When you tear your rotator cuff at work, you are potentially looking at time away from work and the possibility of surgery. Workers’ Comp is supposed to take care of all of this, but knowing how to file and what to expect through that process is difficult without a lawyer on your side.
You should get immediate medical care and report your injury to your employer to start your claim process. Treatment in the first 90 days usually needs to be through a doctor your employer chose. If your claim is denied or your employer refuses to pay disability benefits, we can file a Claim Petition to start a formal claim through the state. Settlements might be available, depending on the specific facts of your case.
For help, call Cardamone Law’s Certified Pennsylvania Workers’ Compensation Lawyers at (267) 651-7945.
Requirements for a Workers’ Comp Claim
To file a Workers’ Compensation claim for a torn rotator cuff – or any other work-related injury – you have to meet the following requirements:
Employee Status
Workers’ Comp is only available for employees, not independent contractors. Most workers whose jobs are controlled by their supervisors and employers will qualify under this status.
Even if you are called a “contractor,” but your work is controlled closely, the “employee” status might be proper in the Workers’ Comp context, even if you are paid with a 1099.
Work-Related Injury
Workers’ Comp is only for injuries sustained in the course of your job. If your rotator cuff was torn outside of work in an acute accident, it might not qualify. However, work often contributes to injuries over time, and the wear and tear might be work-related even if you notice the injury outside of work.
To qualify as work-related, the injury has to either be caused by dangerous work conditions (e.g., in a slip and fall at work) or because of work tasks.
Disability
Injuries can only get wage-loss benefits if they result in over 7 days away from work. They do not have to be consecutive.
You get paid starting on the 8th day of disability, but you can get back pay for the first 7 days if your injury keeps you from working for at least 14 days. Benefits last as long as you cannot work, but they can be switched to partial disability status after 2 years, giving you 500 weeks max from that point on.
Getting Medical Care
In the first 90 days of treatment, you have to treat with doctors from your employer’s list of approved care providers. If you need surgery, you can choose a doctor for a second opinion, but the employer’s chosen doctor still performs the procedure.
Choosing Your Own Doctor
For any care after the first 90 days, you can pick your doctors.
Pre-Approval Rules
Pre-approval is not supposed to be needed. If your employer thinks your care is unreasonable, they can challenge it in a Utilization Review.
Can You Settle a Rotator Cuff Workers’ Comp Case?
Insurance companies can accept the claim and agree to settle your case up front, ending any need to continue to administer the case through them or treat with their doctors. This can be beneficial, but there are some things to be aware of.
You Cannot Reopen Settlements
If you settle your case in a “global settlement” and get all wage-loss and medical benefits paid in one settlement, you cannot go back to request additional funds later. There is only one chance to get it right, so you should always review your case with our Philadelphia Workers’ Comp lawyers to avoid settling for less than you need to cover your expenses.
“All But Medical” Settlements
In some cases, the amount of time you will lose at work is somewhat predictable, and the wage-loss benefits can be calculated and settled easily. However, the possible medical costs could be more than you expected if there are complications, if your injury heals slowly, or if you end up needing additional physical therapy.
In these cases, a settlement that closes out the other damages but leaves the claim open for additional medical care might be available. Whether this is appropriate for a torn rotator cuff is something you should talk to your lawyer about.
Structured Settlements vs. Lump Sums
Often, lump sum settlements make the most sense for a short-to-medium term injury like a torn rotator cuff. This can get you the money to pay for your medical bills, plus you can get the wage-loss benefits up front so you can pay for expenses at home.
In some cases, it might make more sense to get the settlement money over time in a structured settlement, so always work with a lawyer on how to structure your agreement.
Amount
The value of your case depends on many factors, such as what medical care you need, what your wages are, and how long it is expected for the injury to heal up.
Wage-loss benefits are usually 2/3 of your lost wages
- Wage-loss benefits are calculated as 2/3 of your pre-injury average weekly wage (AWW).
- They last as long as you cannot work at all.
- If you work to some extent, then you get 2/3 of the difference in pre- and post-injury AWW.
- There are caps at the statewide AWW and floors at the lesser of half the statewide AWW or 90% of your AWW.
All medical costs should be paid in full, and additional damages for specific loss (amputation, lost function, lost vision, lost hearing, and serious facial scarring) are also available at 2/3 of your AWW, subject to caps and floors. They last a certain number of weeks set by statute for each injury.
How to File a Formal Claim Through Workers’ Comp for a Rotator Cuff Injury
In cases where your employer doesn’t think the injury was work-related or where their benefits offered are wrong, you can file a claim through the state.
Filing
Claim Petitions are filed with the Department of Labor and Industry’s Office of Workers’ Comp Adjudication. They then assign the case to a Workers’ Comp Judge (WCJ) to hear the case. These cases do not go to “regular” judges in court.
Timeline
Your initial notice of injury needs to go to your employer within 21 days of the injury. If you miss that, you still must file within 120 days to keep yourself eligible for a claim.
After they deny your claim – which takes up to 21 days from your filing – you can file your Claim Petition. It must be filed within 3 years of the initial injury.
What’s Next?
From there, our lawyers will collect evidence and continue negotiating with the insurance company to try to reach a settlement. Contested cases can take over a year, but claims often settle before that.
In the meantime, you have to continue treating with your doctors and attending medical exams.
Call Our Pennsylvania Workers’ Comp Lawyers Today
For your free case evaluation, call Cardamone Law’s Montgomery County, PA Workers’ Comp lawyers at (267) 651-7945.
