In many instances, a work related rotator cuff injury will result in several weeks of lost time and very extensive medical bills. The Workers’ Compensation Law provides that a portion of the injured worker’s lost wages and all of his causally related medical treatment should be covered by his employer through their Workers’ Compensation program.
A torn rotator cuff will often require surgical correction. Usually, a claim is ready to be “finalized” one year after surgery. If there has been no surgery it is sometimes possible to finalize a case one year after the date of accident.
Rotator cuff injuries often qualify for a final adjustment award, also known as a schedule loss of use award. The New York State Workers’ Compensation Board Medical Guidelines (which are subject to modification in the future) presently allow for a 10% to 15% schedule loss of use as a starting point for a rotator cuff tear with or without surgery. In addition to the 10% to 15% loss additional percentages can be added on for mobility defects.
The final percentage loss of use translates into a dollar amount. From that amount, the Workers’ Compensation carrier and employer are allowed to subtract all prior payments made for lost wages only. Medical payments do not get deducted in the schedule loss of use. What is left following those deductions will represent the final award payable to the injured worker.
Even after the schedule loss of use award is made additional medical treatment required as a result of the injury should still be covered by the insurance carrier.
It is quite common for the insurance carrier to secure an independent medical opinion regarding the final percentage loss of use before agreeing to award the percentage offered by the attending physician.
Albany injury attorney, Paul Giannetti has represented hundreds of injury victims in personal injury, workers compensation and social security disability matters throughout upstate New York. His firm handles all types of accident and injury cases and represents only injury victims.