One of the more important, and often overlooked, aspects of a workers compensation claim in Pennsylvania is the description of injury. More times than not, if you get hurt at work and your employer accepts your work injury, the description of your injury provided is nothing more than a ‘strain/sprain’ or ‘contusion’, whether it be to your neck, back, shoulder, etc. . . Often times, it is simply not accurate.
So why is that the description provided on the PA Department of Labor & Industry forms that you get? Could be a few reasons. First, many insurance carries only accept sprain/strains and contusions. Second, your actual injury may have just happened and the actual medical diagnosis is unclear. Third, it may actually be accurate.
More than likely, the first two reasons are applicable. Many insurance carriers do not accept anything outside those generalized descriptions. There is a reason for that. By accepting only generalized descriptions of injury like a strain/sprain, it provides the insurance carrier leeway in denying future medical treatment. For example, if you have an accepted left shoulder strain, but you recently had a left shoulder MRI that indicated a rotator cuff tear, the insurance carrier may deny surgery. They will deny surgery based on the fact that they only ever accepted a left shoulder strain/sprain, not a rotator cuff tear. Another frequent example is a head injury. Often times, the accepted injury for a head injury is a ‘head contusion’. That provides leeway for the insurance carrier to deny treatment for concussion and post concussion syndrome. They often do as well.
Secondly, when the insurance carrier accepts your work injury, they may have no or limited medical records. Initial treatment may very well indicate a strain/sprain until further treatment and evaluation can occur. However, if that more in depth diagnosis does come in, such as a tear or herniated disc, don’t expect the insurance carrier to just accept it and change the form. That likely will not happen. Again, it provides the insurance carrier a basis to deny medical treatment that can become quite expensive.
An accurate description of your work injury is extremely important to your case. It is one of the most litigated components of a workers compensation claim. That is precisely why you need an experienced workers compensation attorney on your case that understands the complexities of litigation and the medical components to your case. Believe me, your insurance carrier is legally represented. You should be too! When you suffer a work injury, you know you can Count on Mooney! Call us today to schedule a FREE consultation at 717-200-HELP or 1-877-632-4656. You can also visit us on the web at http:///www.mooney4law.com. We represent injures works throughout Central and South central Pennsylvania with 15 convenience offices.