Does Workers’ Compensation Cover Carpal Tunnel Syndrome?
Can Carpal Tunnel Syndrome (CTS) be covered by workers compensation?
Carpal tunnel syndrome is a medical condition that affects the fingers, hand, wrist, and arm due to compression of the median nerve that is located in the wrist. Symptoms typically present themselves in the thumb side of the hand, with the thumb and first three fingers most likely to be affected. Symptoms of pain, tingling, and numbness are most commonly seen, but weakness in the hand and grip may also result. Because CTS symptoms develop over time, it is often difficult for a doctor to accurately prove that a person’s occupation is the cause of the condition in order for patients to receive workers compensation benefits in the State of Nevada.
Typical Carpal Tunnel Syndrome cases and physician response
When an employee begins to have symptoms related to carpal tunnel syndrome, it may occur more frequently at night and upon awakening from sleep. Although symptoms may become worse while working, the employee often hopes the symptoms will go away on their own. It may take months before the employee reports symptoms to an employer in order to receive an appropriate medical evaluation. Because symptoms appear gradually over time, it is often difficult for a physician to prove that an individual’s occupation was the direct cause of CTS and its symptoms for Nevada workers compensation benefits claims. When filling out the appropriate C-4 claim form, the physician will often use tendinitis as the diagnosis and will place a question mark in the area used to denote if the injury or illness is related to occupation.
Insurance Adjuster’s denial of the claim
Because there is no clear determination made by the doctor to connect the CTS symptoms directly with occupation, the Nevada workers compensation claim is typically denied. In some cases, the denial of workers compensation benefits in Nevada may have a designation “under medical investigation.” This allows the employee to see a hand specialist for a more thorough examination to prove that the carpal tunnel syndrome is a condition that is directly caused by the individual’s occupation for the purpose of filing an appeal. If there is no investigation notation in the denial, an individual may pay out of pocket to see a specialist for a more definitive diagnosis in order to file an appeal. Any appeal must be filed within 70 days of the denial, whether the individuals have completed their own medical evaluation or not.
Requirements of an orthopedic physician to diagnose CTS was work related
A hand specialist or orthopedic physician may not need to recommend additional testing in order to make a proper diagnosis of carpal tunnel syndrome. However, the insurance adjuster is more likely to approve a Nevada workers compensation claim with proper medical documentation, such as the results from nerve conduction studies and electromyography. The hand specialist must be able to show that a patient’s occupation duties were the direct cause of the condition. In addition, the orthopedic physician will need to rule out and prove that a patient’s medical history or non-occupational risk factors did not lead to the development of CTS. Non-occupational risk factors that may also lead to the development of this condition include:
- • Age; risk increases with aging
- • Pregnancy
- • The presence of other diseases such as diabetes or rheumatoid arthritis
- • Obesity
- • Gender; risk is higher in females
Information that helps the physician determine if CTS is work related
You can help to increase the chance of a successful claim by providing your doctor with relevant information pertaining to your specific work duties; especially those that you feel caused or contributed to your symptoms. In addition, it can help the hand specialist to better make a causal connection if you can provide the doctor with documentation of your specific job duties by providing your employer’s written documentation of the job description and specific duties required by your job. This will provide written evidence for certain occupational risk factors that the doctor will be looking for, which include activities such as the following:
- • Awkward wrist positions
- • Repetitive twisting of wrists
- • Repetitive hyper-flexion
- • Forceful or repetitive grasping and related movements
- • Prolonged use of vibratory tools that are held in the hands
Keyboard usage and Carpal Tunnel Syndrome
While many people associate daily typing or prolonged use of a computer keyboard with the development of carpal tunnel syndrome, research is not clear on the matter. There is conflicting research, even within the 2008 AMA Guides to the Evaluation of Disease and Injury Causation. For this reason, the orthopedic doctor will make their own determination for your individual case and may wish to consider many factors including how you position your hands when you type in order to make a proper determination.
Nevada Occupational Disease Act and Carpal Tunnel Syndrome
CTS is a medical condition that is approved for coverage under the Nevada Occupational Disease Act. However, there is a certain burden of proof that must be met in order to prove the condition was caused as a direct result of an employee’s work duties. Because there are such strong requirements in order for a claim to be approved, it is extremely difficult for the first examining physician to be able to provide enough medical evidence and proof of such a connection between the symptoms and your job duties. In order for these types of claims to be approved, it often takes a hand specialist or an orthopedic physician to provide proper documentation of the problem as well as the necessary proof and documentation to evidence a causal relationship between the symptoms and an employee’s occupational activities.
Legal Assistance for Carpal Tunnel Workers Compensation Claims
If you are pursuing a claim in Nevada for workers compensation benefits due to CTS caused by your occupation, an attorney from the Morris / Anderson Law Firm can help. The qualified attorneys have experience working with these types of cases and can help guide you to building a strong case to help support your claim in order to receive the benefits that you are entitled to receive.