Nothing in this article should be taken as legal advice. Every case is different.
A shoulder injury from a specific accident at work in Virginia is covered by workers’ comp: medical care, including surgery, wage checks while you can’t work or are on lower-paying light duty, and payment for any permanent loss of use, which is rated to the arm. Shoulder claims are also some of the most fought over. Rotator cuffs wear with age, MRIs often show old changes, and the insurance company will look hard at whether the accident caused the tear or just happened near it.
Does Workers’ Comp Cover a Shoulder Injury?
Virginia workers’ comp covers a shoulder injury caused by an identifiable incident at a reasonably definite time that produces a sudden structural or mechanical change in your body. The accident must also arise out of and in the course of your employment, which means an actual risk of your job caused it.
Shoulder accidents at work usually look like one of these:
- Lifting, pushing, or pulling something heavy, and feeling a pop or tearing pain
- Catching a falling load, a patient, or a coworker
- Falling onto an outstretched arm or directly onto the shoulder
- A sudden jerk of the arm by a machine, a hose, a leash, or a person
- A vehicle crash while driving for work
Shoulder pain that builds up over months of overhead work is a different matter. Virginia generally doesn’t cover injuries that develop gradually from repetitive work, even when the job clearly played a part. If you can point to the moment it happened, say so, to your supervisor and to the first doctor, in those words.
Common Shoulder Injuries at Work
| Injury | What it is | Why it matters to the claim |
|---|---|---|
| Rotator cuff tear | A tear in the tendons that hold the ball of the shoulder in its socket and lift the arm | Partial tears are common with age, so causation is the usual fight |
| Labral (SLAP) tear | A tear in the ring of cartilage around the socket | Often missed on early X-rays; may need an MRI with contrast |
| Dislocation | The ball comes out of the socket | Can tear the labrum or rotator cuff and lead to repeat dislocations |
| AC joint separation | The collarbone separates from the top of the shoulder blade | Common in falls; some need surgery, many don’t |
| Fracture | A break in the upper arm bone, collarbone, or shoulder blade | Easy to prove, but recovery can be long |
| Biceps tendon injury | A tear or rupture of the tendon at the front of the shoulder | Often found alongside a rotator cuff or labral tear |
Why Shoulder Claims Get Denied
A few of the many defenses insurance companies raise in shoulder cases:
- “It’s degenerative.” The MRI shows fraying, arthritis, or bone spurs, and the insurance company says the tear was already there. An accident that makes an old shoulder condition worse can still be covered, but you usually need your doctor to explain how the accident made it worse. Here’s more on pre-existing conditions.
- “There was no specific accident.” The first medical record says the shoulder “has been bothering you for a while.” A history like that is hard to undo.
- “The shoulder was never mentioned.” People often report the back or the neck first and the shoulder weeks later. If a body part isn’t in the early records, it is much harder to get covered.
- “Our doctor says it isn’t work related.” The insurance company can send you to its own doctor for an independent medical exam. Here’s what happens after an IME.
Treatment and Surgery
The insurance company is required to pay for medical treatment that is reasonable, necessary, and causally related to your work accident. That doesn’t mean it will. In shoulder cases, the fights usually come at the MRI, at the surgery request, and at physical therapy visits after surgery.
You’ll usually pick your treating doctor from a list (a “panel”) of at least three doctors your employer offers. That choice matters, because the treating doctor’s opinion on causation and restrictions carries the most weight. Here’s more on choosing a doctor for a Virginia workers’ comp claim.
Recovery from rotator cuff or labral repair often takes months, and many people spend part of that time on light duty with lifting and overhead restrictions. If light duty pays less, you may be due partial wage checks for the difference. Here’s more on light duty in Virginia.
How a Shoulder Injury Is Rated
A shoulder injury is rated as loss of use of the arm, at 200 weeks, or 2 weeks of pay for each 1% (Va. Code § 65.2-503). The shoulder isn’t on Virginia’s schedule, so a rotator cuff tear, a labral tear, or a shoulder replacement is paid through the arm. The doctor has to connect the shoulder findings, such as lost motion and strength, to how the arm works.
A rating is usually given once you reach maximum medical improvement. Here’s how an impairment rating works in Virginia and what maximum medical improvement means.
What Affects a Shoulder Claim’s Value
There’s no reliable average for a shoulder claim. The value depends on facts that differ from case to case:
- Whether you needed surgery, and whether more surgery is likely
- How long you were out of work or on lower-paying light duty
- Whether you can go back to your old job with your restrictions
- Your arm rating
- The cost of future medical care, which a full and final settlement usually closes
Here’s more on workers’ comp settlements in Virginia.
Questions About Shoulder Injuries at Work
Is a Rotator Cuff Tear Covered If I Had Shoulder Problems Before?
It can be. The question is whether the work accident caused a new tear or made an old condition worse. Expect the insurance company to ask for your prior shoulder records, and expect the outcome to turn on what your doctor says about the accident.
Can I Get Workers’ Comp for a Shoulder Injury from Repetitive Overhead Work?
Usually not as an injury, because Virginia requires a specific accident at a definite time. If there was a moment, a lift or a pull, when the pain started, that moment may be the accident.
What If I Hurt My Shoulder Favoring Another Work Injury?
An injury caused by your work injury, such as a shoulder hurt using a crutch or a fall caused by a bad knee, can be covered as part of the original claim. Here’s more on injuring another body part while favoring a work injury.
Pathfinder Injury Law
Pathfinder Injury Law handles only Virginia workers’ compensation claims. Call 804-505-0633 or use our online contact form.