Is a joint replacement work-related?
If you need a shoulder, hip or knee replacement, you may be wondering if it should be covered by workers’ comp. The first question is whether the condition was caused by your work. In many cases, the answer is a resounding YES.
First, if there was a specific injury that caused the damage, and a doctor supports that opinion, the joint replacement is compensable. Even if the joint was already in a bad condition, if a work injury aggravated, accelerated and precipitated the joint’s condition beyond normal progression, the claim is compensable. For example, if a worker already had an arthritic knee condition (and might have needed a knee replacement at some point in their life), if a work causes the worker to need a knee replacement sooner than they otherwise would have needed it (and a doctor supports that theory), the knee replacement can be claimed as work-related. Workers with “bad” or arthritic joints should be well aware of this possibility.
Additionally, repetitive stress may be responsible for the injury. If a worker’s work activities worsened an existing condition, they can pursue a work comp claim for the joint replacement. In these cases, it is very important to talk to a doctor about the specific job duties. For example, explain to the doctor how long your did a specific job, the types of movements, awkward movements, the bending/twisting/crouching, etc.
What types of benefits can I get for a work-related joint replacement?
Workers’ compensation benefits for work-related joint conditions typically include:
- Medical expenses: If you have suffered a joint injury, you may be entitled to have your medical expenses covered by workers’ compensation. This can include doctor visits, surgical costs, physical therapy, medication, and any other treatment related to your joint injury.
- Wage replacement: When you are off work related to your joint replacement surgery, you may be eligible to receive wage replacement benefits. These benefits typically cover a portion (2/3) of your lost wages while you are unable to work due to your injury. This benefit is tax free.
- Permanent disability benefits: If your joint injury results in a permanent disability that affects your ability to work, you may be entitled to permanent disability benefits. These benefits are an assessment of how “wrecked” your joint is, and it is assigned by the treating doctor (usually the surgeon). As explained below, the PPD can carry a high dollar value.
- Vocational rehabilitation: If your joint injury prevents you from returning to your previous job, you may be eligible for vocational rehabilitation services. These services can help you train for a new job or career that is suitable for your injury.
If your joint condition was caused by your work, you could be entitled to all of these benefits. If work merely exacerbated an existing condition, you might receive only a portion of these benefits.
Joint replacements are “worth” significant dollar values (for permanent partial disability benefits).
“Permanent partial disability” (PPD) means a doctor indicates that you have a permanent disability to the body part impacted by the work injury. The amount of benefits you could receive depends on several disabling factors, including pain levels, consistency of pain, range of motion limitations, loss of strength, activity limitations, soreness, etc.
Significantly, Wisconsin law holds that a worker who has a work-related joint replacement gets a minimum PPD for having the joint replacement surgery. The minimum PPD carries a significant dollar value for the injured worker! Specifically:
- Hip replacement: 40% permanent partial disability. As of today, that 40% PPD is “worth”, 200 weeks of PPD benefits for the hip at the current rate of $438/wk, totaling $87,600 for the injured worker.
- Knee replacement: minimum 50% permanent partial disability. As of today, that 50% PPD is “worth”, 215.50 weeks of PPD benefits for the knee at the current rate of $438/wk, totaling $93,075 for the injured worker.
- Shoulder replacement: minimum 50% permanent partial disability. As of today, that 50% PPD is “worth”, 250 weeks of PPD benefits for the knee at the current rate of $438/wk, totaling $109,500 for the injured worker.
Also, if a worker has to undergo an additional joint replacement from the same injury, the minimum PPD is “stacked” together for a total PPD (Attorney Charlie Domer was involved in an appeals case that supported this decision). For example, if a worker has two (2) knee replacements from the same injury, the PPD is 100% for the knee (totaling $186,150 for a current injury!)
Check with a work comp attorney to see if your replacement surgery is work-related
The question of whether your joint condition was caused by your work is central to whether you would be entitled to workers’ comp benefits. It’s a good idea to talk to an experienced workers’ comp lawyer who has handled joint replacement claims in the past.
