Preventing Joint Replacement Surgery in Workers' Compensation Claims
Workers' Compensation
Joint replacement claims are becoming more frequent in workers’ compensation, and proving compensability remains challenging. As the aging working population has expanded, so has the need for workers’ compensation to pay for the cost of replacing aging joints.
Joint replacement surgery is a surgical procedure in which a damaged joint is removed and replaced with an artificial joint. This surgery is typically done to relieve pain and improve the function of the joint. Some common reasons for having joint replacement surgery include osteoarthritis, rheumatoid arthritis, and other types of joint damage or dysfunction. The most common joints that are replaced are the hip and knee, but other joints, such as the shoulder, elbow, and ankle, can also be replaced
COSTS OF JOINT REPLACEMENTS
The cost for a new hip or knee can cost as much as $30,000 to $40,000 for the surgery alone. Additionally, workers’ compensation companies may be responsible for paying temporary disability benefits to injured workers who must undergo surgery. Should the medical procedure fail, the insurance company could be liable for paying total disability benefits to the injured worker.
Historically workers’ compensation programs were only liable for specific traumatic injuries. The original acts enacted in 1911 were amended in the 1940s and 1950s to cover occupational conditions and cumulative stress disorders.
ELIGIBILITY FOR JOINT REPLACEMENTS
Whether a joint replacement is required because of a work-related condition sometimes becomes a problematic proof issue. Pre-existing conditions. ie. natural degeneration, may be considered as the sole or contributing factor for the need for replacement. . Ruhe v. Industrial Commission of Arizona, 2010 WL 1253527 (Ariz. App. Div. I), Raymer v. Interstate Brands Company, 2009 WL 277539 (Ky. App.). A prior condition may be ruled out as a con-contributory factor. In re Anheuser-Busch Co. Inc., 156 N.H. 677, 940 A.2d 1147 (N.H. 2008).
FUTURE MEDICAL CARE
Even if there is a traumatic injury, there may be a need for a joint replacement that can be anticipated in the future. Stevens v. Citizens Memorial Healthcare Foundation, 244 S.W.3d 234 (Mo. Ct. App. 2008). In such situations, future medical care should be considered at the time of the initial judgment.
HOW TO PREVENT JOINT REPLACEMENTS
Avoiding the need for joint replacement is the best solution altogether. While 400,000 people a year have joint replacement surgery, taking the preventive route of caring for your joints by going low impact and controlling weight can save both lot of money and a lot of discomfort. The NY Times has reported some prevention methods that look promising. Workers’ compensation courts should consider these concepts and order recognized preventive programs when adjudicating claims where potential joint replacement may be anticipated.
The author, Jon L. Gelman, practices law in Wayne, NJ. He is the author of NJ Workers’ Compensation Law (Thomson-Reuters) and co-author of the national treatise Modern Workers’ Compensation Law (Thomson-Reuters). For over five decades, the Law Offices of Jon L Gelman 1.973.696.7900 jon@gelmans.com have represented injured workers and their families who have suffered occupational accidents and illnesses.
Recommended Citation: Gelman, Jon L., Preventing Joint Replacement Surgery in Workers' Compensation Claims, www.gelmans.com (2010), https://www.gelmans.com/ReadingRoom/tabid/65/ArtMID/1482/ArticleID/994/preview/true/Default.aspx
© 2001-2023 Jon L Gelman. All rights reserved.
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