Workers’ Comp for Back Injuries: 10 FAQs Answered by Experts

Workers’ comp for a back injury can be overwhelming. You have questions, and we’ve got the answers from both medical and legal experts.

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Back pain at work can affect everyone from long-haul truckers and manual laborers to food service and hospitality workers. Even desk jockeys who occasionally lift something heavy are at risk.

Workers comp spine injuryYou may be entitled to workers' compensation if you hurt your back while you're on the clock

Many work-related back injuries can be prevented by lifting properly. “Prevention is the best medicine,” says Dwight S. Tyndall, MD, FAAOS, of DrSpine.com, a spine surgeon in Munster, Indiana who specializes in treating spine condition in the injured worker.

If you experience back pain at work because of an injury that occurred there, however, you may be entitled to workers’ compensation benefits. How does workers’ comp back injury coverage work? Here are 10 frequently asked questions about the workers’ comp program.

1. What Is Workers’ Compensation?

Workers' compensation is an insurance program that provides cash benefits and/or medical care for workers who are injured or become ill as a direct result of their job. Dating back to 1912, “it’s a no-fault system,” says Samuel Marcellino, a workers’ compensation attorney with Barkan Meizlish, LLP in Columbus, Ohio.

The gist? “If you’re injured at work, employers have negotiated to free themselves of most of the liability in exchange for paying for your recovery,” Marcellino says.

Employers with 500 employees or more can manage their own workers’ compensation program. In general, though, workers’ compensation programs are managed by state governments. Every state has its own workers’ compensation program that employers must pay into. The federal government also manages a federal workers’ compensation program for federal employees. The program is funded by your employer; the cost of the program doesn’t come out of your paycheck.

2. What Does Workers’ Compensation Cover?

Every state’s workers’ compensation program is different, but typically workers’ comp pays for your initial emergency department or urgent care visits, diagnostic testing that’s recommended by the emergency department, urgent care or follow-up physician, surgical intervention and any necessary rehabilitation.

Under workers’ comp, your workers’ comp back injury treatment is completely covered; you won’t have to meet a deductible or pay premiums, copayments or coinsurance. You’ll also continue to receive your regular health insurance benefits from your employer--which may require a meeting a deductible, paying a premium, copays and coinsurance--so you can get treatment for other health issues that may arise while you’re receiving workers’ comp treatment.

If you’re unable to work because of your workers comp back injury, you can expect to be paid your base salary after taxes while you’re being treated. “For patients whose salary is largely dependent on overtime work, that’s a disadvantage,” Dr. Tyndall says. “Workers’ comp can be a pay cut for those patients.”

In general, your workers’ comp pay can depend on the state you live in. “In many cases, there’s a wage rate set by the state,” Marsellino says.

3. Who Is Most Likely to Sustain a Spine/Back Injury on the Job? 

Employees who perform physical labor such as construction, factory workers and healthcare workers are at increased risk for injuring their back on the job, says Dr. Tyndall. The injuries typically result from improper lifting techniques, such as repetitively turning or twisting while lifting or holding something heavy, lifting heavy objects above your head or relying on your back muscles rather than your hips and legs when lifting by bending your knees and bringing a heavy object close to your core.            

Studies suggest that long-haul truckers also have a higher risk of back injuries. “After sitting for long periods, the back muscles become deconditioned. Then when long-haul truckers get to their destination, they have to unload their truck. It’s a double stress on the spine,” Dr. Tyndall says.

Long hours sitting plus physically demanding labor can equal increased back injury risk for truck driversLong hours sitting plus physically demanding labor can equal increased back injury risk for truck drivers

4. When and to Whom Should I Report My Injury?

Report your workers comp back injury to your supervisor or your company’s human resources’ department. Depending on your state, there’s a statute of limitations to file a claim for an injury. In Ohio, for example, you have one year from the date of injury to file a workers’ comp claim with your supervisor or human resources department.

Still, it’s best to report your injury and seek help as soon as you can after getting injured at work. The longer you wait, the more apt your employer is to dispute the legal validity of your workers’ comp claim, as in: If you were injured last year, why didn’t you file for workers’ comp sooner?

5. Does My Injury Qualify for Workers’ Comp?

“If you’re injured at work, you should assume your injury will be covered by workers’ comp,” Marsellino says. But it’s not always clear. What if you’re injured at a work-related BBQ? What if you’re working from home and trip down the stairs? These are gray areas.

With more people working from home as a result of COVID-19, “we’re just now starting to see some of these kinds of workers’ comp claims,” Marsellino says. In any event, report your injury to your employer and see how it goes. If your situation is untraditional, expect some back and forth with your employer. “It hasn’t been determined yet what constitutes being injured on the job if you’re working from home,” Marsellino says.

6. When Will I Be Referred to a Spine Specialist?

To receive treatment in the workers’ comp system, many patients with back injuries will initially be referred to an occupational therapy clinic. “An occupational therapist or clinic  will initiate the treatment, which might include medication, physical therapy, and diagnostic studies, such as an MRI or CT scan, or X-rays,” Dr. Tyndall says. “For many patients, that may be enough to get them back to work.”

If those initial treatments fail, you may be referred to a spine specialist to finetune your treatment plan. A spine specialist may recommend additional therapy, medication, diagnostic imaging or spinal injections or surgery. “Patients generally try occupational therapy for four to six weeks before they’re referred to me or the appropriate spine specialists ,” Dr. Tyndall says. But depending on your situation, you may be referred immediately for specialty spine care or even in six months. Much depends on your medical situation.

7. What Does My Employer Need From My Spine Specialist?

In most states, your employer will request to see your treatment plan and the spine surgeon’s clinic notes, the notes he or she writes about your case during your office or telehealth encounters.

“We have to provide our clinic notes and treatment plan to human resources departments and the workers’ compensation insurance carrier,” Dr. Tyndall says. “Sometimes, they will want us to extrapolate on when we think the patient will be back to work. There’s active communication between the treating physician, the company’s human resources department and the insurance carrier.”

It’s important to note that workers’ compensation is exempt from HIPAA privacy regulations. Your employer and the workers’ compensation insurance carrier can access your medical records related to your workers’ comp back injury without your permission, but your medical information unrelated to your injury is still restricted.

8. Can My Doctor Help Me Obtain Workers’ Comp?

Generally, no. Obtaining workers’ comp is between you and your employer, not your doctor. “Sometimes I will be asked to make a determination if a patient’s injury is work related, which involves going through the patient’s medical records presented to me, but those instances are rare,” Dr. Tyndall says.

9. How Long Do Workers’ Comp Benefits Last?

It depends on your case and where you live. “Every state is its own animal,” Marsellino says. In Ohio, workers’ comp treatment can be ongoing for decades as long as treatment is consistent. If you have a workers’ comp claim, he recommends meeting with a workers’ comp attorney in your state at the beginning of the process to learn your rights and the process timeline.

To prevent issues from arising, such as your employer pressuring you to come back to work before your doctor‘s given you the okay, “it’s better to be proactive,” Marsellino says.

10. What Can I Do to Make the Most of Workers’ Comp?

“Keep your appointments and be compliant with care and treatment recommendations,” Dr. Tyndall says, “and be transparent with your physician. If you’re improving with treatment, say so. If you’re not improving, try to be as descriptive as you can about what ails you and what makes you feel better.” The idea is to team up with your doctor so you can get better and back to work and your daily activities as soon as possible.

Updated on: 08/10/20
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Dwight S. Tyndall, MD, FAAOS
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