November 24, 2017

Unrepresented Claimant with Rotator Cuff Injury Denied Necessary Rehab

post surgery rehabI want to talk with you today about rotator cuff injuries and the importance of both proper medical care and appropriate rehabilitation and followup.

In many respects the right kind of rehabilitation and follow-up medical care can make the difference between a return to full function and long term (and sometimes permanent) restriction of movement, stiffness and pain.

Recently I received a call from a prospective client who tore her right rotator cuff and underwent surgery, but was seeking legal advice because she sensed, correctly, that her workers’ comp doctor was not providing appropriate follow-up 1.

The prospective client told me that she hurt herself attempting to move a heavy box over her head and that shortly thereafter her right shoulder became painful, swollen and weak.  The industrial clinic doctor was unable to do much (other than waste a couple of weeks) and she was referred to a local orthopedist for consultation.

Let me say here that had I been retained as the employee’s lawyer at this time I would have pushed hard for a different orthopedist.   Over the years I have observed the work of many of the orthopedists who accept workers’ comp. cases and I have very definite opinions about which ones offer quality care.  The referral in this case was made to an orthopedist whose work is, in my opinion, average at best.

In any case the orthopedic physician diagnosed a torn rotator cuff and proceeded to undertake a surgical repair.  Thereafter he instructed my prospective client to keep her right arm immobilized in a sling for the next 6 weeks.

After about 2 weeks of this, my prospective client was becoming increasingly uncomfortable and she called her doctor, but the doctor reiterated that she was to keep her right arm in a sling and not to try to use it at all.

This is when the prospective client called me.

As we talked I asked her if she had ever discussed with her doctor the pros and cons of incorporating a more active rehabilitation into her post-surgical recovery.  She replied that none of this had ever been discussed and that the orthopedist always seemed “impatient” with her.

I told her (as I am now telling you) that I am not a doctor and it is not my role to recommend medical treatment for an injury.  However, I have represented dozens of clients with rotator cuff and shoulder issues over the years and I know that there are a variety of approaches to rehab following surgery 2.

For example, one of my rotator cuff clients was prescribed sessions in a device known as a CPM (continuous passive motion) chair and his functioning is almost fully restored.  A CPM chair is a chair with an attachment that lifts and rotates the patient’s arm for as much as 4 to 6 hours per day.  The purpose of this therapy is to enhance flexibility and strength in a controlled environment while the tissues heal. 3

Obviously CPM therapy or any active rehab is a more expensive option for the insurance company.  My goal as a claimant’s lawyer, of course, is focused on helping my clients get the care they need.  The insurance company, of course, wants to keep its costs down.

My point here is not to say that my prospective client should have been prescribed a CPM chair, or that the immobilization process is or is not a good option for her.  I do think that the various options – ranging from total immobilization to limited exercise to CPM chair sessions – should have been discussed so that my prospective client could have done her research and made an informed decision in conjunction with her treating doctor’s advice.  Some patients develop adhesive capsulitis (frozen shoulder) when left with complete immobilization.

Had I been the attorney of record, I would have done the following, at a minimum:

  • I would have negotiated with the adjuster to have a different orthopedist authorized.
  • I would have discussed with my client the different rehab options potentially available to her.
  • I would have incorporated the cost of a more intensive rehab into settlement negotiations and explored a settlement option that also included surgery if the client wanted to settle at that time.
  • I would have negotiated with the insurance adjustor to approve a different physician for rehab and/or authorize more intensive rehab therapy if my client’s condition was not improving with immobilization

Obviously at this point – post surgery – my prospective client’s options are fewer but there are some that still exist.  Specifically, this case may be ripe for settlement if negotiations are handled properly.

I hope you can see how knowledgeable and proactive representation can make a huge difference in giving you some control over your medical treatment and, ultimately, the financial outcome of your case.

If you have been injured on the job and want to talk to me about tactics that might be available to you, please feel free to call me at 770-351-0801 or use the form on this page to email me.

  1. I have changed the details of this case to preserve confidentiality, but the underlying principles are real.
  2. Here, for example, is a common rotator cuff rehab protocol from a hospital.  Compare this to a 6 week immobilization plan.
  3. I found a YouTube video of a CPM chair in action, which you can view here.
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Jodi Ginsberg

Attorney Jodi Ginsberg represents employees who are injured on the job and who need medical care and missed wage benefits available under Georgia's workers' compensation laws.

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