Filing a Workers’ Comp Claim for Complex Regional Pain Syndrome

Workers’ compensation is no-fault insurance that covers employees’ work-related accidental injuries and occupational illnesses. If you’re injured or become ill in the course and scope of performing your job duties in South Carolina, you may file a claim for workers’ comp benefits, which cover all your medical expenses and two-thirds of wages you lose due to time off work. In some cases, long-term disability benefits and vocational re-training are available as well. If you lose a loved one to a work-related accident or illness, you may file a claim for workers’ comp death benefits.

Nearly every South Carolina company or business with four or more employees is required to carry workers’ comp insurance, and most employees are eligible to receive benefits. There is no need to prove your employer was negligent or did anything wrong to cause your injury or illness. Even workers who are responsible for their own accidental injuries may file claims, and employers may not terminate or retaliate against them for doing so. You must, however, be able to prove your injury or illness is work-related, and some claims are easier to prove than others. Claims for complex regional pain syndrome (CRPS) are among the most difficult.

Work-Related Complex Regional Pain Syndrome

CRPS, sometimes called reflex sympathetic dystrophy (RSD), is a condition that can develop after you’ve recovered from a work-related injury. You might think of it as your body’s delayed reaction to extreme physical trauma. The symptoms of CRPS are:

• Swelling of the affected area
• Extreme sensitivity to touch or cold
• Stiffness in joints
• Spasms, weakness, or atrophy of muscles
• Abnormal nail and hair growth
• Changes in the color or texture of the skin
• Permanent contraction of muscles and tendons in the affected area
• Chronic and extreme throbbing or burning pain in the limbs, hands, or fingers

The most significant characteristic of CRPS is that its symptoms can be much more severe and debilitating than those of the original injury that caused it. This means you might recover from your original injury, be cleared by your doctor to return to work, stop receiving workers’ comp benefits, and then discover that you’re even more incapacitated and less able to work than you were when you first got hurt.

CRPS Is a Difficult Diagnosis to Make

Although CRPS was first diagnosed in the 19th century, there has not been much research done on it since that time, and there is currently no diagnostic test that definitively identifies CRPS. Because the symptoms of the condition tend to change over time and to vary among different sufferers, it is often diagnosed only after other possible conditions have been eliminated by diagnostic testing. Nonetheless, CRPS can cause chronic and debilitating pain that lasts for months, years, or life, so it’s important that you do whatever it takes to pursue your claim successfully.

Accidental Injury vs. Occupational Illness

A work-related accidental injury generally results from a one-time mishap on the job. A factory worker, for example, might get a hand, arm, or finger severed or crushed by a machine, or an office worker might slip and fall on a slippery floor. On the other hand, occupational illnesses like carpal tunnel syndrome from repetitive motion or respiratory problems from long-term exposure to toxic materials develop over time on the job. While you’re entitled to benefits for either, an accidental injury that ultimately causes CRPS is much easier to prove and harder for the insurer to dispute than the resulting CRPS, which falls into the category of occupational illnesses.

Handling a Workers’ Comp Denial

Workers’ compensation claims are generally paid by an insurance company to which your employer pays regular premiums, just as you do to your health or auto insurer. Because insurance companies are in business to earn profits, they typically look for ways to dispute expensive claims if they can. Claims for occupational illnesses are the most likely to be disputed. The insurer might claim that your repetitive motion injury or respiratory problem resulted from a pre-existing condition or non-work-related activities. The burden is then on you to prove otherwise.

After sustaining and recovering from a compensable work-related injury for which you’ve received benefits, you could develop CRPS as a result of that injury. In such a case, the insurer is likely to deny your new claim and refuse to recognize your CRPS as a compensable occupational illness because you’ve already received benefits for the injury that caused it.

You Can Fight Back After a Workers’ Comp Denial

Some simple workers’ comp claims for minor injuries resulting in low medical bills and little or  no time off work can be successfully pursued without the help of a workers’ comp lawyer. A CRPS claim, however, is not a simple one. It’s potentially very expensive for the insurer and likely to be denied, but that doesn’t mean you should give up. Untreated CRPS can leave you disabled and in need of lifelong medical care and pain management, so it’s important to do whatever it takes to prove your claim for work-related CRPS.

Why You Need an Attorney

While you’re dealing with your debilitating illness, your attorney can help you by:

• Consulting with your doctors about your condition and prognosis.
• Organizing and presenting your medical evidence.
• Bringing in expert medical witnesses to prove your CRPS is work-related.
• Requesting an informal conference with your employer and the workers’ comp insurer.
• Requesting a hearing before the South Carolina Workers’ Compensation Commission (SCWCC).
• Requesting a commission review.
• Appealing your denied claim to the SC Court of Appeals if necessary.

What to Do If You Develop CRPS Symptoms

If you’ve recovered from a work-related injury and find yourself suffering the symptoms of CRPS, you should take the same steps you’d take with any workers’ comp claim:

Report Your Injury and File a Claim

Report your condition to your supervisor right away. Although you have 90 days to do so, do not wait. After reporting, file your claim with Form 50 from the SCWCC website. You actually have two years to do so, but again you should not delay.

Seek Medical Attention

You should have a thorough examination from either the doctor who treated you for your original work-related injury or another doctor certified by your employer’s insurer. Follow all this doctor’s medical advice, keep all appointments, take medication as prescribed, and keep receipts and other documentation of your treatment. If you’re not satisfied with the doctor you’re seeing, your attorney can petition for an independent medical exam.

Have You Been Injured on the Job in South Carolina?

If you've been hurt at your job, you can speak with a workers' compensation lawyer. Please contact us online or call our Charleston, South Carolina office directly at 843.488.2359 to schedule your consultation. We are also able to meet clients at our Conway, Myrtle Beach, Murrells Inlet, Mt. Pleasant, North Myrtle Beach, Florence or North Charleston office locations.