Complex Regional Pain Syndrome
Complex Regional Pain Syndrome (CRPS), also known as Reflex Sympathetic Dystrophy (RSD), is a condition that affects more than 1 million Americans. It often occurs following a workplace injury and can be the basis for filing a successful Boston workers’ compensation claim.
Complex Regional Pain Syndrome, as defined by the National Institute of Neurological Disorders and Stroke, is a chronic pain condition that often lasts more than six months. It most commonly affects a single limb such as leg, arm, foot or hand, and typically occurs following an injury. This includes injuries due to workplace accidents.
Much remains unknown about Complex Regional Pain Syndrome, but researchers have surmised the condition occurs when an injury damages the central nervous system or the peripheral nervous system. The serious medical condition is further broken down into the following:
- CRPS-1 – which involves a condition where there has not been any confirmed damage to the nervous system. This type of CRPS was formerly known as reflex sympathetic dystrophy syndrome.
- CRPS-2 – involves a situation in which a nerve injury has been confirmed. This type of CRPS was previously known as causalgia.
This condition commonly occurs in women more than men, but it also seems to peak at the age of 40, and, as a result, our workplace injury lawyers often hear from prospective clients who are around that age. However, it can occur in individuals of all ages, depending upon your injuries.Difficulty Working With CRPS
It is very difficult for any person to work their normal job if they suffer from Complex Regional Pain Syndrome. The symptoms can be quite extreme, often consisting of:
- A pins and needles feeling that gets to the point where the skin feels like it is on fire or burning for prolonged periods of time in the affected limb. In some cases, the burning sensation will spread, and, if the affected area is touched, even lightly, it can cause debilitating discomfort.
- Skin in the affected area changing in texture, and becoming very thin and shiny.
- The limb that is affected may sweat excessively.
- Joints may become very stiff.
- Hair may grow at the site of the condition in abnormal patterns.
- Muscle function and motor control will often become diminished.
- Tremors and abnormal jerking may occur in the affected limb.
Employees who are affected with some or all of these symptoms may have a difficult time working a full-time job, let alone the job they were previously working before they were injured by an on-the-job accident. Pursuant to Massachusetts General Laws Chapter 152, Section 34, if an injured worker is deemed totally disabled, they are entitled to compensation for a workplace injury, calculated as 60 percent of the employee’s average weekly wage (AWW) prior to becoming injured. If the 60 percent rate is below the state minimum compensation rate or above the state maximum weekly compensation rate, then the amount received will be calculated differently. The state maximum and minimum compensation rates are published by the Massachusetts Department of Industrial Accidents (DIA) each year.
Section 34 total disability payments can be paid for a maximum of 156 weeks. If an employee is still injured after 156 weeks, the benefits may be converted to an award for permanent and total incapacity benefits under Massachusetts General Laws Section 34A.
In many ways, Complex Regional Pain Syndrome is like fibromyalgia. Both these conditions affect the nerves and cause employees to suffer considerable levels of chronic pain, but they are not fully understood. They are also both conditions that rely heavily on patient narratives to diagnose. In the case of CRPS-1, there is no evidence of nervous system damage following a Boston workplace injury. This often leads to an insurance company denying a claim, arguing that the employee does not actually have the serious medical condition.Mechanism for Initial Denial of a Workers’ Compensation Claim
If an employee is injured on the job, he or she should notify their employer immediately. If the employee fails to do so, the employer’s insurance company may not have a record of the injury and may issue a denial of workers’ compensation benefits. A denial of a claim for benefits does not necessarily mean the employee’s claim is invalid. However, consultation with a Boston workplace injury lawyer may be necessary. If the insurer denies your workers’ compensation case a claim must be filed with DIA in order to obtain benefits.
The workers’ compensation insurance company may at some point during a case ask the employee to submit to a medical evaluation with a provider of their choosing. It is likely this doctor will find the employee is not incapacitated, or not totally incapacitated if there is any credible way to do so.
Massachusetts legislators were concerned that doctors who were hired by an insurance company might have a level of bias towards that company just as a treating physician might show some level of bias towards his or her patient. To address this issue, state legislators in the Commonwealth created a mechanism for the DIA to use to obtain a more neutral result. In cases where there is a genuine dispute as to a medical diagnosis or the employee’s work capacity, the DIA may have the injured worker examined by a court-appointed impartial physician. Pursuant to Massachusetts General Laws Chapter 152, Section 11A, the impartial medical examiner will examine the employee and write a report with their findings as to the employee’s medical condition, work capacity, and recommended ongoing treatment. Once that report is complete, the administrative law judge (ALJ) at the DIA is not permitted to review any additional medical records submitted by either party so long as the impartial physician’s report is deemed adequate. Additional records submitted by the parties may be used in other proceedings, such as during a deposition of the impartial medical examiner.
A genuine dispute as to a medical diagnosis will be more likely in cases that involve a diagnosis such as Complex Regional Pain Syndrome than it would be in cases involving clear injuries, such as a broken leg. The greater degree of uncertainty surrounding the medical conditions allows more room for an insurance company to argue that the employee is malingering, and not quite as injured as they claim to be. The most important thing an employee can do to address this issue is to speak with an experienced legal team who can fight for the employee’s rights to a full and appropriate award of benefits.