On The Job Injuries

Carpal Tunnel Syndrome

TULSA OKLAHOMA CARPAL TUNNEL SYNDROME & REPETITIVE MOTION INJURIES

Carpal tunnel syndrome, like overuse syndrome, cumulative trauma and other repetitive motion workers compensation injuries are unique in that they cannot be identified or defined by any particular date, time, event or place. They come about due to nothing more than an Oklahoma City or Tulsa area worker getting up, going to work and putting in 110% at the same or similar task for long enough to develop the underlying problem, whether for the same employer or successive employers. Of course carpal tunnel syndrome & other overuse, cumulative or repetitive motion injuries are by nature reserved for those who persevere in spite of mere discomfort, since many workers quit the task causing the continuing damage thereby avoiding the injury altogether.

Historically the filing of these type of carpal tunnel workers comp cases with either the Oklahoma or Tulsa Workers’ Compensation Courts have resulted in the current employer &/or his or her attorney or lawyer dragging into the suit every employer they could identify who could in any small way be responsible for activity resulting in the carpal tunnel syndrome injury. Such conduct inured to the current employer’s benefit and many hurt workers simply gave up the work comp claim owing to the time delays inherent in the procedural nightmare of lining up and allocating liability & any final cash settlement of the carpal tunnel case among multiple successive employers, many of which could not even identify who their insurance company was during the time period the injured worker was under their employ.

Such gave way to the current system of liability in Oklahoma for carpal tunnel syndrome injuries, under which the last employer and its insurance company under which the injured employee worked and was exposed to the conditions which caused the carpal tunnel syndrome injury for more than 90 days is soley responsible for the entire workmans compensation settlement & injury, and 100% of the medical expense and indemnity payments payable for the industrial injury*. However problems still arise, since the last employer legally responsible may have changed workmans comp insurance coverage during this 90 day period. The employer and his or her attorney or lawyer may also defend these workmen’s compensation carpal tunnel cases asserting that the claimed carpal tunnel condition was instead caused by activity outside of the work environment or by a degenerative or other condition unique to the injured worker.

Industrial carpal tunnel syndrome is classically associated with symptoms of pain, swelling, numbness, tingling and weakness of an overworked employee’s hand or both hands (classified as “bilateral carpal tunnel syndrome”). As part of a comprehensive office examination a doctor can confirm the presence and extent of an injured worker’s carpal tunnel syndrome by standard orthopedic tests including, but not limited to, the Phalen’s maneuver test & the Tinel’s sign. More detailed examination of the fact and severity of an injured employee’s carpal tunnel syndrome can be had by performing minimally invasive electrodiagnostic tests referred to as electromyography & nerve conduction studies (“EMG” & “NCS”, or EMG/NCS, respectively). Mild symptoms of carpal tunnel syndrome can be treated conservatively with splinting (usually with a “cock-up” splint) and injections–either a steroid injection &/or a cortisone injection, or both. More serious carpal tunnel syndrome cases can only be resolved by carpal tunnel surgery, more specifially a carpal tunnel release, either done as an open carpal tunnel release or an endoscopic carpal tunnel release. These surgeries are typically performed by an hand surgeon, an orthopedic surgeon, a neurosurgeon or even a plastic surgeon.

As with all industrial injury, an injured worker &/or his or her attorney or lawyer are required to prove, with competent medical evidence, that the claimed occupational exposure is and was the “major cause” of the carpal tunnel syndrome, and that the carpal tunnel syndrome arose out of the course and scope of the employee’s work duty, as opposed to some unrelated outside activity. Furthermore, proof of a carpal tunnel syndrome injury before either the Oklahoma City or Tulsa Workers’ Compensation Courts must be by objective medical findings, not simply an injured worker’s perceived or subjective complaints*. Finally any medical testimony and other opinions offered by any attorney or lawyer from a medical doctor addressing compensability and permanent partial impairment in a carpal tunnel syndrome case must be stated within a reasonable degree of medical certainty, to be admissible as competent evidence before the Oklahoma & Tulsa Workers’ Compensation Court.

*NOTE: The Oklahoma City & Tulsa Workers’ Compensation Courts define a carpal tunnel syndrome or any other ”cumulative trauma” injury as one, the major cause of which results from employment activities which are repetitive in nature and engaged in over a period of time and which is supported by objective medical evidence.

*NOTE: The pertinent language of the Oklahoma Workers’ Compensation Act addressing the exclusive liability of the last of a line of successive employers each contributing to the injured worker’s cumulative trauma or carpal tunnel syndrome injury is as follows:

“Where workmens comp is payable for an injury resulting from carpal tunnel syndrome, the last employer in whose employment the worker was last injuriously exposed to the trauma causing carpal tunnel syndrome during a period of at least ninety (90) days or more, and the insurance company, if any, on the risk when the employee was last so exposed under such employer, shall alone be liable therefor for workers compensation benefits, without right to contribution from any prior employer or insurance company. If there is no employer in whose employment the employee was injuriously exposed to the trauma for a period of at least ninety (90) days, then the last employer in whose employment the employee was last injuriously exposed to the trauma and the insurance carrier, if any, on the risk when such employee was last so exposed under such employer, shall be liable thereof for workers comp benefits.”

Filing and other procedural requirements are strict for Oklahoma & Tulsa carpal tunnel syndrome work comp cases. There is a presumption against the work-related nature of carpal tunnel syndrome claims if not filed within a specified period following a workers’ separation from the employment, for whatever reason*. Additionally–employers and their attorneys & lawyers will engage in strained interpretations in calculating the law related to the required 90 day exposure period. To further complicate matters, even though liability for the injury is determined by the date of last exposure, benefit levels by workmens compensation law will be determined by the date of awareness or initial onset of the symptoms, which could be several years earlier.

*NOTE: For carpal tunnel syndrome injury cases filed in Oklahoma there is a rebuttable presumption before the Oklahoma City & Tulsa Workers’ Compensation Courts stating that any injury from carpal tunnel syndrome caused by cumulative trauma does not arise out of and in the course of the hurt worker’s employment unless oral or written notice is given by the injured employee to his or her employer within ninety (90) days of the employee’s separation from employment. Such presumption must be overcome by a preponderance of the evidence put forth by the injured worker’s attorney or lawyer. Additionally–the Oklahoma Workers’ Compensation Act provides that in all cases, including carpal tunnel syndrome and other repetitive motion trauma claims, post-termination injury claims must be filed by the injured worker &/or his or her attorney or lawyer within six (6) months of the injured employee’s termination of employment.–or are forever barred. Finally, with respect to any disease or injury caused by repeated trauma causually connected with employment, including carpal tunnel syndrome, a formal claim must be filed by the hurt worker &/or his or her attorney or lawyer with either the Oklahoma City or Tulsa Workers’ Compensation Court within two (2) years of the date of last trauma or hazardous exposure to the repetitive conditions causing the carpal tunnel syndrome in the first place.

Carpal tunnel syndrome injury cases in Oklahoma are not properly filed unless & until the injured worker &/or his attorneys or lawyers file with either the Oklahoma City or Tulsa Workers’ Compensation Court a fully executed FORM 3 EMPLOYEE’S FIRST NOTICE OF ACCIDENTAL INJURY AND CLAIM FOR COMPENSATION.

NOTE: The Oklahoma City & Tulsa Workers’ Compensation Court rules provide, that as between the injured employee and the insurance company, any notice to or knowledge of the occurrence of the injury on the part of the employer shall be deemed notice or knowledge, as the case may be, on the part of the insurance company.

LIMITATIONS OF TTD FOR CARPAL TUNNEL SYNDROME: THE “SOFT-TISSUE” INJURY

The Oklahoma City & Tulsa Workers’ Compensation Courts seriously limit the time an injured worker can draw Temporary Total Disability benefits (or “TTD”) for a repetitive carpal tunnel syndrome injury defined by law as a “Soft Tissue Injury”. More specifically, the Oklahoma Workers’ Compensation Act provides that in the case of any nonsurgical soft tissue injury, in which the employer and its insurance company have promptly provided medical care, temporary total compensation shall not exceed eight (8) weeks. However, any injured worker who has been recommended by his or her treating physician for one or more injections may petition the Oklahoma City or Tulsa Workers’ Compensation Court, as the case may be–for one extension of temporary total disability compensation, and the Court may order such an extension, not to exceed eight (8) additional weeks. Finally, any injured employee who has been recommended by his or her treating physician for carpal tunnel surgery may, through his or her attorney or lawyer, petition the Oklahoma or Tulsa Workers’ Compensation Court for one extension of temporary total disability benefits compensation and the court may order such an extension, not to exceed sixteen (16) additional weeks, if the treating physician indicates that such an extension is appropriate or as agreed to by all parties and their attorneys or lawyers.

However–in the event the carpal tunnel syndrome surgery is not performed within one hundred twenty (120) days of the approval of the surgery by the employer or employer’s insurance company or an order of either the Oklahoma City or Tulsa Workers’ Compensation Court authorizing such carpal tunnel syndrome surgery, the benefits for the extension period shall be terminated by the Court, unless the Court finds the delay was beyond the control of the injured employee.

In the event carpal tunnel release surgery is performed, the period of temporary total disability and total payments of workers comp for TTD benefits may not exceed a maximum of one-hundred fifty-six (156) weeks (or three years) in the aggregate except for good cause shown, as determined by either the Oklahoma City or Tulsa Workmens Compensation Court, upon timely application and proper proof to the Work Comp Court of such an extension by the injured worker &/or his or her attorney or lawyer.

NOTE: For purposes of the Oklahoma Workers’ Compensation Act, “soft tissue injury” means damage to one or more of the tissues that surround bones and joints and specifically includes carpal tunnel syndrome and other cumulative trauma type injuries.

TULSA CARPAL TUNNEL PERMANENT PARTIAL DISABILITY AWARDS & SETTLEMENTS

The determination of an injured employee’s permanent partial disability settlement for his or her carpal tunnel syndrome is always the responsibility of the Oklahoma City & Tulsa Workers’ Compensation Courts. In this regard–any claim submitted by an injured worker by his or her attorney or lawyer for compensation for permanent partial disability for a carpal tunnel syndrome injury must be supported by competent medical testimony. Additionally, any carpal tunnel syndrome settlement &/or award for permanent partial disability must be supported by objective medical findings and evidence and which shall include an evaluation by a physician stating his or her opinion of the injured worker’s percentage of permanent impairment related to the carpal tunnel syndrome and whether or not in the doctor’s opinion the carpal tunnel syndrome is job-related and caused by the accidental occupational injury. Finally–any medical opinions addressing permanent impairment of a worker’s carpal tunnel syndrome put before the Oklahoma Workers’ Compensation Court must be stated within a reasonable degree of medical certainty.

NOTE: Oklahoma City & Tulsa Workers’ Compensation Court rules set forth that in Oklahoma “Permanent Partial Disability” for a carpal tunnel syndrome injury means permanent disability which is less than total and shall be equal to or the same as permanent impairment. In turn Oklahoma Courts have determined that the term “Permanent Impairment” as it relates to carpal tunnel means any anatomical abnormality after maximum medical improvement has been achieved, which abnormality or loss a physician considers to be capable of being evaluated at the time the rating is made. In this regard in Oklahoma “Maximum Medical Improvement” has been defined to mean that no further material improvement would reasonably be expected from medical treatment or the passage of time.

Unlike brain, head, neck, back, spine, disc, shoulder, hip & other “whole person” or “whole body” injuries, commonly referred to by the Oklahoma Workers’ Compensation Court as “OTHER CASES” for permanent partial disability rating purposes, carpal tunnel syndrome injuries are instead classified as a “SCHEDULED INJURY” and as such, and as opposed to the “OTHER CASES”, any physician evaluating an injured employee’s permanent disability resulting from & related to his or her carpal tunnel syndrome IS NOT required to follow the AMA Guides to the Evaluation of Permanent Impairment as such physician would be required to strictly follow when evaluating & providing an impairment rating for “OTHER CASES” injuries. When providing an impairment rating for and relating to a carpal tunnel injury or surgery case, as with all other scheduled member injury claims, a physician can rate and consider the overall “nature & extent” of the injured worker’s injury and impairment including any pain or loss of strength of the employee’s hands. However–all evaluations of permanent impairment must by supported by objective medical evidence.

The Oklahoma City & Tulsa Workers’ Compensation Court considers carpal tunnel syndrome to be a hand injury for permanent partial disability settlement purposes. Furthermore–for the total loss or total loss of use of a hand the Oklahoma Workers’ Compensation Court provides an injured worker a permanent partial disability award of two hundred twenty (220) weeks of benefits. However, for the permanent partial loss of use of an injured worker’s hand due to the residuals of a carpal tunnel injury or surgery–compensation shall be seventy percent (70%) of the employee’s average weekly wage during that portion of the number of weeks in the foregoing schedule provided for the loss of such hand which the partial loss of use thereof bears to the total loss of use of such hand.

TULSA CARPAL TUNNEL SYNDROME VOCATIONAL REHABILITATION & RETRAINING

When, as a result of the injured worker’s carpal tunnel syndrome, they are unable to perform the same occupational duties he or she was performing prior to the development of carpal tunnel syndrome &/or carpal tunnel realease or surgery, the Oklahoma City &/or Tulsa Workers’ Compensation Court, as the case may be, will award and otherwise find the hurt employee entitled to such vocational rehabilitation services, retraining and job placement so as to restore the injured employee to gainful employment–all which shall be provided at the expense of the employer.

vocational rehabilitation services or training shall not extend for a period of more than fifty-two (52) weeks. This period may be extended for an additional fifty-two (52) weeks or portion thereof by special order of the Court, after affording the interested parties an opportunity to be heard. A request for vocational rehabilitation services or training may be filed with the Administrator by an interested party at any time after the date of injury but not later than sixty (60) days from the date of the final determination that permanent partial disability benefits are payable to the employee.

Common sense will dictate that an injured worker even after completing treatment for a cumulative trauma workmens comp condition will be unable to return to his normal and customary occupation, since the repetitive nature of this work caused the worker to be injured in the first place. As such certain permanent disability and future economic loss will occur in these worker’s compensation cases. Our office understands the unique challenges inherent in cumulative trauma claims. Call one of our attorneys or lawyers today for a free analysis of your case.