Your shoulders play a part in nearly every work task. Everything from lifting and carrying to driving to typing requires your shoulders to be in good working order, and any shoulder injuries can result in time away from work and expensive medical needs.
A Workers’ Compensation claim can typically cover the medical care, surgeries, MRIs, and physical therapy needed to treat a work-related shoulder injury. It can also supply you with wage-loss benefits while you are unable to work. For help filing your claim, work with a lawyer.
For your free case review, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945 today.
How to File a Claim
There are important steps to take to file your claim and protect your rights as the claim progresses:
Get Medical Care
Get immediate medical care to treat your injuries after they happen. This will not only document the injuries and help you show they were work-related, but it is also a vital step of Workers’ Comp and helps prevent injuries from getting worse.
Call a Lawyer
Working with a Pennsylvania Workers’ Comp lawyer can help you avoid delays, denials, and problems dealing with the insurance carrier and your employer.
Report Injury
You must report a work injury within 21 days in most cases. However, you may still report up to 120 days out and get your claim granted, though these delays complicate matters and delay your benefits.
This is the process to start your initial claim; once you report your injury, your employer can make a decision within 21 days. If they deny you or fail to respond within 21 days, you can move on to a formal Claim Petition.
File Claim Petition
If your initial claim is denied, you can file a Claim Petition within 3 years of the injury. This puts the decision before a Workers’ Compensation Judge (WCJ), who can take evidence and decide your claim.
Attend All Exams
You must attend independent medical exams (IMEs) that your employer requests. Your employer chooses and pays the doctors used in an IME, and they gather information about your condition to write a report to use against you.
You must attend these appointments, but these doctors are separate from your treating physicians.
Workers’ Comp Hearings
You must attend a hearing if your case has not been settled. At the hearing, the WCJ accepts all evidence and testimony, then renders a decision in the days after the hearing.
Hearings may be one event or multiple days, depending on the case and the judge’s needs.
What You Need to Prove to Qualify for Workers’ Comp
Your case involves three essential elements:
Employee Status
Independent Contractors are not covered under Workers’ Comp, so you have to be an employee. However, this status is dictated by the facts on the ground, such as how much control your employer exerts over your job tasks and hours.
Employers often misclassify workers, especially “gig workers” and other part-time employees.
Work-Related Injury
The injury must be related to your work. This doesn’t necessarily mean it happened at a specific office or workplace, but one of these must be true:
- The injury happened because of work tasks within the scope of your job, such as straining your shoulder while lifting boxes.
- The injury happened because of conditions at your workplace, such as slippery floors that caused a fall that broke your collarbone.
Disabling Injury
Shoulder injuries must be disabling for at least 7 days to qualify for wage-loss benefits. You can get medical care even if the injury doesn’t last this long, but ongoing disability benefits are only available for these long-lasting injuries.
What Benefits Workers’ Compensation Covers for a Shoulder Injury
Workers’ Comp pays the following regardless of who caused the accident:
Medical Benefits
The costs of all medical care to treat the work injury should be covered. With things like a dislocated shoulder or torn rotator cuff, this might mean MRIs and potential surgery, plus physical therapy.
These costs are often expensive, even if the injury ends with you getting back to work quickly, so it is important to get them paid through Workers’ Comp.
Wage-Loss Benefits
If you miss enough work, you can qualify for ongoing wage-loss benefits. If you cannot work at all, these benefits are paid at 2/3 of your pre-injury average weekly wage (AWW). If you work to some extent, they are the difference in AWWs from before the injury and now.
Wage-loss benefits are capped at the statewide AWW, which is set by law each year. You also cannot get less than the lower of
- Half the statewide AWW or
- 90% of your pre-injury AWW.
Specific Loss Benefits
These are also paid at 2/3 of your pre-injury AWW, with a cap at the statewide AWW and a floor at half that. However, they last for a different number of weeks depending on the specific injury.
Specific loss benefits pay you for a permanent injury/loss, generally limited to amputations, total lost function, lost vision, lost hearing, and serious facial scars. If these happened alongside a shoulder injury or you lose all use of your shoulder, you can claim these additional benefits.
What Shoulder Injuries Are Covered?
All kinds of shoulder injuries should be covered under Workers’ Comp, including
- Dislocations
- Broken bones (e.g., collar bone)
- Rotator cuff injuries
- Tears
- Strains
- Sprains
- Nerve damage.
Wear and tear resulting in soreness, pain, discomfort, and even a need for a shoulder replacement should also be covered if the cause was work-related.
FAQs for Shoulder Injury Claims through Workers’ Comp in Pennsylvania
Do You Need a Lawyer?
You should always work with a lawyer; never try to handle your case on your own.
What is the Filing Deadline?
Injuries must be reported to your employer within 21 days (or up to 120 in some cases), and Claim Petitions must be filed within 3 years of the injury.
Lawsuits must be filed within 2 years of the injury in most cases.
How Severe Does Your Injury Need to Be to Qualify?
Any work-related injury can get medical care covered. For wage-loss benefits, your injury needs to be severe enough to reduce your wages or keep you out of work entirely for at least 7 days, but they do not need to be consecutive.
Call Our Workers’ Comp Lawyers in Pennsylvania Today
Contact Cardamone Law’s Philadelphia Workers’ Compensation lawyers at (267) 651-7945 for your free case review.
