To get the maximum amount from your workers compensation knee injury settlement you’ll have to make sure you follow a few simple guidelines. In this article I’ll walk you through everything you need to know in order to know the next steps you should follow after a workplace injury.
Knee injury claims are among the most common issues that workers are likely to contend with in any workplace. The knee is one of the most sensitive and important parts of our body, as we use it for almost every work-related activity. Moreover, it is also the load-bearing joint that plays a crucial role in any activity or movement, which explains why they are more likely to get hurt or wear down.
With these injuries’ sensitivity, getting compensation after filing knee injury claims for a work-related injury is extremely important. Here we look at all what you need to know about the workers compensation settlement for knee injury claims.
Table of Contents
Can I File for Workers’ Compensation If I Suffered a Knee Injury?
Yes, if you suffer a workplace knee injury, you may be eligible to file for worker’s compensation and receive benefits. Some of the common knee injuries in the workplace that are eligible for worker’s compensation include:
- Strains
- Torn ligaments
- Arthritis
- Fractures
- Tendonitis
- Tendon injuries
- Cartilage injuries
- Contusions
- Dislocations
- Bursitis
How to File a Worker’s Compensation Claim?
Employees file a claim after experiencing a injury at the workplace to get compensation and other benefits. The filing claim process involves reporting the injury to the worker’s compensation insurance carrier or the employer. Once you report a knee injury at work, you will have to undergo a medical evaluation and then later receive treatment.
While receiving treatment, you get the compensation that may include receiving benefits indefinitely if the injury leads to permanent disability. The average settlement amounts for knee injuries are based on your average weekly earnings. However, if you are able to work after the injury, getting compensation will be like receiving a salary for a number of weeks to cover your injuries.
Here are steps on how to file for a worker’s compensation claim.
1. Reporting knee injury to your employer
The first step in filing for a worker’s compensation claim involves reporting the injury to your employer and the worker’s compensation insurance carrier within the first 21 days. Reporting the injury within the specified number of days ensures that you receive benefits retroactively from the injury date.
Fortunately, you may still be allowed to report the injury within 120 days if you fail to report within the first 21 days, but you will only receive benefits from the reporting date.
2. Visit your doctor for medical evaluation
In case of a work injury, you need to immediately seek medical attention and inform your doctor that the injury is work-related. The employer may also provide you with a work injury acknowledgement form that includes a Panel List of Providers. A Panel List of Providers consists of medical providers’ list to consult for medical evaluation and treatment.
The panel provider will treat the injured workers for up to 90 days or until when they are released. However, you are free to seek medical attention from any medical provider if the employer fails to offer a work injury acknowledgment form.
While receiving treatment, you should inform your medical provider that the injury is work-related as it is critically important in the worker’s compensation claims process.
Informing your medical provider is necessary as it ensures that the report to your employer and the medical documentation shows the relationship of the injury to your work.
3. Workers’ Compensation Claim Filing
The last stage in this process is the filling workers’ compensation claim, and it starts once the employer submits their first report on the injury. For example in California, the law requires the employer to send you a claim form known as a D.W.C. 1 within one day of knowing about your injury.
The insurance company will then reach you through an adjuster, asking you to take the next step, which is the claims process. The claims process involves submitting your medical bills and records. In case your claim is disputed or denied, you will need to hire a good worker’s compensation attorney and clear documentation of every step you have taken up to this stage.
What Should I Do If I Hurt My Knee At Work?
Usually, a knee injury can take a long time to heal because we use our knees while doing almost everything from standing to sitting. Consequently, a work-related injury may keep you from work for weeks, months or even forever and also cause your medical bills from therapy, surgeries and injections to add up quickly.
Knee injuries are serious injuries that can easily lead to complications that might make it more difficult to resume your job if you fail to handle them well. Therefore, if you experience an injury at work, you should try to avoid fighting through the swelling and pain. Inform your employer in writing and visit a medical provider immediately for medical attention.
After seeking medical attention, you should follow the doctor’s instructions and avoid returning to work until you fully recover from the injury. Remember, using ice and heat and elevating your leg can significantly help increase blood flow and relax the muscles at the injured knee for a speedy recovery.
What does Workers’ Comp Cover?
So you might be wondering what are the workers’ compensation benefits for knee injuries
Under California law, there are various categories of workers’ comp benefits. Therefore, it is advisable to involve a reliable attorney to avoid missing out on receiving the maximum benefits you deserve. The categories of workers compensation benefits under California law include:
- Free medical care
- Permanent disability benefits
- Temporary disability benefits
- Restraining
- Death benefits
- Life pension
Usually, employees who experience injuries in the workplace are awarded financial protections for clearing medical expenses for a work injury and lost wages. If you experience an accident that results in knee injuries in the workplace, you are eligible for a number of workers’ compensation benefits. These benefits include:
- Replacement of lost wages (a lump-sum settlement or weekly installments)
- Specific loss benefits (use of limb/loss of limb)
- Payment of medical bills on the work knee injury
- Subsequent injury benefits
- Disfigurement benefits
As provided under California law, the benefits that result from temporary or permanent disability are based on the average weekly earnings (A.W.E.). The maximum A.W.E. considered for both cases varies depending on the injury date. Moreover, the temporary disability benefits are paid at the rate of two-thirds of your average weekly earnings. The benefit is limited to 2 years (104 weeks) regardless of whether you cannot return to work.
Usually, the workers compensation benefits are determined by:
- Classification or severity of the injury
- Medical expenses
- Wage loss from the injury
Workers compensation benefits offer full payment on your medical expenses since knee injuries are extremely costly to treat, regardless of whether you have an insurance cover or not. The benefits cover medical expenses on knee replacement, other types of surgeries or physical therapy if necessary for speedy healing.
The medical benefits and wage loss that you get will mainly depend on the severity and type of your injury and the duration that you will be unable to resume your job.
How Much Compensation for Knee Injury?
Generally, the workers’ compensation system is set to help you from work-related illness or injury by paying you the lost wages, medical care and helping you return to work.
The workers comp settlement covers all the necessary and reasonable medical treatment expenses for a work-related injury, provided that you seek medical attention from an authorized health care provider. In addition, you may also get mileage reimbursement for travel to and from the health facility for your doctor’s appointments.
In case of a temporary disability, you may get some cash benefits if you decide to break from work for more than 7 days to allow you to recover from your injury in the workplace. The cash benefits are meant to replace part of the lost wages due to your inability to return to work. However, it is good to mention that you will not be able to receive the cash benefits for the first week unless you break for more than two weeks (14 days).
The amount you receive as temporary disability benefits depends on the extent of the disability and your average weekly earnings before the work injury. While seeking medical attention, the doctor will assign you a 0 to 100 disability percentage depending on the extent of the disability.
If your treating doctor indicates that you have 100% temporary disability, you will receive two-thirds of the average weekly earnings as the temporary disability benefits.
The temporary disability benefits are up to a maximum amount, which depends on the injury’s date. For injuries during the period between 2020 July and 2021 June, the maximum weekly amount is $966.78. For example, in New York you can check the W.C.B. (New York Workers’ Compensation Board) for the other injury dates, as they keep on updating the maximums’ list.
If you suffer a permanent total disability, it means that you will not be able to return to work at all due to the limitations. However, employees with some form of disabilities like loss of either legs, eyes or arms may still earn a limited amount of cash while receiving their disability benefits.
How Workers’ Comp Is Computed
If you experience an injury in the workplace, understanding the structure of the workers’ compensation in your state enables you to plan for your future accordingly. Understanding how workers’ comp is computed and the entire process allows you to ensure that your employer’s claims adjustor and employer are fair in their assessment and compensation.
Consequently, it is important to learn how to calculate the workers compensation benefits if you or someone close to you experiences work-related injuries or illnesses in any state. This is because every state has some unique laws and different ways of dealing with workers’ comp issues.
For instance, under California law, you are eligible to receive two-thirds of your average weekly earnings, but there is a maximum allowable and legally accepted minimum amount. To compute your average weekly wage, you need to divide your annual salary by 52. For instance, if you earn $52,000 per year, your weekly wage will be $1000. The maximum benefit will be two-thirds of the weekly wage ($1,000) with no tax as the state law dictates, which will amount to $666.66 in this case.
However, you can get the remaining third of your average weekly earnings if your employer offers a “Disability with Leave Pay” program. In case of permanent disability, you are eligible for SJDB (Supplemental Job Displacement Benefits). However, if you suffer a partial disability you are likely to be assigned less physically demanding jobs for the rest of the days in your career.
The Supplemental Job Displacement Benefits include a voucher for vocational skills training and other benefits in compensation, which may amount to $6,000. You will also be eligible for medical expenses, including doctor’s visit and treatment compensation of up to $10,000 until your claim is accepted or denied.
Calculating Your Workers’ Comp Wage
The workers’ compensation law applies the average weekly wage to determine the weekly wage replacement benefit that you need to include in your claim. If you suffer temporary disability due to a work-related knee injury, you are eligible to receive 2/3rds of your average weekly earnings with no tax. Therefore, when calculating your workers’ comp wage, the most important thing in determining the number of benefits is your average weekly wage.
However, there are common mistakes that you need to avoid when filing workers’ compensation claims to ensure that you are not denied the maximum benefits that you deserve. Here are the common mistakes.
- Using after tax wages rather than gross wages when calculating the average wages
- Failing to realize that you need to use the average of the 52 weeks before the accident
- Accepting what the workers’ compensation board or the insurance company say without consulting a reliable
- Including earnings from concurrent employment
Worker’s Comp Examples
“I Live in California. What’s my weekly wage limit?”
Wentworth
Wentworth is taking a break from work due to a workplace injury that has caused him to lose his leg. He earned $900 a week on average at his petroleum engineer job. Since he is out of work and under doctor’s care he is eligible to receive $600 as lost wages ($900 x 2/3= $600). Therefore, Wentworth is entitled to get $600 a week as compensation for the lost wages since he is out of work due to the injury.
Olivia
Olivia was injured on July 1, 2020. Before her injury, she earned $2100 a week as a flight engineer. With a serious knee injury, she is now out of work. Using the lost wage formula, Olivia will be able to recover $1400 a week as lost wages ($2100 x 2/3 = $1400).
However, since the maximum benefit in California on the date of her injury is capped at $1,251.38 per week, she is limited to $1,251.38 despite the weekly benefit being $1400 after calculating using the lost wage formula.
Average Workers Comp Knee Injury Settlements
According to the Bureau of Labor Statistics, there are about 150,000 cases of work-related knee injuries across the US every year. The number makes up over 13% of the total injuries. The average workers’ comp settlement cost is about $32,622 (in lost wages and medical expenses), according to the National Safety Council (NSC) data.
Here is a table showing the average workers’ comp settlements for knee injuries based on the NSC data.
|
Severity of Knee Injury |
Estimated Average Settlement Amounts |
Types of Injury |
|
Mild |
$1,000 – $21,748 |
Tendonitis, bursitis and contusions |
|
Moderate to severe |
$21,748 – $32,622 |
Strains, sprains, fractures and minor tears |
|
Extremely severe |
$32,622 and above |
Amputations, torn ligaments (MCL, ACL, LCL) loss of use and many others |
Can I Get Workers’ Comp Benefits If I Already Have Knee Pain?
Many employees experience chronic pain, mainly from knee cartilage wearing down due to workplace injury, age, arthritis or overuse.
Cartilage tears and arthritis can lead to swelling or frequent pain, making it difficult for you to carry out physically demanding activities. Moreover, severe chronic pain may also require a surgical procedure such as partial or total knee replacement that may keep out of work for several days.
If you had preexisting cartilage wear or arthritis, you are still eligible for workers compensation benefits as long as you can prove that the workplace injury worsened the condition. However, proving that a workplace injury worsened or aggravated your preexisting worn cartilage or preexisting requires a reliable attorney and a report from at least one medical practitioner.
Inside the Knee
The knee is one of the most sensitive and complex parts of your body as it features a joint that is strong enough to hold the leg together and flexible enough to allow different movements.
Cartilage protects the ends of your thigh bone (femur) and shin bone (tibia), which helps reduce friction between these bones when making movements. Synovial tissue secretes a fluid that lubricates the lines of the joint capsule and the knee joint.
Bursae are fluid-filled sacs that offer cushioning between different knee parts, including patellar tendon and tibia. Menisci are the pads found between the tibia and femur, which acts as a cushion while also distributing weight across the joint for enhanced stability.
Ligaments provide stability to the knee. There are four types of knee ligaments:
Anterior Cruciate Ligament (ACL). ACLs are found in the middle of the knee and help control the shin bone’s forward and rotation movement.
Medial Collateral Ligament (MCL). The MCL offers additional inner knee stability.
Posterior Cruciate Ligament (PCL). This is also found in the middle of the knee, and it controls backwards shine bone movement.
Lateral Collateral Ligament (LCL). The LCL offers additional outer knee stability.
Therefore, it is evident that there are many parts in your knee that can sustain serious injuries and damage when you experience workplace injury. You will learn about each injury case below and how they affect workers’ compensation.
Most Common Causes of Workplace Knee Injuries
Here are some of the common types of knee injuries:
- Loss of Limb/Amputation
- Tibia-Fibula Fracture (Broken Leg)
- Broken Kneecap
- Dislocated Kneecap
- Knee Swelling
- Knee Strains and Sprains
- Torn Meniscus
- Knee Bruising
- Torn ACL Ligament
- Torn PCL Ligament
- Torn MCL Ligament
- Ligament Tear
- Chondromalacia Patellae. This is the softening and damage of patella, which is the cartilage under the kneecap. Work-related injuries can cause post-traumatic arthritis or worsen pre-existing arthritis, which may lead to knee cap misalignment and damage of patella.
The cost of knee injuries treatment varies depending on a number of factors, including the kind of treatment and their severity. For instance, knee sprains and strains heal with over-the-counter medications and days of rest. Some injuries may require much more in terms of treatment.
Torn Meniscus: This injury involves the pieces of cartilage in your knee that absorb pressure and prevent bones’ rubbing on the joint. The injury results from an awkward twist of the knee joint, especially in older people since the meniscus wears down thin with age. Some of the common symptoms of a torn meniscus include knee locking or stiffness, a popping sensation, limited knee motions and swelling.
A severely torn meniscus may require surgical procedures. This includes meniscus removal (meniscectomy), meniscus repair and arthroscopy. Arthroscopy cost between $7,400 and $9,000. Fortunately, you may recover from a minor meniscal with rest, compression, ice, and leg elevation.
Ligament Tears (Torn Anterior Cruciate Ligament/Posterior Cruciate Ligament/ Medial Collateral Ligament): The injury results after the ligaments (connective tissues) that control stability and knee movements get torn.
When the ligaments are torn, you may have limited knee movement, some knee-buckling, a painful swelling and a popping sound. On average, anterior cruciate ligament repair costs roughly $9,276, and it may take up to six months to recover.
Patella Fracture (Broken Kneecap): Broken Kneecap injuries usually require a splint or a cast, which costs about $2,500. However, you should be ready to spend more in case of severe fractures that may need surgical procedures.
Osteoarthritis: This is a condition that is likely to occur in a knee that has experienced an injury before, and it is possible to file a workers’ compensation claim for it. Osteoarthritis may require knee replacement surgery in severe cases, which can be considerably expensive. For instance, the total knee replacement operation in the US costs from $49,500 to $57,000, while partial knee replacement cost 10% to 20% less.
Common Procedures for Knee Surgery
Your doctor may recommend surgical procedures in severe injury cases to help you recover quickly and without much complications. Here are some of the common surgery for knee injuries:
Meniscus Repair
If you suffer a torn meniscus injury, you may need a meniscus repair surgical operation. After the surgery, you will receive crutches and a brace to ensure that you stay off the leg for a number of weeks. Usually, meniscus repair takes longer to heal than an ACL injury.
Knee Arthroscopy
Knee arthroscopy is mainly done to smooth the cartilage and remove a torn meniscus. The recovery period is about three to five months, but you will also require crutches for several days.
Knee Replacement/ Total Knee Arthroplasty
If your workplace injury leads to post-traumatic arthritis or worsens preexisting arthritis making it hard for you to perform your day-to-day duties, you may require a full knee replacement. After the procedure, you are likely to be limited to light or sedentary work for the remaining days in your career.
Knee Ligament Reconstruction
In most cases, knee ligament reconstruction is performed to repair torn anterior cruciate ligament. Many employees that undergo knee reconstruction for torn ACL take about six months before full recovery. However, some employees are unable to return to jobs that require frequent stooping, twisting and bending.
Treatment for Workplace Knee Injuries
Most workplace injuries result from sprains and strains to the muscles, tendons and ligaments around the knee area. However, severe knee injuries can lead to fractures, torn ligaments and torn cartilage.
Usually, your doctor will require you to undergo an MRI or Xray to determine the injury’s severity. After the evaluation, he may recommend various treatment options, such as:
- Rest
- Elevating the injured knee. This helps reduce knee swelling
- Keeping weight off the knee
- Aquatic or physical therapy
- Whirlpool treatment
- Compression stockings to reduce swelling and restrict movement
- Alternating heat and ice
- Steroid injections
- The use of an assistive device or cane
- A brace for knee joint stabilization
- Surgery
Keys to a Strong Workers Comp Case
Knee injuries are costly to treat even with insurance. Therefore, it is important to understand how to put up a strong workers compensation case to ensure you receive the maximum benefits. You also need to ensure that the employer’s worker compensation insurance covers all the employees.
Moreover, you also need to ensure that everything about the injury and treatment is documented. This will make it easy for you and the attorney to argue for a fair settlement. It is critically important to ensure all the paperwork is done according to your state’s laws and within the stated timeline. The documentation should include your medical history without trying to cover up anything.
