Joint replacement surgeries as a result of a work-related injury are not all that uncommon, especially in older workers. Often times, when an injured worker is recommended for a knee replacement, a shoulder replacement, or a hip replacement, the workers’ compensation claim suddenly becomes a nightmare, with the insurance carrier denying further medical treatment, including the joint replacement surgery. Knee replacement, shoulder replacement, and hip replacements are by far the most common involving work-related injuries.
Over the years, I have represented numerous injured workers in which their case involved a total knee replacement. These type of cases are heavily litigated because of the expense of joint replacement surgery, associated wage loss, and likely permanent work restrictions to follow knee replacement surgery. Mooney Law has had tremendous success in handling knee replacement cases. We have won and settled many cases involving total knee replacements.
Recently, I negotiated a settlement for an injured worker in Chambersburg. He worked at a warehouse. He injured his knee at work and had surgery. Unfortunately, despite the surgery, his knee did not improve. That eventually led to a total knee replacement. His surgery was denied. We filed a petition and entered litigation. After several hearings and testimony from doctors, we reached a lump sum settlement that also included payment of medical bills for the total knee replacement and the establishment of a Medicare Set Aside agreement, which the employer also agreed to fund for future medical expenses.
In another matter, I recently represented another warehouse worker in Carlisle. He injured his knee at work when he twisted and felt intense knee pain. His workers compensation claim was denied. He ended up having surgery to repair a torn meniscus. The surgery was not successful. His doctor recommended a total knee replacement. We ended up fully litigating that case. After taking the medical deposition of the injured worker’s treating doctor at Penn State Hershey, the Workers Compensation Judge granted the claim petition and acknowledged the work-related injury as a knee strain/sprain and aggravation of pre-existing arthritis. The Judge also found the total knee replacement to be reasonable, necessary, and casually related to the work injury. This client is still on wage loss benefits today.
Many clients of ours have had to undergo shoulder replacement surgeries due to a work-related injury. Just like total knee replacement cases, these are heavily litigated due to the costs, future costs, and wage loss exposure.
I represent a client in Carlisle for two separate work injuries to his shoulder. In the first case, he injured his shoulder while he was loading a truck. He ended up having two separate shoulder surgeries that ended with a partial shoulder replacement. After fully litigating the case, we won the claim petition and my client was paid all back wage loss benefits owed to him, ongoing wage loss benefits, and payment of all medical bills. After a year of being on benefits, we settled his case for an additional lump sum settlement. He was released to return to work with no restrictions by his doctor.
A few years later, he injured the same shoulder with a new employer. He eventually underwent a total shoulder replacement. His claim was initially denied due to the prior work injury. Unable to settle the claim, we went to decision and won. The Judge found the work injury aggravated his prior condition. He was paid back wage loss benefits owed and all medical bills related to the total shoulder replacement. He is still collecting wage loss benefits today.
Again, as with any joint replacement cases, these cases are almost always denied as well. These injuries usually involve hip and back pain and sometimes can mask as just back pain.
A few years ago, I had a client from Hanover that worked as a maintenance manager for an apartment complex. He suffered a work related injury when he lifted a toilet and felt immediate pain in his low back and hip. His claim was denied and we filed a claim petition. Through treatment, it was determined that he suffered from avascular necrosis of the hip. That condition is a genetic condition that cannot be caused by a work injury. However, my client never had any hip or back pain prior to the work injury. We argued that his asymptomatic genetic condition was aggravated by the work-related injury. Through litigation we took medical testimony from the treating surgeon and the IME doctor. We won the claim and the Judge found the non work-related avascular necrosis of the hip was aggravated by the work injury, and therefore, the hip replacement surgery was also related to the work injury. It was a big win given the diagnosis. After being paid back wage loss benefits and medical expenses, my client was on wage loss benefits for another entire year before we reached a lump sum settlement.
Many work-related injuries that end up with joint replacement surgeries are involving older workers that also have involvement with osteoarthritis. Osteoarthritis is common in individuals over the age of 50. Often times, injured workers have no idea that they even have the arthritis, because they are not symptomatic. Yet, workers compensation insurance carriers frequently deny claims when they see the presence of arthritis in diagnostic tests.
The key here is to not get discouraged or let an insurance carrier bully you into thinking they do not need to pay for a joint replacement surgery or even accept your claim because of arthritis. Believe me, they try. Denials are issued for joint replacement surgeries because of the associated costs of the surgery and post-surgery rehabilitation, the potential of long term wage loss liability, and the fact that often times, injured workers are then given permanent light duty work restrictions due to joint replacement.
Mooney Law can help. If you have been injured at work and may be facing a joint replacement, you should speak to an experienced workers compensation attorney immediately. Mooney Law is trusted, experienced, and proven in representing injured worker throughout Pennsylvania. We also offer absolutely FREE consultations. Call Mooney Law today at 833-MOONEYLAW or 717-200-HELP.
Tags: Hip Replacement, Knee Replacement, Shoulder Replacement, Workers Compensation