Bone injuries that occur while on the job can lead to a considerable amount of time out of work, as well as some complex litigation in a Boston workers’ compensation case.
Common types of bone injuries include:
- Stable fracture
- Open/ compound fracture
- Transverse fracture
- Oblique fracture
- Comminuted fracture
In workers’ compensation cases, the most common causes of bone fractures are trauma and overuse.
The fact that doctors have the ability to make such a precise diagnosis is good news for their patients in terms of eventually healing and getting back to work. However, workers’ compensation insurance companies are often not on the same page.
Independent Medical Exams
In many workers’ compensation cases, claimant will be treated by his or her doctors and then those records are sent to the insurance company. Insurer will review these records and then probably send one of their own doctors from company’s list of preferred physicians. Although this doctor is referred to as an “independent examiner,” he or she is paid by the insurer to review the medical records, and in many cases, perform his or her own quick examination on the claimant. While this doctor is supposed to use his or her independent medical judgment, they know full well who cuts their paychecks, creating an incentive to favor employers and insurer. These insurance companies are for-profit operations, almost always far more concerned about making money than the well-being of the injured claimants. A claim denied is money saved. Many denied claimants will simply give up and the company will not ever have to pay that claimant’s benefits.
Since the doctor probably doesn’t have any type of clinical practice, as is often the case, he or she relies on being a preferred reviewer for the insurance company to make a living so that tends to mean he or she will generally form an opinion that makes the company happy. This is not to say every doctor operates like this, but our Boston workers’ compensation have seen more often than not that the opinion of the insurance company’s doctors tends to favor a denial of benefits of a classification at a lower impairment rating.
Medical Diagnostic Issues
If you apply for workers’ compensation with a diagnosis of a bone bruise, the insurance company will probably tell you to go see their doctor. This doctor may say that you do not have this ailment and this will lead the insurance company to deny your claim. At that point, you must file a hearing request with the Massachusetts Department of Industrial Accidents (DIA). The DIA will first make you go to what is known as conciliation to see if you can this settle matter prior to going to court.
The authority for DIA to order the parties to go to a conciliation comes from Chapter 152, Section 10 of the Massachusetts General Laws (MGL). The conciliation is an informal meeting that is facilitated by a person provided by DIA. If the parties are unable to come to an agreement, the conciliator, has no power to order a settlement and the parties must proceed to request a hearing before an administrative judge (AJ) with DIA. However, before a hearing can be held, there is a requirement for a conference, which is an informal meeting before the AJ. At this meeting, if the parties do not reach a settlement on their own, the AJ can issue a temporary order that will become permanent if the parties do not request a hearing.
If there is a dispute over a medical issues, the judge will require the claimant to submit to an impartial medical examination by a doctor from DIA’s list of providers. These doctors are impartial because they do not work for either party and this is supposed to eliminate any bias from the doctors selected by the parties. This is governed by Chapter 152, Section 11A of the Massachusetts General Laws. The AJ will not hear testimony or read records for other doctors, but those records can be used during the deposition of the independent medical examiner.
The reason we said that a patient diagnosed with a bone bruise may run into issues, for example, is because this is a relatively new diagnosis. This doesn’t mean that people have not been suffering from bone bruises for as long as there have been people getting injured, but it takes new MRI machines to be able to see the damage. It will not show up on an X-ray. This diagnosis is something we often hear about in the sports world. For example, Washington Nationals franchise player Bryce Harper was running to first base when his foot slipped on a rain-covered base and he hyper extended his knee. This caused everyone in the stadium and the sports world to gasp as Harper is one of the most high profile players in the game.
As discussed in a recent news article from the Washington Post, while everyone feared Harper had torn his anterior cruciate ligament (ACL) or his medical meniscus, but they say he “only” bruised his bone significantly. As for what a bone bruise is, it is a traumatic injury to a bone that is generally less severe than a fracture. Essentially, when you get a bruise on your arm, it is because you damaged blood vessels. Bone is also made of tissue, and there are various layers of different types of material. However, at the center of the bone with the marrow is a region that contains what are known as trabeculae.
If these are injured, but not completely torn apart like in the case of a fracture, they can leak blood and swell just like any other bruise. This is what a bone bruise is. Prior to advanced MRI machines, there would be no way to detect this and it would not seem like the claimant suffered such a serious injury. This condition is very painful and takes a few months to heal. If the bone bruise was in the knee for example, it might be very hard to work a normal shift depending on your type of employment.
In cases such as this, your doctor would be quite clear in what was wrong with you, but the workers’ compensation insurance company might send it to their doctor and he or she might say there is no evidence of such a condition on the X-rays. This might lead to considerable litigation.
If you or someone you love has been injured a Boston work accident, call for a free and confidential appointment at 1-888-367-2900.
Bryce Harper’s knee injury not as bad as initially feared, and Nationals breathe sigh of relief, August 13, Jorge Castillo, Washington Post
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Report: Three Workers Burned in Natural Gas Explosion, Feb. 18, 2017, Boston Workers’ Compensation Lawyer Blog