A shoulder injury can happen while doing almost any job. Maybe you lifted something too heavy on the construction site. Or perhaps years of repetitive motions in an office or a warehouse finally caused pain. No matter how it happens, shoulder pain makes working and even simple daily life tough.
The good news is that California has a workers’ compensation system made to help employees who get hurt on the job. If your shoulder injury started at work or was made worse by your work duties, you may be able to get benefits. We will walk you through filing a claim and handle the liable insurance company for you.
Common Types of Work-Related Shoulder Injuries
Shoulder problems are very common in jobs that involve lifting, reaching, or doing the same motion over and over again. People who work in construction, healthcare, manufacturing, warehouses, delivery, and even offices can all be affected.
Some injuries happen instantly, like in a fall or a sudden accident. Others happen slowly over a long time due to repeated strain, which is called cumulative trauma.
Here are some common shoulder injuries that qualify for workers’ comp:
- Rotator cuff tears (the supraspinatus is the most common kind).
- Shoulder impingement and bursitis.
- Labral tears (like SLAP tears) that cause joint instability.
- Frozen shoulder, also known as adhesive capsulitis.
- Fractures of the collarbone (clavicle) or the upper arm bone (proximal humerus).
- Nerve problems like nerve entrapment or traction injuries.
Even if your pain began gradually, you can still qualify for workers’ comp if your job duties caused your condition or made a pre-existing condition worse.
How to Prove Your Shoulder Injury is Work-Related
To receive workers’ compensation, you just need to show that your job caused or contributed to your shoulder injury. This is a very important point: you do not have to prove that your employer did anything wrong. Fault is not a part of workers’ comp cases. You only need to show that your work duties led to the injury.
The main pieces of evidence used to prove this connection are:
- Medical records and reports from doctors.
- Statements from coworkers who either saw the incident or who can describe your daily job tasks.
You must also tell your employer about your injury. California law requires you to report the injury within 30 days of when you realized it might be work-related, as stated in California Labor Code $\S$ 5400. However, it is always best to report the injury as soon as you can.
What Workers’ Compensation Benefits Cover
If your claim is approved, you may receive several types of benefits to help you recover without financial stress. The benefits cover four main areas:
- Medical Expenses: This pays for all necessary medical treatment for your injury, including doctor visits, surgery, physical therapy, and medications.
- Temporary Disability Payments: These payments replace part of your wages while you are unable to work or must work reduced hours because of the accepted injury. You can receive up to 104 weeks of these benefits.
- Permanent Disability Payments: If your shoulder does not fully heal and you are left with a lasting impairment, you may receive payments for ongoing compensation.
- Job Retraining: If your injury prevents you from going back to your old job, you may receive a voucher for education or training to prepare you for a new line of work.
What Drives Settlement Value in California Shoulder Cases
If you have a job-related shoulder injury in California, you are likely wondering what a fair settlement looks like and how the value is calculated. The value of your settlement is based on several key factors:
- Permanent Impairment: This is measured by doctors as Whole Person Impairment (WPI). The doctor uses the AMA Guides, 5th Edition, to measure the permanent loss of function, such as how much you have lost in your range of motion (flexion, abduction, rotation). These measurements are often taken with a tool called a goniometer.
- The PD Rating: California does not pay settlements based on WPI alone. The WPI percentage is converted into a Permanent Disability (PD) rating using the California 2005 Schedule. This schedule applies age and occupation modifiers to the WPI number. The final PD rating determines the number of weeks of payments you are owed at your statutory weekly rate.
- Apportionment: This is the part of the process where the insurance company or doctor argues that some portion of your disability is due to things outside of work, like a past injury or age. This can lower the final settlement value.
- Other Financial Factors: The value includes any temporary disability money paid or still owed, plus potential penalties for late payments. It also includes the cost of future medical care you will need.
Realistic Settlement Ranges and Examples
While every case is unique, looking at rough examples can help you understand how the math works in California workers’ comp. These are illustrations and not a promise of results:
- Example A: Non-surgical Impingement with Range of Motion Loss
- WPI: 5–8%
- PD Rating: 6–10% after adjustments
- Rough Value: Often $15,000–$45,000, depending on earnings and apportionment.
- Example B: Rotator Cuff Repair with Good Result
- WPI: 10–14% after surgery and residual limitations
- PD Rating: 12–18%
- Rough Value: Often $25,000–$60,000+, with temporary disability, penalties, and future care added in.
- Example C: Massive Tear, Permanent Overhead Limits, Older Worker in Heavy Job
- WPI: 15–20% (sometimes higher)
- PD Rating: Can reach the mid-20s after age/occupation modifiers
- Rough Value: $45,000–$90,000+, especially if future care is substantial or returning to the same job is not possible.
Remember, the weekly rate of payment, arguments over apportionment, and the accuracy of the doctor’s impairment write-up all cause these ranges to vary.
How to Increase the Value of Your Shoulder Case
You have a lot of control over how well your case is documented and, as a result, its value. Follow these steps to help your case:
- Get the Right Imaging: Ensure you get the correct tests, like an MRI or ultrasound, that match your symptoms.
- Report Consistently: Always report your symptoms and pain accurately and consistently to all doctors. Early, accurate reporting prevents the insurance company from arguing that you delayed treatment.
- Be Compliant with Rehab: Attend all physical therapy sessions and consistently do your home exercises. This compliance matters in your medical record.
- Document Work Impact: Keep a simple log of the tasks you cannot do, any flare-ups you have, and how your injury is affecting your sleep.
- Be Careful with Forms: Do not sign any papers from the insurance company without having a lawyer review them first.
QME and Medical-Legal Pitfalls to Avoid
When a Qualified Medical Evaluator (QME) is involved, there are important steps you must take to protect your rights and settlement value:
- Do Not Miss Deadlines: Pay attention to any panel deadlines set by the state.
- Ensure Complete Records: Make sure the QME receives all of your medical records. Incomplete records can lead to a lower impairment rating.
- Insist on Measurements: Do not let the doctor “estimate” your range of motion. The report should document exact goniometer measurements.
- Challenge Apportionment: Do not accept a statement that says 100% of your injury is non-work related if no real analysis is provided.
- Address All Pain: Make sure the doctor considers secondary problems, such as nerve involvement or pain that travels to your neck.
When surgery is involved, remember that the procedure itself does not guarantee a high settlement. What matters most is the functional change you experience at Maximum Medical Improvement (MMI), the final restrictions you have, and how well the medical reports document those changes.
What To Do if Your Shoulder Injury Claim Is Denied
If the insurance company denies your claim, you still have options. Insurance companies often argue that a shoulder injury is from a past issue, age, or an activity outside of work.
You can request an independent review from a Qualified Medical Evaluator (QME). This doctor can offer a new, independent medical opinion. You can also file an appeal with the California Workers’ Compensation Appeals Board (WCAB).
Denied shoulder claims can still be won. Even if you already had shoulder problems from sports or age, the key is determining how much of your current disability is related to your job. This is the apportionment analysis, and it is not an automatic reason for denial.
Most shoulder cases tend to resolve after you reach MMI and a definitive medical-legal report is generated, though timelines vary if surgery or QME scheduling is needed.
Protect Your Right to Fair Compensation
You deserve fair treatment and the full benefits available under the California workers’ compensation system. If you have injured your shoulder while working, you need to understand the complex process of WPI, PD ratings, and apportionment to ensure you get what you are owed.
We are dedicated to helping injured employees get medical care and wage benefits after a work injury. Call Hinden & Breslavsky today at (323) 954-1800 to schedule a free consultation with a workers’ compensation lawyer.