 weeks): $1,600
Estimated Workers’ Comp Settlement Value: $24,600
Work-Related Rotator Cuff Tears
Workers who lift a lot of heavy items over the course of a day are at special risk of torn rotator cuffs. (Older workers in general are also more susceptible to this injury.) In simple terms, your rotator cuff is a series of four muscles in your shoulder that hold your arm in place.
Impact or a combination of age and repetitive stress can strain or tear the tendons attaching these muscles to the bones. These tears can be classified as partial or full thickness, with full thickness meaning that there’s a hole in the tendon or it’s completely separated from the bone.
Rotator cuff injuries can cause severe, chronic pain. This pain can be especially debilitating when you’re trying to sleep. Rotator cuff injuries can also restrict your range of motion or cause significant weakness, making certain physical jobs difficult or impossible.
If you have a rotator cuff tear, continuing to work through the pain will likely make it worse. Though roughly 75% of cases will not need shoulder surgery, it’s important that you work closely with your doctor to present your case to the workers’ comp insurer quickly and thoroughly. This helps ensure you can treat the condition properly before it worsens.
The importance of speed in treating injuries is well documented. In one study, the costs of treatment, as well as recovery time, were directly linked to how quickly the patient was referred to a specialist.
When a quick referral happened, the cost for rotator cuff surgery and related care was around $25,000, and they returned to work in about 7 months. When they weren’t referred to a specialist quickly and had to go through a gatekeeper, the cost was over $100,000 and the recovery time was 18 months.
Example: Torn Rotator Cuff Settlement
Jeff works nights at a warehouse for an internet company. He makes an average warehouse worker’s salary of $15 per hour. One night, he tries to lift a large piece of merchandise from the floor to a shelf 3 feet off the ground. He immediately feels tearing and intense pain in his shoulder.
Jeff’s co-workers rush him to the hospital, where he is treated with painkillers and receives a shoulder X-ray, which shows a full-thickness tear in one of the tendons in his shoulder.
His primary care doctor and a specialist both agree that the best course of medical treatment is surgery. This particular surgery will cost $30,000 and keep him completely out of work for eight weeks, with physical therapy three times per week. Even after that, he won’t be completely recovered until at least eight months after the surgery.
Workers’ comp wage benefits are typically two-thirds of average pre-injury income when the victim has to stop working. We’ll multiply Jeff’s wages by 0.67 in order to get his estimated wage benefit.
Past medical bills (hospital, doctors and X-ray): $5,000
Lost wages benefit ($563/week x 6 weeks x 0.67): $3,018
Physical therapy (3 times/week for 8 weeks): $4,800
Estimated Workers’ Comp Settlement Value: $42,818
Fractured Shoulder Bones
Many workplace accidents, especially motor vehicle accidents and high-impact industrial accidents, involve broken bones.
Fractures of the clavicle (collarbone), humerus (upper arm bone), and scapula (shoulder blade) can do more than prevent you from doing certain tasks. They can put you out of work altogether for a significant time.
Though simple fractures can be treated without surgery, complex or open fractures can result in serious tissue damage and will likely need surgery, which can cost between $15,000 and $20,000. Along with surgery comes the other medical costs and lost time at work. Recovery time after surgery can take three to six months.
Example: Broken Shoulder Settlement
Oliver works as a bicycle messenger for a company in New York City. His job pays $20 per hour, slightly better than average. On his way to a delivery, he is broadsided by an out-of-control taxi and is thrown from his bike. He collides violently with another car and breaks his shoulder.
Oliver is rushed to the hospital, where he has to stay for a week while he recovers from his injuries. His medical expenses pile up quickly. Oliver’s shoulder was shattered by the impact and he needs shoulder replacement surgery.
Oliver won’t be able to work with a broken shoulder. He’ll have a temporary total disability for four months after the surgery. We’ll multiply Oliver’s wages by 0.67 to get his estimated wage benefit to comply with workers’ comp norms. He’ll also need physical therapy four times per week for all four months.
Past medical bills (one-week hospital stay, doctors and X-ray): $23,000
Lost wages benefit ($800/week x 13 weeks x 0.67): $6,968
Physical therapy (4 times/week for 16 weeks): $12,800
Estimated Workers’ Comp Settlement Value: $62,768
Factors Limiting Workers’ Comp Settlements
Workers’ compensation benefits do not cover the full amount of an injured employee’s wages. Wage replacement disability benefits typically cover about two-thirds of the injured worker’s average weekly wage.
You won’t be able to get any compensation for pain and suffering in a workers’ compensation shoulder injury settlement. However, in limited circumstances you may have the right to sue your employer for a work injury. In a personal injury lawsuit, you can seek compensation for all your damages, including pain and suffering as well as your full wages.
Workers’ Comp Settlements and Medical Benefits
Workers’ compensation insurance will cover reasonable and necessary medical expenses. Your doctor must document the need for surgery, and justify the amount of time you are excused from work. Depending on your state’s workers’ compensation laws, the insurance company might not pay for chiropractic care or “alternate” treatments, even if they make you feel better.
If you’re thinking about settling your workers’ compensation case for a lump sum, it’s important to anticipate future medical expenses and include those expenses in the final settlement amount.
Most insurance companies will ask you to waive your right to any future medical care as part of the settlement. If you waive medical benefits, you can’t go back to workers’ comp for more money if you develop medical complications later in life.
Disability Wage Settlement Schedules
Your work injury may have left you with a permanent partial disability (most common) or a permanent total disability. Federal and most states’ workers’ compensation programs use a loss-of-use schedule of injuries to calculate permanent disability settlements. The schedule allocates a specific number of wage benefit weeks for each body part or function.
A scheduled settlement award can be requested after you’ve reached maximum medical improvement (MMI). In other words, your doctor says your shoulder injury won’t get any better with treatment. Your doctor will determine an impairment rating to express the percentage of your disability.
For example, based on New York State’s Loss of Use Schedule, the maximum award for a shoulder (arm) injury is 312 weeks. The settlement is calculated by using the worker’s weekly wage benefit and the impairment rating. If you have a 50% impairment rating, you would get 156 weeks of wage benefits. Let’s say your workers’ comp weekly wage benefit is $500. Your wage settlement would be 156 x $500 = $78,000.
Getting Back on Track and Back to Work
The pain and disability resulting from a shoulder injury can be life-changing. Even though you can’t ask for pain and suffering from the worker’s comp claim process, you can still make sure your costs are paid. You can also get a good portion of your lost wages. However, your time to negotiate a workers’ comp settlement is limited.
If you or a loved one has suffered a work-related accident resulting in a shoulder injury, you need to act soon. State law imposes strict deadlines for workers’ compensation claims.
Contact a qualified workers’ compensation lawyer in your state today for a free consultation and evaluation of your workers’ comp shoulder injury case.
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