Rotator Cuff Tear Injuries and Long Term Disability Insurance Claim

What is a Rotator Cuff Injury?

Four tendons surround the shoulder joint, attaching the muscle to the bone and allowing the arm to move freely. Since these tendons rotate the shoulder within the joint, these four tendons are commonly referred to as the rotator cuff.

Rotator cuff injuries are one of the most common injuries to the shoulder. Damage to these tissues often happens as a result of repetitious motions over a long time. These repeated motions are typical in sports, the workplace, and even household chores. The repeated friction within the tight space of the rotator cuff causes inflammation, which leads to three types of rotator cuff injuries:

  • Rotator cuff tendonitis inflammation of one of the tendons of the rotator cuff, which causes pain only during the same kind of motions that caused the damage
  • Shoulder bursitis inflammation from the tendons spreads into the fluid that lubricates the shoulder joint, causing pain whenever the joint is moved and often is worse at night
  • Rotator cuff tear if inflammation weakens the tendon, it can cause it to partially or completely tear

Symptoms of damage to the rotator cuff include pain and weakness in the arm and shoulder, which may spread into the upper back. Pain is usually sharp when the area is moved and dull at night, though patients with severe injuries may experience pain throughout the day.

Diagnosing Rotator Cuff Injuries

While a doctor may make a preliminary diagnosis based on an exam, diagnosing rotator cuff injuries usually depends on diagnostic testing. Clinical exams include the doctor taking the patient’s medical history and symptoms and a physical exam that tests the range of motion of the shoulder, the location of pain, and the strength of the joint. Diagnostic testing can include:

  • X-rays to look for signs of arthritis, bone spurs, or other causes of symptoms
  • Ultrasound to observe the soft tissues while the shoulder is stationary and moving
  • MRIs to examine the structure of the joint and surrounding bones and soft tissues

Treating Rotator Cuff Injuries

If the injury is mild, conservative measures such as ice, resting, and physical therapy may heal the damage within a few months. If the patient does not rest the area, the injury can become more severe. More severe injuries require more intensive interventions. Depending on how quickly the injury is treated and the extent of the damage, the symptoms may take even longer to resolve and may not go away.

  • Steroid injections into the affected joint
  • Arthroscopic tendon repair, the least effective surgery, which repairs damage to the tendon through small incisions
  • Open tendon repair
  • Tendon transfer which replaces the involved tendon with another if the injured tendon is too damaged to be reattached
  • Shoulder replacement

Physical therapy is vital both before and after any procedures. A doctor may prescribe either over-the-counter pain relievers, such as ibuprofen or Tylenol, or stronger painkillers such as tramadol or opioids. In some cases of severe rotator cuff injuries, the injured person may never fully recover and can experience symptoms for the rest of their life. These people will have to apply for disability benefits for their rotator cuff injury.

Disability Evaluation of Rotator Cuff Injuries

If a person cannot work because of their rotator cuff injury and they have a long term disability insurance policy (individual or as part of a group plan with their employer), they may apply for Long Term Disability (LTD) benefits. The insurance company will review their claim to see if the claimant qualifies under the conditions of that plan.

Definition of Disability

Most LTD plans consider a person disabled if they have a medical condition that causes them to 1) be unable to perform their current job for the first two years of the policy and 2) be unable to work in any other position for the years following the initial 2-year period. Every plan is different, so it is important to review your policy for its specific requirements.

Evaluating Disability For People With Rotator Cuff Injuries

Disability claims are evaluated based on how the person is limited in their everyday activities. Claims adjusters assess each claim on an individual basis. Particular limitations for people with disabling rotator cuff injuries include an inability to bend or lift items, difficulty reaching above or below the shoulders, and making repetitious movements. Since most workplaces require workers to use their arms and hands, sometimes it is difficult to find work that does not include motions that can cause further injury.

Chronic pain from rotator cuff injuries can lead to symptoms that interfere with a person’s quality of life. Pain can lead to insomnia, difficulty focusing, difficulty understanding or communicating, and trouble staying in a single position for long periods. Some patients experience depression or anxiety as a result of their injury and its effect on their lives.

When applying for long term benefits for rotator cuff injuries, it is essential to list all of the conditions and symptoms that affect your quality of life and ability to work. Benefits are not typically decided based on one condition, but the total health of the applicant.

What the Insurance Company Needs From You and Your Medical Providers

The insurance company will need to know how to contact all of the doctors who have treated you so that they can get your records when evaluating your claim. You may need to send those records yourself if your insurance company cannot get them from your doctors. While all your medical records are important, it is especially helpful to include a history of any treatments and surgeries as well as records of your ongoing symptoms. If you have other medical conditions that can impact your quality of life, it is essential to include those records as well.

The insurance company will need to see proof of your diagnosis and your ongoing symptoms, as well as evidence of how those symptoms affect your life. Providing detailed documentation is key to a successful claim. Residual Functional Capacity (RFC) assessments determine how you are affected by the condition and what you can do with your limitations. It is used to determine what jobs you may still be qualified to perform. Make sure that you are as honest as possible with your doctors so that they can complete a correct RFC for you.

Working with an Experienced  LTD Insurance Attorney

If you have a rotator cuff injury, you may be intimidated by the long-term disability process. You do not have to fight the insurance companies alone. An experienced disability attorney will guide you through the process and give you the best chance of getting the benefits you deserve for your rotator cuff injury.

The experienced disability attorneys at the Ortiz Law Firm can help you through the process, from appeals to potential litigation. You can seek help without worrying about upfront costs or unexpected bills. Our law experts will focus on your case so you can focus on your illness.

The Ortiz Law Firm has successfully represented people in disability cases across the United States. To see how we can help you win your long-term disability case, call us at (850) 308-7833