Is a knee replacement covered by workers compensation.

Knee injuries are common in the workplace, especially in industries like construction, agriculture, and manufacturing. The most common knee injuries result in a torn meniscus (cartilage in the knee), tendon tears, or aggravation of pre-existing arthritis. For all types of knee injuries, one surgery can lead to another and, eventually, a knee replacement. The cascade of knee degeneration from surgeries ultimately resulting in a knee replacement - and especially aggravation of pre-existing arthritis - are often denied by worker’s compensation insurance companies. The worker’s comp benefits you are entitled to following a knee replacement can be significant, thus the denial. You may need a dedicated and experienced worker’s compensation attorney to fight for the benefits you are entitled to for a knee replacement.

Common Workplace Knee Injuries

Workplace accidents can cause a variety of knee injuries. Some of the most common work-related knee injuries include:

  • Dislocation
  • Tendon injuries
  • Torn meniscus
  • Ligament injuries
  • Sprains
  • Fractured patella (kneecap)
  • Torn anterior cruciate ligament (ACL)
  • Torn medial cruciate ligament (MCL)
  • Aggravation of arthritis or aggravation of a prior injury/surgery

Some of these injuries occur immediately, while others occur over time. But if the cause of the injury was an incident at work or your work activities over time, you are eligible for worker’s compensation benefits. Kingree Law Firm can evaluate your situation and fight for the worker’s compensation benefits you deserve.

Why Do Worker’s Compensation Carriers Deny Claims for Knee Injuries?

Even if your knee injury was caused by your employment and should be covered through worker’s compensation, your employer’s worker’s compensation insurance carrier may deny your claim. Knee replacement surgery is expensive, and so are the indemnity benefits for lost wages and permanent disability following the knee replacement. Insurance companies love to save money, and knee replacement cases cost them a significant amount of money. To avoid paying the claim, they may argue your knee replacement was caused by preexisting conditions or is not work-related. This is true even if the carrier has already paid for one or more knee surgeries and the indemnity benefits that resulted from those surgeries. Then, when it comes time for the knee replacement, your benefits are denied.

If your doctor will support that your work injury or work activities were at least a material contributory causative factor in the onset or progression of your knee condition resulting in the need for a knee replacement, you may have a successful case. Your work injury or work activities, and any surgeries prior to the knee replacement, do not need to be the primary cause of the need for the knee replacement. They only need to be “a cause,” which can be as little as 5% to 10% contribution. Again, even if your doctor will support causation for the knee replacement, you may need our assistance because insurance carriers often fight these claims vigorously.

Benefits in a Worker’s Compensation Case for Knee Replacement Surgery

If your knee injury is work-related, the full cost of medical treatment can be claimed.

In addition to medical bills and other related expenses, you may be entitled to the following:

  • Temporary Disability. If you are temporarily disabled and cannot return to work while in the healing period, you are entitled to receive 66.67% of your average weekly wage when you are unable to return to work. If you return to work on light duty but are making less compared to pre-injury, you are entitled to 66.67% of the difference between your light duty earnings and your average weekly wage.
  • Permanent Disability. You are entitled to permanent partial disability for each surgery performed. PPD is paid regardless of work status, and is intended to cover the permanent functional damage to your knee. The minimum PPD rating for a knee replacement is 50% to the knee, which is stacked on top of any PPD ratings for work-related surgeries prior to the knee replacement.

Do I Have a Worker’s Compensation Case for a Knee Replacement?

The first step is that your doctor needs to support work-related causation. Nothing can be done in any work injury unless your doctors support it. However, there are many additional steps beyond this. Kingree Law Firm has extensive experience handling worker’s compensation claims for knee injuries. Luke Kingree can analyze your circumstances, discuss your options, and develop a strategy to obtain the compensation you deserve.

Kingree Law has offices in Madison and Eau Claire and proudly represents injured workers throughout Wisconsin. To learn more, read our FAQ section and Information Center on worker’s compensation benefits. Then contact Kingree Law to schedule a free, confidential consultation to discuss your situation and how we can help.