Workers who suffer severe shoulder injuries may require a reverse total shoulder replacement to restore mobility and reduce pain. Given the complexity of this surgery and its long recovery period, workers compensation settlements for these claims can be substantial. Understanding the settlement process, factors affecting compensation, and legal considerations is critical to ensuring a fair outcome.

This guide provides a comprehensive overview of workers compensation settlements following a reverse total shoulder replacement, detailing key factors influencing settlement value, eligibility for benefits, and how to maximize compensation.

What Is a Reverse Total Shoulder Replacement?

A reverse total shoulder replacement (RTSR) is a surgical procedure performed to replace the damaged ball-and-socket joint of the shoulder. Unlike a traditional shoulder replacement, in which the natural ball-and-socket orientation is preserved, an RTSR reverses the placement. The ball component is attached to the shoulder blade, while the socket is affixed to the upper arm bone (humerus).

This procedure is typically recommended for individuals with:

• Massive rotator cuff tears that cannot be repaired.
• Severe arthritis (rotator cuff tear arthropathy).
• Failed traditional shoulder replacements.

Due to its complexity, the surgery requires a lengthy recovery, which can significantly impact a worker's ability to perform job-related tasks, leading to prolonged disability and high workers compensation settlements.

Eligibility for Workers Compensation After Reverse Total Shoulder Replacement

To qualify for workers compensation benefits following an RTSR, the injury must be work-related. This typically includes:

• Acute workplace injuries, such as falls, heavy lifting, or accidents leading to rotator cuff tears and shoulder fractures.
• Repetitive stress injuries, which develop over time due to continuous overhead movements or heavy labor.
• Exacerbation of a pre-existing condition, where a previous shoulder issue is significantly worsened by work activities.

A workers compensation attorney can help prove that the injury was directly related to job duties, ensuring the injured worker receives the maximum benefits available.

Factors Influencing Workers Compensation Settlements

1. Medical Costs

Workers compensation settlements must cover all medical expenses related to the reverse total shoulder replacement. These include:

• Surgical costs (hospital fees, surgeon fees, anesthesia).
• Rehabilitation and physical therapy.
• Medications for pain management and inflammation.
• Assistive devices, such as slings or adaptive equipment.

Since recovery from RTSR can take up to a year, future medical costs should also be factored into the settlement.

2. Lost Wages and Disability Benefits

Following an RTSR, workers often experience temporary total disability (TTD) or permanent partial disability (PPD), depending on their recovery progress. Compensation for lost wages is based on:

• The worker's average weekly wage (AWW) before the injury.
• The duration of time off work due to recovery.
• Any permanent work restrictions that prevent returning to the previous job role.

If a worker cannot return to their prior occupation, they may qualify for vocational rehabilitation benefits or permanent disability payments.

3. Impairment Rating and Permanent Disability

After maximum medical improvement (MMI), a physician assigns an impairment rating based on the loss of function in the shoulder. A higher impairment rating leads to larger settlements, especially if the injury results in:

• Chronic pain and weakness despite surgery.
• Limited range of motion, restricting arm movement.
• Inability to perform essential job duties, leading to permanent disability.

4. Future Medical Expenses

Many injured workers require additional medical care long after the initial settlement. A well-negotiated settlement should include compensation for:

• Future surgeries (e.g., revision surgery).
• Continued physical therapy.
• Long-term pain management treatments.

5. Employer and Insurer Negotiations

Workers compensation insurers prioritize minimizing payouts. They may attempt to undervalue the claim by:

• Disputing the severity of the injury.
• Challenging the necessity of reverse total shoulder replacement surgery.
• Pressuring workers into a low settlement offer.

An experienced workers compensation attorney ensures fair negotiations, pushing for maximum compensation based on medical evidence and expert testimony.

Typical Workers Compensation Settlement Amounts

Settlement amounts for reverse total shoulder replacement claims vary based on the severity of the injury and its long-term impact. However, typical settlements range between $100,000 and $250,000, with some exceeding $300,000 in cases involving permanent disability or career-ending injuries.

Examples of Settlement Scenarios

• Moderate case: A worker undergoes RTSR but fully recovers and returns to light-duty work – settlement ranges from $75,000 to $125,000.
• Severe case: A worker suffers permanent movement restrictions, preventing them from resuming their previous job – settlement ranges from $150,000 to $250,000.
• Extreme case: The worker cannot work in any capacity due to chronic pain or complications – settlement exceeds $300,000 and may include lifetime medical benefits.

How to Maximize Your Workers Compensation Settlement

1. Seek Immediate Medical Attention

A prompt diagnosis and treatment plan help establish a clear link between the work injury and the need for RTSR. Delayed treatment may lead to disputes over causation.

2. Follow All Medical Recommendations

Failure to attend physical therapy or follow post-surgical instructions can be used by insurers to argue non-compliance, reducing settlement value.

3. Document Everything

Keep detailed records of:

• Medical visits, prescriptions, and therapy sessions.
• Correspondence with employers and insurance companies.
• Daily limitations and pain levels to illustrate loss of quality of life.

4. Work With an Experienced Workers Compensation Lawyer

An attorney skilled in handling complex shoulder injury cases can:

• Ensure the full extent of damages is accounted for.
• Negotiate with insurance adjusters to prevent unfair reductions.
• Take legal action if settlement offers are inadequate.

Lump Sum vs. Structured Settlements: Which Is Better?

Workers compensation settlements can be paid out as:

• Lump sum settlements, where the worker receives a single payout.
• Structured settlements, where payments are made over time.

A lump sum provides immediate financial relief, while a structured settlement ensures long-term financial security. A legal expert can help decide which option best suits the injured worker's needs.

Final Thoughts on Workers Compensation Settlements for Reverse Total Shoulder Replacement

A reverse total shoulder replacement is a life-altering surgery that can leave workers with long-term impairments and significant financial losses. A well-structured workers compensation settlement should fully cover medical expenses, lost wages, and permanent disability compensation.

By understanding settlement factors, documenting injuries properly, and working with a skilled attorney, injured workers can secure the compensation they rightfully deserve.

If you or a loved one is facing a workers compensation claim after a reverse total shoulder replacement, consult an experienced lawyer to ensure you receive the maximum settlement possible.