To pursue workman's comp, or not to?
July 8, 2009 10:20 PM   Subscribe

Should my husband pursue a workman's comp claim for his tendonitis, or pursue treatment on his own?

My husband has a repetitive stress injury in his right hand, with a tentative diagnosis of tendonitis--he saw his PCP about it several months ago and took a referral to a specialist, then let it go for awhile until it flared up again. He visited his PCP today, and it was suggested that if he continued to pursue treatment on his own, it might cause problems in the future if he were to choose to pursue a workman's comp claim for the condition.

So now he's unsure what to do next. The condition is certainly rooted in the way he uses his hand for his job, but also almost certainly exacerbated by nonwork activities like playing guitar, rock climbing, etc (which he disclosed to his doctor) and he's concerned about how these would affect a potential workman's comp claim--it's not as though he comes home and rests his hand every night in anticipation of another day of heavy mousing.

He's reluctant to speak to HR about this until he has a better idea of what to expect, and reluctant to pursue further treatment without a better understanding of whether it would be better to file a workman's comp claim. Is it better? Is it applicable in his situation?
posted by padraigin to Work & Money (6 answers total)
If it's a repetitive stress injury caused by his working environment, then definitely file a workman's comp claim. That's what it's there for. It's highly unlikely that the guitar playing/rock climbing caused this injury, especially if he uses a computer keyboard/mouse for a living (and has been doing so for quite some time). Having just been through the workman's comp wringer for the last two & a half years (most of which I spent fighting with the insurance carrier for treatment), I highly recommend retaining the best workman's comp lawyer you can find.
posted by torquemaniac at 10:37 PM on July 8, 2009

Workers comp law differs from state to state, so keep that in mind when you get advice here. More importantly, get yourself a WC attorney. At least around here, it won't cost you anything - they just get a percentage of whatever award you receive.
posted by amro at 6:13 AM on July 9, 2009

(Disclaimer: I studied workers' comp in law school and did a WC practicum, and my answer is based on Pennsylvania law. But I am not a lawyer/your lawyer, etc.)

In PA, repetitive stress injuries are compensable, but must be reported (1) to someone in a position of authority at the company (2) within 120 days of the time the worker knew or should have known of the relationship between the injury and his work. So if your husband has any suspicion at all that his tendinitis* is work-related, he should report it immediately (and keep copies of documentation! -- document everything).

I would not be too concerned about the effect of extra-curricular activities if the injury was in fact caused by work, so long as long as your husband is acting reasonably and following his doctor's instructions. PA compensates for aggravation of a work injury.

In PA, employers provide injured workers with a list of six health care providers ("panel" doctors), and the employee has to treat with one of the listed providers for 90 days. If he does not, the employer does not have to pay for treatment in that 90 day period. After that the employee may go to a doctor of his own choosing.

Most workers' comp attorneys operate on a contingent fee basis (i.e., you pay nothing unless there is a court award), and give free consultations. I don't know how the system works in California, but if I were your husband, I would: (1) report my injury immediately to a supervisor, (2) document everything, and (3) talk to a lawyer.

* Tendinitis is the formal spelling, which I did not know prior to studying workers' comp. And it still looks wrong to me.
posted by the littlest brussels sprout at 6:41 AM on July 9, 2009 [1 favorite]

He can't pursue treatment for the injury through insurance without making a workman's comp claim. If you try to go through regular insurance, and the insurance company determines that the injury is work-related, the claim can be denied. However, if you want to pay out of pocket for the entire treatment, then by all means feel free to do so.
posted by crazycanuck at 7:35 AM on July 9, 2009

He needs to report it and get a worker's comp claim going.

Let a clinician decide whether his hobbies are contributing.
posted by FergieBelle at 10:14 AM on July 9, 2009

Same story here. I was compelled to file a workers comp claim after 11 years of treatment with Motrin and metal-reinforced splints did nothing to alleviate the pain. Good things resulting from the claim: I was given a new diagnosis of degenerative arthritis;I have no cartilage left in my right wrist, 1/3 left in my left wrist and had x-rays to show me what that looked like. I was also sent to physical therapy and I continue with the exercises my therapist gave me to this day. Also, no more Motrin and the new Neoprene splints prescribed by my doctor help a lot. So treatment is ongoing and for the most part successful, although I stlll get occasional flare-ups. Bad thing resulting from the workers comp claim: I had to be evaluated by a Qualified Medical Examiner to see if my ongoing claim could be resolved or denied. That was basically scary and embarrassing but turned out ok, I guess. His opinion was that the injury was stationary and continuous, which means I'm not disabled and can still work but can still be recompensed for the money I spend on treatment. BTW, I live in California, your state may have different rules for when/how/why to file workers' comp claims.
posted by Lynsey at 10:48 AM on July 9, 2009

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