Workers’ Comp for Shoulder Injury: Do You Qualify?
Do you need workers’ comp for a shoulder injury?
Shoulder injuries are among the most complicated types of injuries in the world of worker’s compensation. For a shoulder injury to qualify for coverage under a North Carolina worker’s compensation claim, it typically needs to be the result of a “specific injury by accident.”
There are thousands of pages of case law from the Industrial Commission and the North Carolina appellate courts addressing what types of workplace injuries qualify as specific injuries by accident. The rules can be quite arcane and don’t necessarily match up with what common sense would tell you to expect. And the rules are different for workers’ comp for shoulder injuries than they are for injuries to some other body parts, like workers’ comp for back injuries.
Different Rules for Workers’ Comp for Shoulder Injury
It is hard for folks to understand why an injury to one’s shoulder should have a different set of rules as opposed to an injury to one’s back or neck, but the rules are indeed very different. With a back injury, a person can qualify for workers’ compensation benefits if you can point to a specific moment in time when your back was hurt. In other words, a person who was lifting things on the job all day and gradually began experiencing back pain would typically not qualify for worker’s compensation benefits, but a person who suffered a sudden sharp pain to his back while lifting on the job would typically qualify for workers’ comp coverage.
Workers’ compensation for a shoulder injury is different.
An injured worker claiming workers’ comp for shoulder injury usually also has to meet this test of pointing to a specific moment in time when he or she suffered the shoulder injury. But there is an additional benchmark, where the Industrial Commission will usually ask the injured worker to also prove he or she was injured as a result of an “accident.”
An accident basically means something unusual and unexpected, but again, the definitions can be incredibly complex. A person who falls and injures his shoulder is usually considered to have suffered an accident, but if an insurance company alleges that the reason you fell was because you blacked out or passed out, then maybe that doesn’t qualify as an accident.
Similarly, a person who is carrying a box that falls, and tries to catch that box, resulting in a shoulder injury, would probably be considered to have been injured in an accident. But if the insurance company alleges that the box was not dropped, but rather the worker just hurt himself carrying the box, then they may succeed in proving the injury did not result from an accident.
Obstacles to a Workers’ Compensation Claim
To make things even more complex, adjusters will regularly hire second opinion doctors to review shoulder injury workers’ comp claims and try to determine if the “mechanism of injury” matches the findings on MRIs or other diagnostic tests. For example, a doctor might look at a labrum tear, and conclude that this could not have occurred in the way the injured worker claims because a labrum tear is usually from throwing something, rather than from trying to catch a falling box.
Adjusters may also try to take your recorded statement early on in a shoulder injury workers’ comp claim and ask you questions that can bar your right to recovery. They know the quirks in the law, and they may ask you questions in a way that leads you down the path they want you to go. “So nothing unusual was going on that day. You were just doing your job in the normal way you do it every day, right?” Well, if you answer that question the wrong way, you may have just given them grounds to deny your claim and say you didn’t suffer an “accident.”
One of the unfortunate themes here is that workers’ compensation insurance companies will often use various “tricks” to avoid paying workers’ comp claims. This can make claiming workers’ compensation for a shoulder injury extremely frustrating and difficult. An experienced North Carolina workers’ comp lawyer can help.
Potential Complications in Medical Treatment
Another issue with workers’ comp for shoulder injury claims is that shoulder surgeries are often not as successful as other surgeries. Any baseball fan knows that pitchers who injure their elbows and undergo “Tommy John” surgery regularly have excellent recoveries, but pitchers who have shoulder injuries often never recover enough to pitch well again.
Shoulders are just incredibly complicated joints, and doctors will even say that MRIs often miss things going on in there. It is not unusual for MRIs to appear clean, but for doctors to go in with a scope during surgery and find torn ligaments. Ask anyone who has had a “successful” shoulder surgery, and they will often tell you that they have never had a perfect recovery, and that they still have trouble doing certain specific things like lifting their arm above their head.
“I’ve suffered a shoulder injury at work. How do I claim workers’ compensation for a shoulder injury?”
For the reasons listed above and many more, we recommend that injured workers who have suffered a shoulder injury consult with an experienced workers’ comp attorney early on.
It can be exceedingly difficult to get the workers’ comp for shoulder injury that you need and deserve, and we would love to help however we can.
The workers’ comp team at Riddle & Brantley is led by attorneys Chris Brantley and Adam Smith, both Board-Certified Specialists in Workers’ Compensation. They have experienced handling shoulder injury workers’ comp claims and would be more than happy to consult with you about your legal options.
For a FREE consultation with a Board-Certified Specialist in Workers’ Compensation about your workers’ comp for shoulder injury claim, please call 1-800-525-7111 today.
“I would recommend Riddle & Brantley to anyone who needs help with … workers’ comp.”
–B. Fields, Riddle & Brantley client
There is no obligation and you won’t pay a dime in attorney fees unless we are successful and you get the workers’ comp benefits for your shoulder injury that you need and deserve.
Call 1-800-525-7111 or complete the fast and easy form below for a FREE consultation.
Justice Counts for those injured on the job. We’re ready to help however we can.