Work Comp Injury | Complex Regional Pain Syndrome (CRPS)
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area.
When a client develops CRPS (formally called RSD), disability in the workers' compensation system can be tricky. The current system requires use of a book called the AMA Guides which rates "medical impairment." Medical impairment often does not take into account functional loss. Functional loss is essentially how you are limited in your daily life and work. Medical impairment often times will not take into account the impact from the CRPS.
CRPS can be a devastating, because many people have a complete loss of use of the extremity and in some ways it can be worse than amputation injury.
CRPS is an elusive and frustrating problem to treat.
Medications, nerve blocks, spinal cord stimulation, drug pumps, or other stimulation can provide relief. The problem is no specific plan works; every individual is different and it often requires the physician to find the right combination of treatments and/or medications to address the problem.
These cases have high medical cost exposure to workers' compensation insurance companies. Therefore, carriers will want to settle the future medical. However, without understanding the long term cost of this type of medical problem, it can be hard to evaluate the value. If a Medicare Set Aside trust is not performed (see below), then it's recommended that an attorney obtain a life care plan from a qualified person to address those issues.
Social Security / Medicare
In many catastrophic claims, the injured worker is eligible for Social Security Disability. Although that is not an area of law we handle, it's important for a workers' compensation attorney to understand the impact of Social Security with the workers' compensation claim; special paperwork needs to be done.
Additionally, Medicare is a critical benefit especially if the injured worker has other health conditions. A workers' compensation settlement can impact Medicare rights, therefore, your attorney must understand how to prepare the proper paperwork that Medicare will approve.
Structured Settlements / Medicare Set Aside Trusts
If you are on Social Security Disability and/or you are a Medicare beneficiary, then a Medicare Set-Aside Trust (MSA) would be required before you settle your case by Compromise and Release. The workers' compensation insurance company would obtain a MSA from a company who prepares them. Then that MSA would need to be submitted to CMS (the third-party agency that Medicare uses to address these issues). The MSA company would need all medical records from your workers' compensation case in the last two years, a prescription list from all pharmacies for the last two years, and a Social Security Administration release.
Special Needs Trusts
If a client is on Medi-Cal, public assistance, welfare, or any other benefit which is dependent on income and assets, a Special Needs Trust may need to be setup in order to properly settle a workers' compensation case.
Pre-Existing Conditions Combined With CRPS
If a client has CRPS, that injury alone may not limit them from having a productive future at work. However, in some cases, the injured worker has pre-existing injuries, health conditions, anxiety, depression, and other disabling conditions that the worker could manage before the CRPS condition. However, the CPRS has put the client "over the edge" as far as ability to work in the market.
Basically, from a practical point of view when you combine the pre-existing problems with the stroke residual symptoms, the client cannot function in the open labor market. This doesn't mean that they can't live their life; it means they cannot compete in a competitive job market. There is a special type of workers' compensation claim called a Subsequent Injuries Benefit Trust Fund (SIBTF) claim and that type of claim is one that your attorney should understand and consider in these situations.