Tim Kennedy is certified as a specialist in the practice of Workers' Compensation law by the Pennsylvania Bar Association's Section on Workers' Compensation Law as authorized by the Pennsylvania Supreme Court
Shoulder injuries are among the most common work injuries suffered by Pennsylvania workers. They can present unique challenges in the workers' compensation context, because it is sometimes difficult to prove the full nature and extent of a shoulder injury. MRI testing may be used to attempt to confirm shoulder pathology, but it is very limited for this purpose and can have a high rate of false negatives. That is, you may have a serious shoulder injury, such as a rotator cuff tear or labral tear, yet an MRI might be read as negative or equivocal. Workers' compensation insurance companies often use this against injured workers, treating any MRI that fails to show clear support for a full tear as if that condition has been ruled out. Insurance companies also will typically understate even fully diagnosed shoulder injuries. For example, they might document only a "shoulder strain and sprain" when doctors have recognized a more definite (and more long-term and more expensive) injury such as a rotator cuff tear.
Meanwhile, insurer and employer-referred doctors may push to keep you working even though shoulder injuries can be very painful and very limiting in "real world" settings. If this is happening to you, it will help to call us to discuss options for switching to doctors more likely to help you and help your claim, as well as other ways we can act to advance and protect your rights under the Workers' Compensation Act, to secure your benefits in the short term and to get you a lump sum settlement that compensates you for the long-term harm to your earning potential caused by your work injury. Call us at 484-453-8144.
Meanwhile, it is helpful to know as much as possible about your condition. This is because insurance company doctors in workers' compensation cases will work very hard to downplay your injury. One way they impress the insurance carriers -- and get referrals for more work from insurance carriers -- is by arguing against any significant diagnosis based on what symptoms they claim you don't have, or symptoms you don't report, rather than looking for the medical cause of the symptoms and problems you do have. That is, you may have a number of significant, legitimate symptoms, but if they can argue that these do not fit the textbook pattern for a particular diagnosis -- your pain is over too broad an area, not following the typical pathways or triggered by the specific movements to indicate the diagnosis they want to rule out -- they will claim that the diagnosis is ruled out. They may claim that your symptoms and problems are therefore not real at all, or should not be credited to keep you out of work or allow you medical treatment.
In workers' compensation matters, many of the doctors you may be asked to see will be referred by your employer or their insurance company. In a very real sense, these doctors are being paid to work against you, rather than for you.
Believe it or not, because the doctors often are working against you, it can harm your case if you state (or indicate) symptoms they can claim are "too general" -- even when you are telling exactly where you have pain and answering all questions honestly. For example, in the case of a shoulder injury, insurer-referred doctors may fault you if all you do is make a broad complaint that you have pain in your entire shoulder, even when this is the absolute truth. The insurance company referred doctor may later claim he was trying to assess you for a diagnosis typically marked more by pain at a specific location, or a diagnosis that typically brings on pain only with particular types of movement.
Often, if the doctor was honest in asking whether you had greater pain in a particular area or with a particular movement, you would equally honestly note that your pain is worse in that area or with that that movement. But in workers' compensation, your interaction with insurer-referred doctors doesn't work as it normally should. An insurance-oriented doctor will not tell you what he or she is looking for. He may be trying to impress the insurance company by working hard to rule out all significant (or expensive) diagnoses. He may have very little interest in diagnosing you correctly, since identifying any significant diagnosis could harm his relationship with the workers' compensation insurance carrier he relies upon to send him work.
If you report generalized pain when the insurance company doctor was looking for specific pain, that doctor may not ask any follow-up questions, such as where it hurts most. They will simply smile at you, pat you on the back, and quietly mark down in their note to the insurance company that your "generalized pain" did not fit the specific pattern they were seeking. This may allow them to justify minimizing your injury, or even allow them to argue that your complaints are not real and that your entire claim of injury and disability may be false. All the while, you remain with a substantial injury that may hugely affect whether or not you can perform your job.
The best way to defend against that kind of tactic is to report all of your symptoms both fully and specifically, but without exaggeration, each time you are seen for an examination. For example, if you have generalized pain, you should certainly report it, but you should also emphasize any areas where your pain may be greater, or any movements that increase your pain.
It is also very helpful to have a clear view of what the doctor might be looking for, and how that may relate to your legitimate symptoms. We strongly encourage you to "read up" on your injury, particularly using online sources.
For example, you might learn that a treating or examining doctor suspects a "rotator cuff tear". Perhaps they gave you a referral slip saying "R/O RC Tear" (rule out Rotator Cuff Tear) when referring you for an MRI or for consultation with a specialist. You would then do well to investigate, online, the standard symptoms supporting that diagnosis. In this way, you can consider in advance the degree to which your legitimate symptoms fit the diagnosis. In many cases, some or all of your symptoms may fit, while you may also have other symptoms that are not strictly within the textbook criteria for the given condition. You may have a symptom which affects you only minimally, of the kind you would not normally go out of your way to report. Just because a symptom is subtle and may not itself add to your limitations at work does not mean it is not important to your work-injury diagnosis. At the same time, reporting too many unrelated symptoms can harm your claim, since it may confuse the core medical issues. Recognizing which of your symptoms fit the diagnostic picture for a particular condition can allow you to avoid being tricked by an insurance-company-hired doctor who may be bent on documenting your examination in a way that downplays the extent of your injury. Reading up on your condition may also help you to recognize symptoms you might otherwise dismiss as unimportant, but which may be significant diagnostic indicators validating your serious injury.
Where possible, we include on our pages some links to get you started in your research. We also encourage you to look beyond what you may find here. Try "Google" searches such as "pain in shoulder from trauma at work". Or substitute in place of "trauma at work" a more specific statement of the work you perform or the work injury you experienced. For example:
"shoulder pain from fall from ladder"
"shoulder pain from drywall spackling"
"pain in shoulder from packing boxes"
"cannot move shoulder after injury at work, diagnosis"
Searches like these can help give you an idea of the types of injuries people in your line of work, or with your type of accident, may frequently suffer. Chances are, your work injury is not all that unique. This kind of research can help you even if the doctors treating you have not advised you of their full diagnosis.
When you have a diagnosis in mind, do a further search such as "typical symptoms of rotator cuff tear" or "clinical signs for tear of labrum" or "what are the signs of a partial thickness tendon tear in the shoulder" or "how is a rotator cuff tear diagnosed". Any such search may give you very helpful information.
We hope this page has given you insight on one way of protecting yourself from falling into traps set by the insurance industry for injured workers. This advice may help you on those occassions where you must interact with an insurance company doctor, who almost certainly does not have your best interests as his main concern, and who may very likely be actively working against your interests.
Of course, we encourage you to call and talk directly to attorney Tim Kennedy, to discuss what steps can be taken to block insurance company efforts to push you into the hands of doctors who are serving their insurance company masters at the expense of your good health.
Getting us involved early, to monitor and guide your claim can make a huge difference in how your rights are enforced and in the ultimate value of your claim, including for possible lump sum settlement. Call us to see how.
Tim Kennedy is a Certified Specialist in Pennsylvania Workers' Compensation Law. Call now at 484-453-8144.