Case Example: Dispute Over Workers’ Comp Disability Rating and Benefits

Work injuries can happen suddenly or develop over time. Follow one woman’s fight over her workers’ comp disability rating and benefits.

Not all work injuries are caused by a single event.

Many types of workers, including office workers, grocery clerks, and factory line employees develop repetitive motion injuries to the muscles and tendons in their hand, wrist, and arm.

In this case, an administrative assistant develops carpal tunnel syndrome from years of typing on the job.

This case study is for educational purposes only. It is based on actual events, although names have been changed to protect those involved. Any resemblance to real persons or entities is purely coincidental.

We’ll cover how our victim was injured, her eligibility for workers’ compensation benefits, and the final resolution to the injured worker’s case.

Our case example finishes up with a list of important points about how claims work and the different types of workers’ compensation benefits.

How the Workplace Injury Developed

Wilma Roget was a 27-year-old single mother of four.  After completing secretarial school, Roget was hired as a receptionist at Talmage and Associates. Her duties included answering multi-line telephones, mail sorting, appointment monitoring, and some light typing.

She began her job in excellent health with no significant physical impairments. Roget worked for the busy corporate office as a receptionist for two years before being promoted to a secretary position. After about another year, Roget was promoted again, this time to the position of administrative assistant.

About a year into her position as an administrative assistant, Roget began to experience intermittent discomfort in her right wrist. At first, she thought little of it. When the pain became impossible to ignore, Roget would take short breaks.

As the weeks passed, Roget’s intermittent discomfort in her wrist gave way to acute discomfort and pain. Although the breaks she took helped somewhat, her discomfort and pain seemed to persist for most of her working day.

Roget notified the office manager that she could not continue to type the same volume of correspondence and reports she had been for the last year or so.

She explained how her once intermittent discomfort had given way to acute pain. Roget told the manager she was unable to work for more than three hours a day. Even that amount of time, Roget said, produced severe discomfort and pain.

The manager, sympathetic to Roget’s plight, referred her to the company’s workers’ compensation benefits advisor. The advisor, in turn, sent Roget to one of the insurance carrier’s approved orthopedic surgeons.

The orthopedic surgeon ordered an MRI of Roget’s right wrist. The MRI showed the fibrous tissue surrounding Roget’s wrist’s median nerve was swollen. It was clear on the MRI that Roget’s claims of discomfort and pain were credible. The orthopedic surgeon diagnosed Roget’s condition as carpal tunnel syndrome.

Carpal Tunnel Syndrome is caused by the tissue surrounding the wrist becoming inflamed. This inflammation causes the tissue to press down on the nerves running through the wrist, which causes the subject to feel pain in their fingers and hand. The syndrome can be caused by a person making repetitive motions with their hands, especially typing.

Light Duty Work for Lower Pay

The doctor’s carpal tunnel diagnosis and prognosis were communicated to the workers’ compensation insurance adjuster. The doctor estimated Roget’s disability at 12 percent and recommended Roget be assigned, at least for the time being, to light-duty, which did not include typing.

The adjuster notified the company, and shortly after that, Roget was transferred to the filing clerks’ pool. With the transfer to the filing pool came a reduction in Roget’s pay. Workers’ compensation insurance covered two-thirds of the difference in her wages.

Roget complained to management that she believed the insurance company’s handling of her workers’ compensation claim was unfair. She said it was demeaning to be demoted to a file clerk position, especially after all the years she loyally served the company.

Roget also told the law firm she couldn’t survive on the reduced pay, even with the additional disability pay she was now receiving.

The manager and HR specialist told Roget business was slower than usual, and only because of her many years of loyalty to the company were they keeping her on as a filing clerk. They told Roget they had no influence over the insurance company’s workers’ compensation decisions.

Appeal and Final Resolution

Roget hired a personal injury attorney to fight the insurance company. On her behalf, the attorney served notice to the workers’ compensation insurance company and her employer that she was appealing the workers’ compensation disability rating of only 12 percent. She asked for the authority to see another of the insurance company’s approved orthopedic surgeons.

When she went to see the newest orthopedic surgeon, the surgeon first examined the results from the MRI taken only two months before. At her request, the doctor ordered another MRI. The latest MRI confirmed the first surgeon’s diagnosis of Carpal Tunnel Syndrome.

After an extensive examination and review of the latest MRI, the new orthopedic surgeon classified Roget’s disability at 22 percent. Although better than 12 percent, Roget still argued that her permanent partial disability was a minimum of 80 percent.

Frustrated, Roget sought out her own orthopedic surgeon. She paid for the surgeon from her pocket. Determined to prove her disability was much greater than the 22 percent, she requested the doctor to order a CT scan as well.

Unfortunately for Roget’s appeal, the CT scan offered no new evidence of disease or injury to the muscles, tendons, or fibrous tissue in her right wrist or forearm. Her orthopedic surgeon was only able to increase Roget’s disability rating to 25 percent.

The state workers’ compensation commission heard her appeal. After reviewing the three surgeons’ medical evidence, the commission increased Roget’s disability rating to 25 percent. They would go no higher.

Roget chose to accept a lump-sum settlement of $18,000 for her 25 percent permanent partial disability. She began job hunting in earnest for a job that required little typing. Within three months, she was hired for a position more to her liking and resigned from Talmage and Associates.

Important Points About Workers’ Comp

  • Most employers are required by state law to have workers’ compensation insurance for their employees.
  • Workers’ compensation pays medical and treatment bills for the work-related injury or illness, and a portion of the injured worker’s lost wages.
  • If the doctor releases you for light-duty work, you must accept the position that meets your work restrictions, or risk losing your workers’ comp benefits.
  • You may need the support of an experienced attorney to handle disputes over wage calculations or permanent partial disability ratings.


Charles R. Gueli, Esq. is a personal injury attorney with over 20 years of legal experience. He’s admitted to the NY State Bar, and been named a Super Lawyer for the NY Metro area, an exclusive honor awarded to the top five percent of attorneys. Charles has worked extensively in the areas of auto accidents,... Read More >>