Workers' Comp for Spine Injuries

Spine Injuries & Workers’ Comp: The Nitty-Gritty

Types of Accidents Leading to Spine Injuries

Workplace back injuries often result from:

• Overexertion: Lifting, pulling, pushing, or carrying objects that are too heavy or handled improperly.
• Falls: Slipping on wet surfaces, tripping over obstacles, or falling from ladders, scaffolding, or vehicles.
• Repetitive Motion/Strain: Performing the same movements over and over, like twisting, bending, or maintaining awkward postures for long periods (common in assembly lines, data entry, or healthcare).
• Impact/Trauma: Being struck by an object, crushed, or involved in a vehicle accident while on the job.
• Prolonged Sitting/Standing: Poor posture or lack of ergonomic support can gradually lead to chronic back issues.

Types of Spine Injuries Covered

Workers’ comp can cover a wide spectrum of spine injuries, including:

• Sprains and Strains: Damage to ligaments or muscles in the back. While common, they can be debilitating.
• Herniated or Bulging Discs: When the soft cushion between vertebrae ruptures or pushes out, pressing on nerves (also called slipped or ruptured discs).
• Fractured Vertebrae: Broken bones in the spinal column, often from falls or impacts.
• Spinal Stenosis: Narrowing of the spinal canal, putting pressure on the spinal cord and nerves. Can be caused or aggravated by work activities.
• Sciatica: Pain radiating down the leg caused by compression of the sciatic nerve, frequently linked to disc problems.
• Degenerative Disc Disease Aggravation: While wear and tear happens naturally, a work injury or repetitive strain can significantly worsen a pre-existing degenerative condition, making it compensable.
• Spinal Cord Injuries (SCIs): Severe damage leading to potential paralysis or loss of function.
• Cervical Spine Injury: Often resulting from trauma, can range from minor sprains to severe spinal cord damage.
• Neck Fusion Surgery: Typically performed to address conditions like herniated discs, degenerative disc disease, or spinal stenosis.
• Sacrotuberous Ligament (STL) Injury: This broad, fibrous ligament connects the lower spine to the hip bone and can be strained by sudden movements, falls, or repetitive stress. Injury to this area often results in stiffness, discomfort, and limited mobility in the lower back and hips.

Relevant South Carolina Laws and Concepts

Keep these points from the South Carolina Workers’ Compensation Act (Title 42) in mind:

• “Arising Out of and In the Course of”: Your injury must happen because of your work duties and while you are performing them. (S.C. Code Ann. § 42-1-160)
• Employer Notice: You must report your injury to your employer, preferably in writing, within 90 days. Failure to do so can jeopardize your claim. (S.C. Code Ann. § 42-15-20)
• Claim Filing Deadline: You generally have two years from the date of the accident (or death) to file a claim (Form 50 or Form 52) with the SC Workers’ Compensation Commission. (S.C. Code Ann. § 42-15-40)
• Employer-Directed Medical Care: Generally, the employer or their insurer has the right to choose the doctor who treats your work injury. Seeking unauthorized treatment might not be covered. (S.C. Code Ann. § 42-15-60)
• No-Fault System: You don’t need to prove your employer was negligent to get benefits. Even if the accident was partly your fault, you’re usually covered (unless specific exceptions like intoxication apply). (S.C. Code Ann. § 42-1-160 implies this by focusing on the work connection, not fault).
• Definition of “Back”: Importantly, South Carolina case law (Clemmons v. Lowe’s Home Centers, Inc.) has established that for workers’ comp purposes, particularly regarding disability ratings, the “back” includes the neck (cervical spine).

The Fight You Didn’t Sign Up For: Battling the Insurance Company

You reported your injury, saw the doctor, and figured help was on the way. Then reality hits. The insurance adjuster starts calling, asking confusing questions, or maybe they just go silent. Perhaps your claim is denied all together.

Welcome to the frustrating reality many injured workers face. Insurance companies, whether private carriers or the State Accident Fund (sometimes used by public employers), are businesses. Their goal is to minimize payouts, not maximize your recovery.

Tactics Insurers Use to Reduce or Deny Spine Injury Claims

Be prepared for potential roadblocks. Adjusters and insurers might:

• Delay, Delay, Delay: Slow communication, unanswered calls, endless requests for “more information” – these tactics aim to frustrate you into giving up or accepting a lowball offer. They might delay authorizing necessary treatments or paying medical bills promptly.
• Dispute the Work Connection: They might argue your back pain is from a pre-existing condition, normal aging, or an injury that happened outside of work. This is especially common with injuries that develop gradually (repetitive strain) rather than from a specific accident.
• Downplay the Injury Severity: The insurer might pressure the doctor for a quick release back to work, challenge the need for surgery or extensive therapy, or push for a low impairment rating to reduce permanent disability payments.
• Request Recorded Statements: They’ll ask to record your statement early on, hoping you’ll say something inconsistent or downplay your pain, which they can use against you later. Politely decline until you’ve spoken with an attorney.
• Use Surveillance: Investigators might discreetly film you doing daily activities, hoping to catch something that contradicts your reported limitations (like lifting groceries when you claimed you couldn’t lift).
• Offer Quick, Low Settlements: They might offer a lump sum early on, hoping you’ll take it out of desperation before the full extent of your injury and its long-term impact are known.
• Independent Medical Examinations (IMEs): They have the right to send you to a doctor of their choice for an evaluation. These IME doctors often produce reports favorable to the insurer, disputing your treating doctor’s opinions.
• Challenge Treatment Necessity: Adjusters may question whether certain tests, therapies, or surgeries recommended by your doctor are truly “reasonable and necessary,” delaying or denying approval.