Preventing Joint Replacement Surgery in Workers' Compensation Claims

Joint replacement claims are becoming more frequent in workers’ compensation and proving compensability remains challenging. As the aging working population has expanded so has been the need for workers’ compensation to pay for the cost of replacing aging joints.

The cost for a new hip or knee can cost as much as $30,000 to $40,000. for the surgery alone. Additionally, workers’ compensation companies maybe responsible for the payment of temporary disability benefits to injured workers who are required to undergo surgery. Should the medial procedure fail, the insurance company could possibly be liable for the payment of total disability benefits to the injured worker.

Historically workers’ compensation programs were only liable for specific traumatic injuries. The original acts enacted in 1911 were amended the 1940’ and 1950’s to cover occupational conditions and cumulative stress disorders.

Whether a joint replacement is required because of a work related condition sometimes becomes a difficult proof issue. Pre-existing conditions. ie. natural degeneration, may be considered as the sole or contributing factor for the need for replacement. . Ruhe v. Industrial Commission of Arizona, 2010 WL 1253527 (Ariz. App. Div. I), Raymer v. Interstate Brands Company, 2009 WL 277539 (Ky. App.). A prior condition may be ruled out as a con-contributory factor. Anheuser-Busch Co. Inc., 156 N.H. 677, 940 A.2d 1147 (N.H. 2008).

Even if there is a traumatic injury, there may be a need for joint replacement that can be anticipated in the future. Stevens v. Citizens Memorial Healthcare Foundation, 244 S.W.3d 234 (Mo. Ct. App. 2008). In such situations future medical care should be considered at the time of the initial judgment.

Avoiding the need for joint replacement is the best solution altogether. While 400,000 people a year have joint replacement surgery, taking the preventive route of  caring for your joints can save both lot of money and a lot of discomfort. The NY Times has reported some prevention methods that look promising.  Workers’ compensation courts should consider these concepts and order recognized preventive programs when adjudicating claims where potential joint replacement maybe anticipated.

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