When you hear of workers’ comp injuries, you can easily construe they are related to high-risk jobs like construction. The truth is these injuries can occur in any workplace, although some occupations have an elevated risk of workers' compensation injuries than others. One prevalent injury in almost all professions is an orthopedic injury which includes issues like fractured bones, joints, tendons, or ligaments.

Orthopedic work injuries occur more quickly than you think. They could be caused by long hours behind a computer monitor, repetitive and powerful motion around the shoulder or neck, and sometimes prolonged pressure on the wrist. The injuries affect your musculoskeletal system hampering your mobility and capacity to perform routines.

Fortunately, the workers’ compensation insurance coverage protects employees who suffer orthopedic work-related harm by offering payment for the expenses arising from the injury. When you or a loved one sustains these injuries and can prove they are work-related, you must immediately speak to The Workers Compensation Lawyer Law Firm for legal representation. We believe workers' compensation is your constitutional right and are willing to help you understand the process and the evidence you need for maximum benefits.

Understanding Workers’ Comp Claims

Workplaces pose a massive risk of injuries to employees. The harm can stem from slips and falls, repetitive motion, or chemical exposure. The government recognizes the risk of work-related injuries, which explains why they have enacted laws to safeguard you and other workers when you incur heavy losses due to on-the-job injury or illness. The insurance coverage is in place to repay you when an injury costs you a lot in medical treatment and prevents you from going to work.

The law requires every employer to buy an insurance plan to indemnify workers when they develop an illness or obtain on-the-job injuries. Many employers contribute to this fund, creating a pool of money where employees can claim reimbursement. The type of workers’ compensation your boss holds varies depending on:

  • Workplace risks
  • Injury nature and treatment costs workers incur
  • Injuries or diseases not protected by the insurance policy
  • Type and number of workers covered under the policy
  • The period provided for filing a claim

The money pool created by the workers’ insurance coverage ensures prompt and efficient monetary aid to injured workers. Once you file a claim, you relinquish your right to sue the employer for negligence.

Explanation of Work-Related Orthopedic Injuries

You will obtain coverage from your employer’s workers’ comp insurance policy for work-related injuries like orthopedic injuries. The injuries refer to any damage to the musculoskeletal system like the joints, tendons, ligaments, and surrounding tissues. The injuries stem from:

  • Repetitive, forceful, and prolonged motion
  • The impact of a slip and fall
  • Being hit by objects or machinery
  • Car accidents
  • Failing from a ladder

When these injuries occur, they can result in death and sometimes partial or permanent disability. Besides, the injuries affect all workers in a workplace, from the junior staff to the management.

It is critical for you as a worker to understand the various types of work-related injuries and whether you are a casualty. Understanding these injuries will allow you to file a claim promptly and know whether your employer covers these workplace injuries. Your employer’s insurance plan can sometimes fail to offer coverage for these injuries because they are widespread. With this knowledge, you can take the necessary steps to protect your interests by hiring a workers’ comp lawyer for legal guidance.

Types of Workplace Orthopedic Injuries

As indicated earlier, there are multiple causes of workplace orthopedic injuries. The common types of orthopedic injuries are:

     1. Repetitive Stress Injuries (RSI)

RSI develops when you outperform your body’s capacity to repair broken muscle soft tissues. You obtain the injuries after repetitive motions over an extended duration without breaking all the body to repair the worn-out muscle tissues. The risk of developing RSI is elevated if you have a poor posture, handle vibrating machinery, or work in a cold environment. Examples of RSI are:

  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
  • Tendonitis
  • Trigger finger
  • De Quervain syndrome

When you suffer RSI and can prove they are work-related, you are eligible for workers’ comp benefits to help you pay for treatment and recover missed wages for the duration you have been away from work. Although you are eligible for these benefits, your efforts to seek reimbursement can be challenged if your employer or insurer believes you did not develop the injuries at the workplace but elsewhere.

For instance, you file a workers’ comp claim after developing cubital tunnel syndrome, which stems from continued pressure or stretching of the ulnar nerve. The condition stems from repetitive motions in clerical work or any other task involving constant movement of the arms like gaming. Therefore, this creates room for your employer’s insurer to argue that the injuries did not occur at work. Instead, they were caused by another task performed away from work and not for the employer's benefit. Policy carriers use this and other arguments to deny your claim. Luckily, even if you are denied a genuine claim, you still have a chance to obtain the necessary benefits by contacting The Workers Compensation Lawyer Law Firm in Los Angeles. A lawyer will take the measures needed to have the case reviewed to receive the payment you deserve.

     2. Neck and Shoulder Injuries

If you are used to hauling heavy weights in a storeroom, you stress the shoulder muscles and the tissues surrounding the neck causing cartilage damage and dislocation. The injuries worsen when left untreated, leading to swelling and nerve injury.

Warehouse workers are not the only individuals susceptible to these injuries. Habits like poor posture or neck craning can injure your neck and shoulders.

     3. Back Injuries

Back injuries or pain is another common form of workplace orthopedic injury. The injuries occur due to over-activity. You will develop back hurts when you are involved in a workplace accident, have a poor sitting posture, or frequently bend.

     4. Knee Injuries

Your knees are susceptible to orthopedic injuries if you are used to bending or heavy lifting. Further, you could develop knee pain after a sprain stemming from an accident.

If you are a worker suffering from the above injuries and others like wrist and arm pain that affect the performance of your daily activities, you are entitled to workers’ comp benefits from your boss. The number of damages to be awarded depends on the severity of the harm and your legal representation.

Reasons for Filing a Workers’ Compensation Claim

Workers’ compensation coverage is a legal right. You can file a claim and obtain benefits, notwithstanding your location and work. Nonetheless, the type of claim will vary depending on your profession, business size, and location.

It is crucial, primarily when you have sustained workplace orthopedic injuries, to obtain compensation, considering the devastating effects of some of the harm, like muscle injuries. The reasons you should seek reimbursement for your on-the-job injuries are:

The Compensation Covers Your Treatment Costs

One of the crucial benefits of obtaining reimbursement is that it covers all the medical expenses linked to your orthopedic injuries. Whether you require an operation or therapy to reverse the condition, the workers’ comp plan provided by your employer should cater to these expenses. When your injuries require therapy or surgery, the cost of these procedures and aftercare is very high, making the treatment expensive to pay out-of-pocket.

However, when you file a claim and prove that your injuries are work-related, you will obtain the deserved reimbursement and pay for treatment without draining your accounts. A workers’ comp insurance plan is an excellent safety net for medical bills. Still, it can help you enjoy these benefits to the maximum, but you must act fast by filing a claim immediately after you learn of the workplace injuries. You will receive the insurance benefits on time, allowing you to focus on healing without having to worry about the hospital bill.

The Compensation Helps You Recover Lost Earnings

Another importance of workers’ comp is that you receive regular payments for the wages lost during the duration you were incapable of working. Some orthopedic injuries take time to heal, while others cause temporary or permanent disability. In any of these situations, you will be unable to return to work for a particular duration. The workers’ compensation policy replaces this lost income with regular payments to help cover your daily costs or restore your financial situation before the injuries. With lost income and medical expenses reimbursement, you can obtain the best medical care and remain financially stable, facilitating quicker recovery.

Workers’ Comp Benefits Equip You With Skills for a New Job

A severe orthopedic injury can hinder you from performing the roles you used to undertake at work before being injured. You will require retraining to obtain new skills for a different role or job position. The workers’ comp benefits will pay for your retraining so that even in your new position, you can be self-reliant without having to return to your previous post.

The Compensation is Not Awarded on a Fault Basis

Workers’ comp is not fault-based, meaning you do not need to prove the employer or another employee was at fault to obtain benefits. All you need is to demonstrate that the orthopedic injury stemmed from work or while performing an activity for the employer's use.

With the above benefits, you should consider talking to your employer to determine if they have a workers’ compensation plan after sustaining injuries. If they have one that covers orthopedic injuries, do not hesitate to make a claim. However, if there is none, talk to The Workers Compensation Lawyer Law Firm to find out the options you can explore.

Bring a Work-Related Orthopedic Injuries Claim

When you suffer an orthopedic injury in your workplace or as a result of work, you should understand that you can bring a claim. You should act fast after learning of the injuries and gather evidence to back the claim. Proving orthopedic injuries are work-related is not easy because you can sustain these injuries while performing other work-related activities. Even though you do not prove fault in these cases, evidence gathering is crucial.

The claim process starts with:

     1. Seeking the Necessary Medical Treatment 

When orthopedic injuries are left untreated, they can be life-threatening. Therefore, you should go for a medical checkup whenever you notice these injuries. Orthopedic injuries gradually grow over time, making it challenging to identify and seek treatment. If it is a work-related accident or emergency that has caused the injuries, seek treatment right away.

     2. Bring a Claim Against Your Employer

Immediately you learn of your work-related orthopedic injuries, inform your boss. It is critical to do this before even going for medical treatment unless it is a medical emergency. Telling your employer is crucial because they will refer you to a medical practitioner recognized by the workers’ insurance plan. Failure to inform your employer of the injuries within 30 days will deny you the right to seek payment.

A day after you have notified your employer and sought medical treatment, they will provide you with the Division of Workers Compensation (DWC) 1 form. The form has two sections, one for you and the other for the boss. You should fill out these forms and return them to the boss within twelve months. However, before completing the documents, the employer should explain your rights, eligibility, and how to proceed.

When filling out your section, ensure you observe all the instructions provided and capture all the types of orthopedic injuries you have sustained in your work and the affected body parts. Once you have filled out the forms, you should deliver them to the boss in person to fill out their section. If serving the documents directly to the boss is impossible, you should consider certified mail to be assured they have received it. After the employer has received the forms, they will complete their section and submit it to the insurance company. Besides, you will receive a copy of the form submitted to the insurer.

Once the insurer receives your claim, they will authorize payment of your medical bills to continue receiving treatment as they conduct further investigations into the matter. Before responding, they should cover no more than $10,000 of your medical expenses. Also, your claim has been approved if you do not receive a denial response within ninety days.

     3. Receiving Workers’ Comp Benefits

When the insurance company approves your claim, they will pay for all medical costs associated with your orthopedic injuries. The payment can only be made to a doctor within the network, so it is always wise to visit the physician your employer recommends.

Similarly, you will be eligible for temporary disability payment, which often covers the lost wages for the duration you will be away from work. The reimbursement is usually 2/3rds of your weekly or monthly salary. For a monthly stipend, the payment comes in a biweekly system. You start receiving these benefits 14 days after filing the claim.

Also, when orthopedic injuries permanently prevent you from working, you are entitled to permanent disability benefits, which provide future wages.

Your descendants are entitled to reimbursement when death strikes due to orthopedic injuries. The statute of limitations for these claims is twelve months. The payment amount depends on the severity of the injuries and the cause of death.

It is crucial to understand that if you paid for medical treatment out-of-pocket before receiving benefits, the insurer would reimburse the money. Also, regular evaluations will be conducted to establish the progress made in treatment. The funds received will be adjusted depending on the orthopedic treatment progress, and the time it will take before you return to work.

     4. Hire a Competent Lawyer

For a successful workers’ comp claim, you must gather all the evidence necessary to prove the orthopedic injuries occurred at the workplace or while performing duties for the employer's benefit, even if it is outside of the workstation. Further, you need contact info of those who witnessed the accident leading to the injuries, pictures of the injuries, and a medical report by the doctor who attended to your injuries.

Most of the time, the injuries will hinder you from conducting investigations and filing a claim within the provided timeline. When you hire a workers’ comp lawyer, they will investigate the matter, gather evidence, and file a claim. A lawyer will allow you to focus on recovery as they handle lengthy and complex claims. And even if the claim is denied, the legal representative will be there to file an appeal.

Eligible Candidates

Your orthopedic injury workers’ comp claim is critical, but you must know that not everybody is entitled to the coverage. Working status, line of work, and nature of the injury, whether job-related or not, determine your eligibility. You are eligible for the benefits if you are a worker in an entity eligible for workers’ comp. Independent contractors like freelance workers, seasonal employees, and consultants are ineligible for these benefits and can only seek reimbursement for work-related orthopedic injuries through arbitration.

Furthermore, domestic, undocumented, and agricultural employees are not entitled to workers’ comp.

Similarly, you are eligible for workers’ comp benefits if the injuries stem from your line of work. You must prove the relationship between orthopedic injuries and work.

Claim Denial

It is not automatic that your claim will be approved. You need to work closely with a workers’ comp lawyer to improve your chances of payment. The consequences will be devastating when you suffer an on-the-job orthopedic injury, and the insurance company denies your claim. You will be forced to turn to your health care insurance, and if you do not have one, you will pay out of pocket, which is financially draining, considering you are incurring lost earnings for missing work.

Additionally, orthopedic injuries affect your musculoskeletal system and thus take longer to heal than other illnesses. Again, the injuries hinder your movement and performance of routines, making life unbearable. The reasons these claims are denied include:

  • Insufficient evidence to demonstrate the injuries stem from work
  • Proof that the injuries are not work-related
  • Making a late claim
  • Insufficient medical evidence
  • The injuries are minor and do not hinder your capacity to resume or continue work

If you feel your claim has been unjustly denied, you can file an appeal with the Workers’ Comp Appeal Board (WCAB).

Appealing a Denied Claim

Considering the financial consequences of a denied claim, you should appeal the decision to the California workers’ comp board within thirty days of the denial. An appeal is not easy because you must find legal grounds for one. At The Workers Compensation Lawyer Law Firm, we are ready to help you with the decision. Our lawyers will send your employer and the insurance firm a copy of the appeal.

Partnering with a lawyer is advantageous because they will gather the necessary evidence, medical reports, and other facts that will help strengthen your application.

Once you have submitted your appeal to the board, they will arrange a hearing in an informal trial, where an administrative judge will review the case, evaluate your evidence, and give a verdict. You, the applicant, and your employer’s insurer will have the chance to provide the side of your story, after which the judge will issue a verdict.

Insurers have genuine reasons for denying claims, but some companies make it a norm which is why you need an appeal. When granted, you will receive the compensation you seek. Nevertheless, you can further appeal the denial to the district court when denied. You should increase the chances of the appeal being granted by hiring an experienced lawyer to guide you through the workers’ comp system.

Find an Experienced Workers’ Comp Lawyer Near Me

Orthopedic work injuries are severe because they deny you happiness when you cannot perform daily activities. As a result, when you sustain these injuries, you have a solid basis for filing a workers’ comp claim to seek benefits. Having an experienced lawyer for the process is critical because they will support you gather evidence and claiming compensation. At The Workers Compensation Lawyer Law Firm, we are ready to help with your claim today in Los Angeles, CA. Call us at 424-501-9228 to discuss your case.