This article talks about:
1. The effect of pre-existing injuries and causation issues in a shoulder surgery case.
2. Shoulder surgery caused by a work accident.
3. Estimated pain and suffering settlement value for a shoulder surgery case in Florida.
4. The insurer may be able to hire a doctor of its choice to examine you.
5. Other factors that can affect the settlement value of a shoulder surgery case in Florida.
6. My and other attorneys’ shoulder injury settlements and verdicts.
7. How to calculate a possible settlement in a shoulder surgery case, including examples.
Anatomy of the Shoulder
The shoulder is made up of three bones:
- Scapula (shoulder blade)
- Clavicle (collar bone)
- Humerus (arm bone)
This article does not really talk about the settlement values of a fracture of one of those bones. Instead, I talk more about settlements involving the soft tissues (ligaments, tendons, muscles, and joint capsule) that join those bones together and to allow the arm to function.
The shoulder is made up of three joints:
- Glenohumeral joint
- Acromioclavicular joint
- Sternoclavicular joint
A rotator cuff tear occurs when one of the tendons is torn from overuse or injury. A rotator cuff repair is a surgery to repair a torn tendon in the shoulder. It can be done with a large cut or with a shoulder arthroscopy, which uses small hole sized incisions. Most of the cases that I have handled and hear about involve arthroscopic surgery and not a large incision (“open”) surgery.
You may want to know how much your case is worth if you have rotator cuff surgery after an accident in Florida – or on a cruise ship or boat – that was caused by someone else.
In order to know how much your case may be worth, you need to know the full value of your damages. Once you know the full value, then you can start to reduce it by things can lower a possible settlement of a case.
1. Pre-existing Injuries/Causation
Many shoulder surgery cases involve a tear of the rotator cuff. The rotator cuff is a group of muscles and tendons that keep the shoulder steady. The four muscles of the rotator cuff are the Supraspinatus, Infraspinatus, Teres minor, and the Subscapularis. Other shoulder surgery cases involve a repair of a labral (labrum) tear.
Shoulder tear surgery cases are similar to herniated disc cases because the liability claims adjuster will generally argue that your injury existed before the accident or incident. You should always consider pre-existing injuries when evaluating your case.
Even if your shoulder tear existed before an incident or accident, in Florida you are still entitled to get damages for an aggravation of a shoulder tear or other pre-existing injury.
Now, as a practical matter, if you are young and you have a rotator cuff tear then you have a strong argument that an incident or accident caused the tear. For example, if you are 15 years old and you have rotator cuff surgery following an accident then it generally will be tough for a claims adjuster to make the argument that you had this tear before the incident or accident.
If you are older, your case may be tougher because a shoulder tear may come with age and repetitive use. This is especially true if you worked in the construction or a similar field which required hard use of your shoulder.
It is also important that your orthopedic doctor relates the shoulder tear to the incident or accident. You can read more about the effect of pre-existing injuries on a personal injury case here.
Sometimes the radiologist will say in his report that the tear “may” have been related to a motor vehicle accident or other incident. A doctor who looks the MRI may say that you have a pre-existing rotator cuff tear based on calcification, which may lower the value of your case.
2. Shoulder Injuries From Work Accidents
If you are suffer a shoulder tear (such as a rotator cuff tear or labral tear) from an accident in Florida that happened while you were working, then you should learn about benefits that injured workers may get. I generally tell my clients to treat through workers compensation instead of using Personal Injury Protection (PIP) insurance or asking the doctors to treat you on a letter of protection. I recommend using your PIP benefits to pay off the workers compensation lien at the end of the injury case.
A letter of protection is when a doctor or other medical provider agrees to give you treatment without asking for money up front, so long as you agree to pay them when your personal injury case settles.
If you do not treat with workers compensation, then the workman’s compensation insurer may later deny treatment by saying that you failed to follow the workers compensation rules.
Advantage of Getting Workers compensation benefits for your Shoulder (Rotator Cuff Tear, Labral Tear) Surgery
If you were injured while working in Florida, one of the advantages is that you may get benefits from your employer or their insurer.
Disadvantage of Using Workers Compensation Insurance for your Shoulder Surgery Case.
The biggest disadvantage to using workers compensation insurance is that a doctor who is paid by a workers compensation insurer may say that shoulder tear was old and unrelated to the accident than a doctor who is a patient advocate. An orthopedic doctor who treats shoulders and is more “patient friendly” is more likely to relate your surgery to the accident.
This is because the doctor being paid by the workers compensation insurer:
a. Knows that if he doesn’t relate the injury to the accident or minimizes your injury then the workers compensation insurer will send him more patients.
b. May be believed by the jury if he or she says that he did not see a tear when he operated on you.
Example of Settlement for a Shoulder Surgery Case if you were working but someone Other than your Employer caused your Accident
Let’s assume that you are working for a company in Florida. Perhaps you are a truck driver. While you are driving your company’s truck you were rear ended by another 18 wheeler. The other truck driver receives a ticket. You report the accident to your employer but you don’t go to the hospital because the pain is not bad enough.
A few days later you decide to go to your primary doctor because your shoulder pain has not gone away. You give that doctor your health insurance information.
You then receive a call from the workers compensation insurer for your employer. They refer you to a medical facility where you receive treatment. A month later you receive an MRI and the report says that you have a torn labrum tear, but the radiologist is unable to tell whether the tear if from the accident. A labral tear basically means that a ligament in your shoulder is torn.
Your doctor – who you were referred to by your employer – continues to treat you. He then says that he will perform shoulder surgery on you if you would like. You choose to have shoulder surgery. You then receive a little more treatment and the doctor tells you that you are as good as you are going to get. The doctor then says that you have a permanent impairment of 2%.
Let’s assume that workers compensation gives you benefits. You are curious how much your case is worth against the driver that hit you. The formula to figure this out is:
Injury Settlement = (Medical bills and lost wage paid by workers comp.) + Pain and Suffering + (Lost wages not paid by Workers Comp)
3. Settlement Value of Shoulder Injury (Rotator Cuff or Other)
a. No Surgery
The full value of pain and suffering for a rotator cuff tear is between $40,000 and $70,000, and possibly higher depending on resultant disability. The lower end of the range is for minimal treatment and little limitation. The higher end of the settlement range is for a longer period of treatment – such as one year or more – and a greater disability.
b. Where Surgery is performed
For a starting point, the settlement range for pain and suffering on a torn rotator cuff where surgery is performed is between $100,000 and $175,000. The low-end of the range is if you had little treatment, are left with limitations and disability after the surgery.
The higher end of the range is for longer treatment (over a year or more), when you left with a larger resultant disability, and your life has significantly been affected.
Without surgery, the full value for pain and suffering is generally less for purposes of settlement. A lot of this article also does not apply to workers’ compensation cases in Florida, as you can generally not get pain and suffering in those cases unless you also have a claim against someone other than your employer. But I do discuss settlements where you were injured while working and someone other than your employer was at fault.
4. The other side can hire their own doctors.
Radiologists who are often hired by insurance companies, claims adjusters or defense attorneys are more likely to say that your injury was existed before the incident. Unless you handle personal injury cases for a living, or know someone who does, you will not know whether the radiologist or orthopedic doctor who is treating you will be honest and be someone who helps your case.
Even if the radiologist and treating orthopedic doctor say that they cannot determine the age of your shoulder tear, you still have the right to get a 2nd opinion with a doctor of your choice. This doctor may feel that the shoulder tear is related to the incident or accident. He will probably want to see the actual MRI films.
So how do you know how much your shoulder surgery case is worth if the doctors who treated you and reviewed the MRI have different opinions? Often times you have to cut the full value of your case by a certain percentage.
You should send a liability claims adjuster the MRI films as soon as you receive them. The claims adjuster may submit these films for a “peer review” or “independent” review. Basically they pay a doctor a lot of money to give his opinion as to whether the shoulder tear existed before the accident and whether the accident could have caused the tear.
You have a stronger case if the radiologist describes the shoulder tear as an acute tear. An acute injury refers to trauma or injury to any body damage due to a due a physical impact or accident. All of the tears above are usually diagnosed by an MRI. An orthopedic doctor may also state that a shoulder tear cannot be caused by certain types of accidents.
If you went to the emergency room on the day of the incident and complained of shoulder pain this helps your case because it shows that you were in pain. Some doctors may argue that if an accident causes a rotator cuff tear you would feel pain immediately following the incident. I have still been offered good money for clients who did not go to the emergency room on the date of the accident or incident.
5. Other factors that can affect the value of your settlement involving surgery for a shoulder tear
- Amount of property damage (particularly true in auto accidents) to the vehicles involved.
- Whether there is liability insurance.
- The actual claims adjuster handling your case.
- The liability insurance company involved (e.g. State Farm, Allstate, GEICO, Progressive, etc.).
- Type of witness plaintiff makes.
- Whether you exaggerated injuries at the deposition (if a lawsuit is filed).
- Whether you lie at the deposition (if a lawsuit is filed).
- The county where the case will be brought.
- Inability to prove a permanent injury (only applies in some auto accident cases).
- And many other factors.
As you can see, there are many factors that go into the value of a case and there is no guarantee that you get any money for pain and suffering.
6. Shoulder Injury (Rotator Cuff Tear) Settlements
a. Without Surgery
$18,000 Settlement (My Case): I settled a personal injury case against Publix in Miami, Florida where my client had a rotator cuff tear for $18,000. She said that she thought that she slipped on water at a Publix in Homestead, Florida. Liability was difficult in that case. My client was 58 years old and the claims adjuster from Publix argued that my client’s rotator cuff tear was from overuse and not caused by this injury.
Actual Case (not mine): $55,000 Verdict for Pain and Suffering alone for a man who suffered a herniated disc and rotator cuff tear when he slipped and fell on a Royal Caribbean gangway (walkway) when it was raining.
Actual Case (not mine): $10,000 verdict for pain and suffering for a 75-year-old female shopper who fell down in Target in Miami-Dade County, Florida who tripped over a garden hose. She broke 2 teeth, tore a shoulder (rotator cuff) and had wrist pain. $5,000 was for past pain and suffering and $5,000 was for future pain and suffering. She was walking into Target in Miami through the garden entrance and she tripped over a garden hose that was in the aisle that was used for customers to walk through this section of the store.
She claimed that the hose should not have been left in this aisle. Target argued that there was a sign next to this hose and that she saw the hose before she fell.
My thoughts: The jury awarded her $500 a year for her future pain and suffering. I arrived at this amount by using the life tables, which show her life expectancy to be 10 more years. $5,000 divided by 10 is $500 per year. This verdict for pain and suffering is way below the average settlement for pain and suffering for a torn rotator cuff (shoulder). Check out some other injury verdicts and settlements against Target in Florida.
b. My Shoulder Surgery Settlements
My case: $210,000 Settlement (Gross) for a man who claimed a labrum tear (in his shoulder) after he was hit by a truck. He had arthroscopic surgery to repair the fraying/tear in his shoulder. The other driver who received a ticket for careless driving. The other driver was under dispatch by a trucking company based in Jacksonville, Florida who had a self-funded retention of $250,000. Broadspire adjusted the claim.
The other trucking company was insured with Travelers Insurance above the self-funded retention. We also received a $10,000 settlement check from my client’s auto insurer – Progressive – who provided uninsured motorist coverage.
My case: $147,000 Settlement (Gross) for a woman who had shoulder surgery following a car accident in Bonifay, North Florida. My client lived in Virginia. The shoulder surgery was unsuccessful so she later underwent a manipulation under anesthesia (MUA).
I have also settled car accident cases where my client had surgery to repair a rotator cuff tear for $65,000, and $57,000. In some of those cases, the liability claims adjuster argued that my client’s rotator cuff tear was not caused by the car or truck accident due to minimal property damage. The claims adjuster also argued that the rotator cuff tear was degenerative (old) and was due to age and overuse.
As you can see from the above settlements amounts, I was still able to collect a lot of money for each client even though there case had some “issues.” The bottom line is that every case is different and even though you may have several things that work against you in a case, your case still may be worth a lot of money.
I had a torn rotator cuff settlement for a client for $18,000 who was injured at a Supermarket in Miami, Florida. My client said that she slipped and fell on water on the floor in the store. In that case, my client was significantly at fault and her injury may have been preexisting.
Other (Not Mine) Shoulder Surgery Settlements or Verdicts
$183,697 Verdict (not my case) for pain and suffering damages and additional undisclosed settlements for a shoulder sprain, multiple bruises to the left shoulder, shoulder; type 1 AC joint sprain, a partial thickness articular sided tear, a partial thickness tear of the subscapularis tendon, shoulder impingement and fraying of the superior labrum and bicep with a type 1 SLAP lesion; subsequent left shoulder arthroscopy with subacromial decompression, distal clavicle and SLAP repair, including insertion of 2 metallic screws and anchors.
Plaintiff settled at mediation with the other 3 defendants, one of which was an uninsured motorist (UM) insurance company.
The Plaintiff, a 48 year-old employee of UPS, was driving home on a highway. He claimed that the Defendant, Rodriguez, made a U-turn (where it was not allowed) and was driving 25 miles per hour below the speed limit. He said that he attempted to avoid the other vehicle and tried to avoid the crash by driving into the grass median.
His truck flew in the air and landed on its side and ended up in the opposite lane of travel. The jury determined that the truck driver was driving a company car. The verdict was in September 2011. The case is Kata vs. K.K. Car Co., Inc. and Ambassador Rent-A-Car.
My thoughts: I do not know the amounts of the other settlements. But because there were additional settlements, the award for pain and suffering is larger than the $183,697 verdict for pain and suffering mentioned above. The amount awarded for pain and suffering is above the average settlement range that I may use as a starting point for pain and suffering for a shoulder surgery.
$69,500 Verdict for Pain and Suffering for a torn rotator cuff that required surgery, neck (cervical) and back (lumbar) strains, and bruises to her arm when she slipped and fell on an unknown substance at a Publix grocery store in Broward County, Florida. She argued that Publix failed to provide a safe environment for her, negligently allowed a dangerous condition remain for an unreasonable length of time, and failed to remedy or warn of the known dangerous condition.
Publix denied liability and argued that the woman was not hurt as bad as she claimed. The jury found her to be 5% at fault. She was also awarded $44,000 for past medical expenses and $80,000 for future medical expenses. The total verdict was for $193,500. The case is Lopez v. Publix Supermarkets, Inc. 05-1465.
My thoughts: The woman who fell was awarded $69,500 for pain and suffering. Most of this money was probably for her torn rotator cuff that required surgery. This is because most juries do not award much for a simple neck and back pain or bruises. This award for pain and suffering is below the average settlement range for a torn rotator cuff with surgery.
7. Calculating Projected Total Settlement
Let’s see how the value of pain and suffering affects the possible total settlement of your accident case where you have rotator cuff surgery. You can calculate your damages in any personal injury case by using the following formula:
Settlement = Out of pocket Medical Bills + Lost Wages + Pain and Suffering
You are passenger in a car in Bonifay (North Florida) or any city in Florida. The car that you are riding in is struck by another car. The other car receives a ticket for causing the accident. The other car does not have bodily injury liability insurance, but you have $300,000 of uninsured motorist insurance (UM) available and the owner of the car that you are in has $100,000 UM/UIM with State Farm insurance.
You treat with doctors for 1 year or so and the doctor who sends you to get an MRI that shows that you have a rotator cuff tear. Physical therapy does not relieve you of your pain so you have surgery to repair your rotator cuff. The orthopedic doctor says that you have a permanent injury. This allows you to make a claim for pain and suffering in a car accident case in Florida.
You are still able to work at the job that you had before the accident. Your out-of-pocket medical bills are $5,000. Your health insurance company has paid $15,000 in medical bills and they may be entitled to be reimbursed. You have $2,000 in lost wages, mainly for the time that you could not work after the surgery.
Possible Settlement = Out of pocket Medical Bills + Lost Wages + Pain and Suffering
Because your life has been minimally affected after the surgery, taking the pain and suffering value from the lower end of the range, let’s plug in the numbers:
Possible Settlement = $20,000 + $2,000 + $100,000
Possible Settlement = $122,000
This above example was from an actual case that I handled. The actual settlement was for $130,000 which is within the settlement range that I gave above. You can read about that shoulder surgery settlement from a car accident in Florida.
Let’s take the same facts as Example #1 except that you were driving the car in Miami, Florida and you were 50% because you and the other driver both say that you had a steady green light at the time of the accident. There are no witnesses. In this case you would use the formula below:
Possible Settlement = (Out of pocket Medical Bills + Lost Wages + Pain and Suffering) x (% Other car’s fault)
Possible settlement = ($122,000) x (50%)
Possible settlement = $61,000
As you can see, if you change one fact to the case the value is cut in half. This is one of the reasons why you should be very careful when comparing your case to your friend’s case or other cases that you read or hear about.
Example #3 – Rotator Cuff tear – No Surgery
You are 18 years old and you are riding a motorcycle in Miami-Dade county – or any county in Florida – and you are stopped at a red light. A car hits you from behind. The impact of the crash causes you to fly of the motorcycle and land on your shoulder. You are taken by ambulance to the hospital.
An MRI reveals that you have a torn rotator cuff. The orthopedic doctor that you are treating with states that your rotator cuff tear is related to the accident. Your out-of-pocket medical bills are $6,000 and you have $500 in lost wages. Your total treatment with the orthopedic doctor is for 3 months.
To get an idea of the settlement range for your case, the formula to use is:
Possible settlement = Out of pocket medical bills + lost wages + pain and suffering
Because your treatment was rather short, and you are left with little if any disability, I will assign $40,000 (taken from the range mentioned above) for pain and suffering for settlement purposes. (Because you were on a motorcycle and you were hit by a truck (a motor vehicle), you do not need prove that you have a permanent injury in order to be entitled to pain and suffering.) Now I will plug-in the medical bill and lost wage figures that I gave in the example into my settlement evaluation for this case:
Possible settlement = $6,000 + $500 + $40,000
Settlement = $46,500
Now let’s take the same facts from Example #3 except that you were speeding and the other car violated your right of way. To keep it simple, let’s assume that you are 50% at fault for the accident. The formula is:
Possible settlement is= (Out of pocket medical bills + lost wages + pain and suffering) x (% fault of other driver)
Possible settlement = ($6,000 + $500 + $40,000) X (50%)
Possible settlement = ($46,500) X (50%)
Possible settlement = 23,250
As you can see from this example, changing one fact to the case cuts the value of your case in half.
Different Insurers in Florida and My Thoughts on Them for Paying Rotator Cuff Surgery Settlements
One of the factors that may affect the amount that you may get offered to settle your shoulder (rotator cuff) surgery case is the particular insurance company that you are dealing with. Some insurance companies pay better than others in terms of paying for rotator cuff surgery.
Better Insurance Companies
- Chubb Insurance & Federal Insurance Company
- Scottsdale Insurance
- Liberty Mutual Insurance
- Lincoln General Insurance Company
- Zurich Insurance
- FIGA (Florida Insurance Guarantee Association)
- Old Dominion Insurance (Main Street America Group)
- Star & Shield Insurance Exchange
Average Paying Insurance Companies
- USAA (United Services Automobile Association) Insurance
- Nationwide Insurance
- Hartford Insurance (A mediator me that they are paying better lately.)
- Metropolitan Life Insurance (Metlife)
- Farmers Insurance
- Kingsway Amigo Insurance (formerly known as US Security)
- GEICO Insurance
Worse Insurance Companies
- State Farm Insurance
- Allstate Insurance
- Progressive Insurance
- Star Casualty Insurance
- United Automobile Insurance Company (Often sold through Estrella Insurance Agency)
- Auto Owners Insurance
- Mercury Insurance
- Philadelphia Insurance Company
- Mt. Hauley Insurance
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I have settled over 4 million dollars in personal injury cases in Florida. Check out some of my settlements in different types of cases where my client had a torn rotator cuff (and possibly surgery) caused by an accident in Florida:
I want to represent you if you have surgery from a torn rotator cuff – or another injury – from an accident in Florida, or on a cruise ship or boat. Call me now at (888) 594-3577 to Get a Free Consultation. I represent clients who are injured in car accidents, truck accidents, slip and fall accidents and much more.
Image Credit: Zameer Hirji