TYPE OF CASE: Workers’ Compensation
FACTS: Our client was a 69-year-old man who injured his right shoulder at work. He sought immediate medical attention and the work comp insurer accepted his claim and began paying medical and wage loss benefits. He was right-handed and had no history of any prior right shoulder injuries or medical treatment. Up until the time of the work injury, he did not have any restrictions or limitations on his right shoulder and was able to perform all of his job duties and all of his daily and recreational activities without any pain or right shoulder difficulties.
Unfortunately, his shoulder problems did not improve with physical therapy or injections and he was eventually referred to an orthopaedic surgeon. The surgeon diagnosed a torn rotator cuff but also found that our client had severe arthritis and that the only real treatment option was a total shoulder replacement. Our client then saw another surgeon for a second opinion and received the same diagnosis and recommendation–total shoulder replacement surgery.
SURGERY DENIED: The work comp insurance company scheduled our client for an “independent” medical examination, also referred to as an IME (check out this previous post for more information on a workers’ compensation IME). As expected, the IME doctor’s opinion was that our client had pre-existing arthritis in his shoulder and the work injury was only a temporary aggravation which had healed after only a few months. Based on the IME report, the insurance company denied our request for the shoulder replacement surgery. We then filed a Medical Request and the matter was scheduled for a trial before a workers’ compensation judge.
We obtained a medical report from our client’s surgeon explaining that the employee’s pre-existing shoulder arthritis was asymptomatic before the work injury. In other words, it was not causing him any pain or requiring any medical care until the work injury. The work injury then aggravated and accelerated the underlying arthritis to the point where it became painful, caused our client’s disability and required surgery.
JUDGE’S DECISION: The compensation judge found our client to be a good, credible witness and also accepted the opinion of our doctor. As a result, the judge ruled in our favor and ordered the work comp insurance company to pay for the employee’s total shoulder replacement surgery. The insurance company was also required to pay our attorney fees and to reimburse our firm for the costs of obtaining medical records and reports. There was no cost or risk to our client for taking this dispute to trial.
QUESTIONS ABOUT YOUR WORK COMP CLAIM?
If you have questions about any aspect of your northern Minnesota work comp claim, please feel free to contact me at any time at Bradt Law Offices. I am happy to speak with you about your claim over the phone or to make an appointment for a free consultation in our Grand Rapids office or wherever it would be convenient for you. We have been representing your friends and neighbors in their work comp claims all across northeastern Minnesota and the Iron Range for more than 38 years. If you’ve been injured, we can help.
Thank you for visiting our blog.
