Getting Workers' Comp Benefits for a Shoulder Injury

Workplace shoulder injuries can be caused by anything from a slip-and-fall accident in an office to repetitive overhead motions like painting or hammering during a construction job.

Because a shoulder injury can make it difficult to reach, lift, carry objects, or even type, employees who sustain shoulder injuries are often unable to work for long periods of time. Severe shoulder injuries can require surgeries such as rotator cuff surgery or shoulder arthroscopy.

If you sustain a shoulder injury at work, workers' comp benefits can help you pay for your medical costs, lost wages, and medical or vocational rehabilitation.

Here's what you need to know to recover workers' comp benefits for a shoulder injury.

Does Your Injury Qualify for Workers' Comp?

To recover workers' comp benefits, you need to show that your shoulder injury is "work-related." An injury is work-related if it happened while you were performing your work duties—whether or not you were actually at the workplace.

For example, falling off a ladder at your worksite or lifting heavy boxes while offsite making deliveries to customers are both activities that can result in work-related shoulder injuries. On the other hand, if you drive to a restaurant with your colleagues during your lunch break and suffer a shoulder injury when your car is rear-ended, your injury probably won't qualify as work-related.

Workers' comp insurers may claim that your shoulder injury is not work-related because it was caused by a pre-existing condition. For example, they may point to an old sports injury, a previous car accident, or an underlying condition like osteoarthritis.

Even if you have a pre-existing injury or condition, your new injury may still be covered by workers' comp if it aggravated—or is unrelated to—the old one. For example, if repetitive lifting aggravates your arthritis, you might still receive compensation for your work injury (although likely not as much as you would if you didn't have a preexisting condition).

And if you can show that your shoulder injury was directly caused by a workplace accident like a fall, the fact that you had a condition like arthritis should have even less bearing on the outcome of your claim.

How to File a Workers' Comp Claim for Your Shoulder Injury

The key to recovering benefits for your workers' comp injury is to notify your employer, your doctor, and the workers' comp board as soon as possible—and to document your injury in as much detail as you can.

There are four primary steps to filing a workers' comp claim:

• Report your injury to your employer as soon as you can—in writing, if possible. State laws limit the amount of time you have to report a workplace injury. In some states, you won't be entitled to your full benefits if you wait more than a few days to report your injury.
• Get medical treatment. When receiving treatment, be sure to mention to your health care provider that your injury is work-related. Describe the facts surrounding your injury and the extent of your limitations. Your medical records can serve as evidence in your workers' comp claim. If you haven't received any treatment for your medical issue, the workers' comp judge might decide that your injury must not be serious.
• Complete the workers' compensation claim forms. Your employer should provide you with the forms you need to file a workers' comp claim. If not, you can download them from your state workers' comp board's website or complete them online. Again, states strictly limit the amount of time employees have to file workers' comp claims, so file your claim as soon as you can. Keep a copy of your claim forms for your own records.
• Hire a workers' comp attorney. Once you've filed your claim, the insurance company conducts an investigation to determine whether to approve or deny it. An experienced workers' comp attorney can help you navigate the investigation, represent you during an appeal if your claim is denied, and negotiate a settlement with the insurance company.

What Expenses Will Workers' Comp Cover?

Workers' comp typically pays for the following types of benefits:

• Costs of medical care. Workers' comp will pay for your medical bills, including doctors, hospitals, medication, and special equipment. State laws differ as to whether you or your employer gets to choose your medical provider.
• Temporary disability. Temporary disability benefits are awarded if you are unable to work while receiving medical treatment for your injury. If you can't work at all during this time, you'll typically receive payments equal to two-thirds of your average wages. (For more information, see our FAQs on temporary disability benefits.)
• Permanent disability. Permanent disability benefits are awarded if you don't recover completely from your injury. Based on your doctor's assessment of your condition, you'll receive payments for either permanent partial disability or permanent total disability.
• Rehabilitation. Rehabilitation benefits pay for medical and therapeutic care (such as physical therapy) necessary to help you cope with and recover from your injury. If your injury prevents you from returning to your job, you may also be entitled to vocational rehabilitation benefits to help you learn to do another job. These may include expenses associated with retraining, career counseling, or other schooling.

The amount you recover in a workers' comp claim depends on factors such as the severity of your injury, the degree to which it impacted your ability to work, and whether your injury required surgery.

Hiring a Workers' Compensation Attorney

Some workers' comp claims are straightforward, but many are contested, lengthy, and complex. An experienced workers' comp lawyer can walk you through the process, keep track of deadlines, and represent you during your appeal.

Hiring a workers' comp lawyer won't cost you anything out of pocket. In most states, workers' comp attorneys charge a percentage of your benefits if you win your case, and nothing (or only case-related expenses) if you lose.