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A serious workplace injury in Boone can upend your entire life overnight. Whether you suffered a severe shoulder fracture in a fall, developed a debilitating rotator cuff condition from years of repetitive work, or were hurt in any other on-the-job accident, the Iowa workers' compensation system is supposed to protect you. But knowing what benefits you are entitled to, understanding the settlement options the insurance company may offer, and deciding whether to handle the process on your own are questions that every injured worker deserves straightforward answers to before making any decisions.
Workplace Shoulder Injuries That May Require Surgery
Shoulder injuries are among the most serious and costly work injuries an Iowa employee can suffer. Falls onto the shoulder are a common cause of fractures in workplace settings. Consider a warehouse worker on a ladder moving boxes on a high shelf who falls several feet and lands directly on the shoulder. When the break is severe and the upper bone shatters, a doctor may not be able to piece the bones back together. According to the American Academy of Orthopaedic Surgeons, that kind of fracture can make shoulder joint replacement necessary.
Before recommending surgery, doctors will typically attempt conservative forms of treatment, including:
- Medication to manage pain and inflammation
- Physical therapy to restore strength and range of motion
- Cortisone injections to reduce joint discomfort
When those options are not enough to relieve pain or restore function, shoulder joint replacement may be the only path forward. Workers who can no longer perform routine tasks that require reaching overhead, or whose shoulder pain interferes with sleep, causes significant weakness, or results in a loss of motion, may be candidates for replacement surgery.
The Four Types of Shoulder Replacement Surgery
Not all shoulder replacement surgeries are the same. A doctor will evaluate the nature and severity of the injury to determine which procedure is most appropriate for the worker's specific situation.
Glenoid Component Implantation
This procedure replaces the socket (glenoid) into which the upper arm bone fits. It is most often performed when the rotator cuff tendons are intact. If the tendons are stretched or torn, the surgeon will typically choose a different approach.
Stemmed Hemiarthroplasty
This surgery replaces the ball, or head of the humerus. It is an option when there is a severe fracture to the humeral head and/or when there is a severe tear to the rotator cuff tendons that prevents other surgical approaches.
Resurfacing Hemiarthroplasty
Rather than replacing the entire humeral head, this procedure only resurfaces the joint surface. It is a preferred option over stemmed hemiarthroplasty for active and younger patients, and a total shoulder replacement can follow if it becomes necessary later.
Reverse Total Shoulder Replacement
Recommended for workers with severe arm weakness caused by torn rotator cuffs, or when a prior shoulder replacement did not succeed. The surgeon attaches a metal ball to the shoulder bone that fits into a plastic socket, allowing the deltoid muscle to take over lifting function from the damaged rotator cuff.
Workers' Compensation Coverage for Shoulder Surgery
As long as the accident that caused the shoulder injury occurred within the scope of the worker's employment, Iowa workers' compensation benefits can cover the cost of treatment. Medical benefits pay for the shoulder replacement surgery itself and related healthcare costs, while disability benefits provide a portion of lost wages during the recovery period when the worker is unable to work.
If the injury results in permanent limitations, the worker may also be eligible to recover permanent partial disability benefits, depending on the degree and lasting impact of the disability. Workers who face denied claims or disputes over the extent of their injuries have the right to appeal those decisions and should seriously consider doing so with legal assistance.
A severe shoulder fracture requiring replacement surgery is exactly the type of permanent, high-stakes injury that warrants working with an experienced Iowa workers' compensation attorney. The cost of surgery, the extended recovery time, and the potential for permanent restrictions all make it critical that your claim is handled correctly from the start.
What Settlement Options Will the Iowa Workers' Compensation Insurer Offer?
After a work injury in Iowa, the workers' compensation insurance company may present one of several different types of settlements. What you are offered will depend on the specific circumstances of your injury, the nature and permanence of your disability, and whether any disputes exist over your benefits. Understanding the differences between these settlement structures before you agree to anything is essential.
Agreement for Settlement
All parties agree upon a compensation amount. Once approved, this type of settlement serves to protect the employee's future rights and secures their compensation going forward.
Compromise Settlement
Used when there is a dispute about the benefits owed. Once filed and approved, both parties give up any future rights to benefits related to the injury. This is a final resolution, and understanding what you are giving up is critically important before signing.
Contingent Settlement
This settlement type depends on a specific event occurring, such as Medicare approving the settlement terms. If the required event does not happen, the approval and the settlement itself may be voided.
Combination Settlement
This approach establishes a claim with an agreement of settlement while also eliminating the remaining balance of the claim through a compromise settlement. It combines elements of both structures in a single resolution.
Lump Sum Payments
While not the typical approach, lump sum payments are sometimes awarded. These may cover all remaining future benefits in one payment, or a partial lump sum covering only a portion of the remaining future benefits owed.
A compromise settlement, once approved, means you and the insurance company no longer have any rights to future benefits for that injury. For a permanent injury like a shoulder replacement, agreeing too quickly could cost you tens of thousands of dollars in future medical and disability benefits. Speak with a workers' compensation attorney before accepting any settlement offer.
Should You Handle Your Boone Workers' Compensation Claim Without an Attorney?
This is a question worth answering honestly, because the answer is not always the same. Sometimes it can make sense to handle an injury claim on your own. For a car accident where total medical expenses are under $5,000 and there is no permanent injury, settling the case independently may be in your best interests. However, for work injuries, the calculation is different. An attorney will generally only accept a workers' compensation case if the injuries are permanent. If your shoulder injury required surgery, has left you with lasting restrictions, or resulted in any form of permanent disability, you are in the category of injured workers who need professional legal representation.
For workers who do proceed on their own in smaller matters, there are three important things to understand about dealing with the insurance adjuster.
Prepare Before You Speak With the Insurance Adjuster
Know your facts before any conversation with the adjuster. Approach the interaction with a confident but polite attitude. Threatening to escalate to a supervisor is unlikely to help your case. Do not interrupt the adjuster. Instead, listen carefully to what is being said and ask questions about their positions. Even if the adjuster makes a surprisingly low offer, do not lose your temper or show frustration. Displaying emotion during negotiations will typically damage your case rather than strengthen it.
Know Your Medical Bills and Treatment History in Full
Before negotiating, understand exactly what medical care you have received and the total amount of your medical bills. In any settlement discussion, this is the baseline from which you are negotiating. For example, if you have $4,000 in medical bills and the adjuster offers $4,500, you can ask directly whether a judge or jury would really award only $500 for everything you have been through and your loss of quality of life. Having the numbers in front of you is essential to having that conversation effectively.
Be Careful About What You Agree to During Negotiations
Once you indicate acceptance of a settlement, even verbally during a phone call and before signing any forms, the insurance company may attempt to enforce that agreement. An oral contract is just as valid as a written one under Iowa law. Before agreeing to any settlement figure, tell the adjuster you will think about it and have an attorney review the offer first. This one step has protected injured workers from accepting far less than their cases were worth.
Getting Legal Assistance In Boone
Navigating the complexities of Iowa workers' compensation laws can be daunting, especially during the recovery process from a workplace injury. Seeking guidance from a seasoned Boone Workers' Comp attorney is invaluable in ensuring your rights are protected and maximizing your chances of a favorable outcome.
Legal professionals play a pivotal role in gathering evidence, preparing documentation, and advocating for your interests throughout the claims process. Don't risk missing out on the compensation you deserve – enlist the support of a qualified attorney to navigate the complexities with confidence.
The Iowa Workers' Compensation attorney team at Walker, Billingsley & Bair know the importance of protecting your work injury claim from the get-go. That's why we provide this FREE book; Iowa Workers' Compensation - An Insider's Guide to Work Injuries: 7 Deadly Mistakes To Avoid If You Are Hurt At Work. To learn more about what our legal team will do to help you protect your Iowa work injury claim, contact Walker, Billingsley & Bair to schedule a no-cost consultation - 641-792-3595.