Hip fractures, labral tears and replacements

An average “hip injury settlement” is a number nobody can stand behind. A California settlement is built from the impairment rating, apportionment, your occupation and age, your earnings, and future medical care. In a hip case, the last of those can outweigh everything else. What the number is built from.

Permanent impairment of the hip is measured under Chapter 17 of the AMA Guides, 5th Edition, the same chapter as the knee and the ankle. Chapter 17 offers thirteen ways to evaluate a lower extremity: diagnosis-based estimates, range of motion, arthritis measured by cartilage interval, muscle atrophy, strength, gait derangement, and others. The result is stated in lower extremity percent and converted at 100% lower extremity = 40% whole person.

The rules for choosing are strict. Arthritis cannot be combined with range of motion, atrophy, strength, or gait. Atrophy, strength and gait derangement are mutually exclusive. Gait derangement is a last resort, used only when nothing else applies. And where more than one method applies, the Guides direct that the method producing the higher rating be adopted. The knee page walks through these rules.

The state’s rating schedule gives each method an impairment number. Around the hip:

Summarized from the impairment number list in the 2005 Permanent DisabilityPD Permanent Disability. Compensation for lasting impairment. A different and much lower weekly rate — 2026 maximum $290/week. Rating Schedule. The list names methods, not values.

Notice what is not on it: a labral tear. As at the shoulder, there is no impairment entry for the tear itself. A labral tear is rated by what it left behind, usually lost motion, and a repair that restores motion leaves little to rate. If the joint also shows arthritic change, the arthritis method may rate higher, and where it does, it is the one to use.

One more thing worth checking: if the leg is shorter after a fracture or a replacement, limb length is its own method on the list. Ask whether it was measured.

Where it broke decides the code. What people call a broken hip can be a femoral neck fracture, a fracture of the femur, or a pelvic fracture, and the schedule lists each separately. Check that the code on your rating stringRating string The row of numbers encoding your entire permanent disability calculation. Checkable arithmetic. matches the bone the imaging and the operative report describe.

If a fall broke your hip, falls are the injury type most likely to produce a second claim against someone other than your employer. Photograph the condition that caused it before it is fixed. If you fell on property your employer does not own or control, or because equipment failed, there may be a premises or product claim. Workers’ compensation pays nothing for pain and suffering. A claim against anyone other than your employer does, and it is frequently the larger claim. I fell at work. · Third-party claims.

If you hit your head, say so now, even if you did not lose consciousness. Traumatic brain injury. And if you fell because an earlier work injury gave way, such as a knee or an ankle, the hip is a compensable consequenceCompensable consequence A new problem caused by the original injury or its treatment. Overusing the other side, the joint above or below, a surgical complication. of that injury. More.

A replacement has its own diagnosis-based entry. The knee page explains how a knee replacement is scored on its result, and why the post-operative assessment decides so much. Ask the same question about a hip: how was the result assessed, and does that match what you can actually do?

Authorization goes through utilization reviewUR Utilization Review. The process that approves, modifies, or denies each treatment request. A modification is a denial of what it left out.. A decision on a complete request is due within five business days. Since August 1, 2026, the treatment schedule has incorporated the Hip and Groin Disorders Guideline (ACOEM, January 29, 2026), at 8 CCR § 9792.23.10. If you get a denial, check which version it relies on. You have 30 days from service to request Independent Medical ReviewIMR Independent Medical Review. The appeal from a UR denial. 30 days (10 if the dispute is only over drugs on the MTUS Drug List)., or 10 days when the dispute is only about drugs on the MTUSMTUS Medical Treatment Utilization Schedule. California’s treatment guidelines. Four of them — shoulder, elbow, hand/wrist/forearm and traumatic brain injury — were replaced January 2, 2026. Drug List, and if the IMR form and an addressed envelope were not enclosed, the clock never started. A late utilization review decision is invalid, so a judge decides the treatment instead (Dubon II, WCABWCAB Workers’ Compensation Appeals Board. The court system that decides these cases. 23 district offices statewide. en banc, 2014). How to check a denial. · I need surgery and they’re stalling.

The settlement decision is the one that costs the most if it goes wrong. A joint replacement has a service life, and hardware can fail. A Compromise and Release closes future medical treatment permanently. Stipulations with Request for AwardStips — Stipulations with Request for Award An agreed percentage paid over time, with future medical left open, and reopening available within five years of the date of injury. These are not two prices for the same thing. keep it open, and you keep the right to reopen for new and further disability within five years of the date of injuryDate of injury For a cumulative or occupational disease claim, the law sets it as when you first suffered disability and knew or should have known it was work-related — not when the wear began. Almost every deadline runs off this.. In a joint replacement case, that decision should not be made without a professionally prepared projection of lifetime cost.

If you are on Medicare, or heading toward it, settling future medical care brings Medicare’s interests into the settlement. If you are on Medicare. · Why the structure matters more than the number.

If the replacement fails, through dislocation, infection, hardware failure or a nerve injury, that disability belongs to the claim. Hikida v. WCAB (2017) treats disability caused by industrial medical treatment as industrial. But we will be straight with you about the limit. County of Santa Clara v. WCAB (Justice) (2020) 49 Cal.App.5th 605 holds that Hikida “precludes apportionment only where the industrial medical treatment is the sole cause of the permanent disability.” In a hip replaced because of arthritis and an injury together, sole cause is a demanding test. The surgery made it worse.

Expect it, often in a paragraph like this:

THE PARAGRAPH TO LOOK FOR

“X-rays demonstrate joint space narrowing consistent with pre-existing degenerative arthritis. I apportion 50% of the permanent disability to the pre-existing degenerative condition.”

• Were you doing your full job the day before? — A worker on full duty without restriction had no disability from the pre-existing condition, whatever the x-ray showed.
• Did the evaluator review your pre-injury records? — If the report’s records list has nothing from before the injury, say so.
• What supports 50% rather than 20%? — The percentage has to be explained, not asserted.

And arthritis is not automatically non-industrial. If your hip wore out over years of the work rather than in one moment, that is a cumulative traumaCT — Cumulative trauma Injury from repeated exposure over time. The largest injury category in California and the least claimed. claim. The date of injury is when you first suffered disability and knew, or should have known, it was work-related — not when the wear began. Apportionment. · They say it’s arthritis. · Cumulative trauma.

For injuries on or after January 1, 2013, the Division of Workers’ Compensation’s rating unit puts it this way: “The WP impairment will be multiplied by the 1.4 modifier, rounded to the nearest whole number, and then adjusted for occupation and age” (§ 4660.1(b)). Your occupational group is assigned by what you actually did all day, not your job title. Your age is your age at the date of injury, and older workers rate higher. How the adjustments work.

Before 2013, injuries were rated with an earning-capacity rank instead of the 1.4. In the schedule, the hip carries rank 5, against rank 2 for the knee, ankle and foot.

Read the string. A hip rated on range of motion produces a string beginning 17.03.04.00: Chapter 17, region 03 (hip), method 04 (range of motion). A replacement begins 17.03.10.01, and a femoral neck fracture 17.03.10.02. Decode yours.

Where every strict method misses, Almaraz/Guzman II (2009, WCAB en banc) lets a physician give the strict rating, explain why it fails, and use a more accurate method inside the Guides. It is an argument, not an entitlement. What it requires.

A hip injury changes your gait. The low back, the knee and the other hip absorb it, and the other leg carries the load. These are compensable consequences, but none of them is added on its own. Tell your treating doctor and make sure the note says why, tell the claims administrator in writing, and make sure the evaluator is asked about it before the examination. Discovery closes at the mandatory settlement conference and undisclosed evidence is generally inadmissible. How to add a body part.

If the injury caused permanent partial disability and your employer does not offer regular, modified or alternative work within 60 days after the claims administrator receives the physician’s Return to Work & Voucher Report, you are owed a Supplemental Job Displacement Benefit: a $6,000 voucher for injuries on or after January 1, 2013. The voucher also opens the $5,000 Return-to-Work Supplement, and that application must be received within one year from the date the voucher was served on you. The voucher and the supplement.

The job itself is protected, if at all, by FEHA, which requires employers with five or more employees to reasonably accommodate a known disability and to engage in a timely, good-faith interactive process. Return to work.

Hip claims cluster where the work is deep bending and squatting, long shifts on concrete, load carried on the body, and climbing in and out: strawberry pickers working at ground level all shift; warehouse crews on ten-to-twelve-hour shifts on concrete; security officers on foot patrol with a duty belt, and on vehicle patrol; line cooks standing ten to twelve hours; Steadicam and handheld operators under a front-loaded rig; yard tractor drivers climbing in and out all shift. And falls, at any job. I was hurt on a ladder.