Contusions, Sprains and Strains
When the Office of Workers Compensation (OWCP) accepts claims, many times they accept the claims as contusions, sprains, or strains. The injured worker is happy because they are getting medical care for their injuries. The injured worker should be concerned about the conditions accepted. It should cause concern because contusions, sprains, and strains resolve quickly. Around ninety days after claims acceptance the claims examiner will set up a second opinion physician examination and send them a Statement of Accepted Facts (SOAF) asking the doctor if the contusions, sprains, or strains have been resolved. The second opinion doctors will surely say these conditions have been resolved.
If they receive this type of claims acceptance, the injured federal employee should immediately go to their treating physician and update their medical diagnosis to the conditions that the injured worker really has and then include the medical test(s) to prove the diagnosis. For example, the injured worker had the claim accepted as a sprain of the left shoulder but actually has a shoulder rotator cuff tear. The next step is for the injured employee to obtain a medical report from the doctor detailing the shoulder rotator cuff tear and then get medical tests which support the diagnosis.
The definitions of contusion, sprains, and strains are as follows:
Contusions are simply bruises of a certain part of your body. One must be aware that a bruise will not last forever, and, in fact, is a short term problem. I have seen a shoulder injury accepted as a contusion. In this case, the worker unknowingly sustained an injury which required shoulder surgery; this surgery should have been paid by the Department of Labor. The doctor inaccurately diagnosed the injury as a contusion. One year later the employee was sent to a second opinion doctor, and the doctor was asked if the contusion had resolved itself. The doctor’s answer was, of course, yes, and the injured worker’s case was then closed – the employee still requiring the surgery for the incorrectly diagnosed shoulder injury. The worker eventually discovered and was diagnosed with a right shoulder rotator cuff tear. In this case and cases like it, the injured worker should forward to the claims examiner the most recent medical report discussing the shoulder injury and the MRI test results and nerve conduction test results which support the updated diagnosis.
Sprain means to wrench the muscles or ligaments around a joint without dislocation. There have been many cases where the claims examiner accepted the condition of a left knee sprain when injured worker’s real condition was a torn meniscus. In this case too, the injured worker should update their medical diagnosis to torn meniscus with a medical report and all tests that were performed to help arrive at the diagnosis.
Strains are weakening of the muscles by over exertion or to stretch the muscle beyond the proper limit. The claims examiner accepts the injured federal worker’s condition as a strain of the right shoulder. However, the real diagnosis should be a right shoulder rotator cuff tear. The injured worker needs to upgrade this condition in the same manner as the prior examples.
Most claimants and their medical providers are so excited that the claim has been accepted that they do not pay attention to the accepted condition and the related danger that the claim is accepted for the wrong diagnosis. The injured worker and their medical provider must perform all tests that are necessary to prove a proper diagnosis. They should also be very persistent in having the condition properly accepted for what the claimant’s condition and diagnosis really are.
If you see the accepted condition(s) as contusions, sprains, or strains, you now know that these are warnings which in the near future could create problems with your claim(s).