Workers’ compensation insurance provides benefits to workers injured on the job. Standard benefits include money for medical and therapy bills, medications, costs of transportation to and from doctors appointments, and partial wage reimbursement.
Benefits may also include a lump sum or structured settlement award for an on-the-job injury resulting in a permanent partial disability. Permanent partial disability (PPD) claims are the most common work injury claims, representing over half of all workers’ comp claims filed each year in the United States.
A worker becomes permanently partially disabled when an on-the-job injury makes it permanently impossible for him to perform his job duties. A PPD settlement is compensation for the injured worker’s diminished earning capacity over the course of his life. He can still work, but he may not be able to do the same job he did prior to his injury. He may have to accept a job paying less money.
Example: Eye Injury While Welding
Charlie was a trained spot welder and well-respected employee at a local manufacturing company. His primary duties were lining up and welding commercial metal fabrication joints. He’d held the job without incident for 3 years.
While welding a metal frame together, a sliver of metal came through the side of his welding mask and lodged in his right eye. The eye was permanently blinded. It ruined Charlie’s depth perception and it’s now impossible for him to weld commercially. After the injury, his employer offered him a lower-paying job loading and unloading completed work orders.
Charlie filed a workers’ comp claim for his medical bills, medications, and for wages lost while he was recovering. He also demanded a settlement award for his permanent partial disability. Charlie’s injury is permanent because he can’t perform his normal job duties, but because he can still work, even if it’s a lower-paying, non-welding job, his disability is considered partial.
Permanent partial disability can result from a wide range of work injuries. It can be caused by traditional physical work injuries, like herniated disks and knee injuries, and also by occupational diseases, such as lung disease from asbestos poisoning or toxic fume inhalation. Mental health injuries may also cause PPD.
The most commonly reported PPD injuries are:
- Back injuries (most common of all)
- Knee injuries
- Loss of vision in one eye
- Carpal Tunnel Syndrome
- Nerve damage to the shoulder and neck areas
- Amputation of fingers, toes, or entire limbs
- Hearing loss
- Post-traumatic Stress Disorder (PTSD)
Maximum Medical Improvement (MMI) and PPD
A determination of permanent partial disability can only be made after you reach a level of Maximum Medical Improvement (MMI). This happens when your primary doctor decides your medical condition is stable and won’t improve with further treatment. Reaching MMI doesn’t mean your medical treatment is complete. You may require ongoing medical or chiropractic care, and therapy so your disability doesn’t worsen.
Once your doctor decides you have reached MMI, the insurance company may want you to submit to an Independent Medical Examination (IME) performed by one of their doctors. This doctor will perform a full medical evaluation, but won’t provide any treatment.
These doctors are supposed to be independent, but a conflict of interest may exist. Doctors employed by insurance companies may be under pressure to conduct IMEs in favor of insurance company standards.
Your Permanent Partial Disability Rating
In most cases, the doctor performing your independent medical exam determines the type and severity of your disability. Based on the evaluation results, the doctor assigns a percentage representing your level of disability and sends a report to the workers’ compensation board. A PPD percentage rating may range anywhere from one to 99 percent. The majority are between five and 35 percent. A rating of 100 percent indicates permanent total disability.
Disability percentage ratings aren’t set by your state’s workers’ compensation board. Doctors performing IMEs usually base a PPD percentage on guidelines established by the American Medical Association’s Guides to the Evaluation of Permanent Impairment. You can purchase a copy of the Guides on Amazon.com or check it out from your local library.
The workers’ compensation board hearing your claim considers several factors when calculating your award. They include the percentage disability rating assigned by the IME doctor, your age, level of education, and work history. The board may also consider psychological and sociological factors such as mental stability, immediate family care and support, criminal history, and other factors they consider relevant to your claim.
After determining the overall disability percentage, the board refers to their state’s mandated disability schedules. These schedules match the percentage of a disability (also called impairment) to a specific dollar amount. These schedules are reviewed and modified annually based on U.S. Department of Labor disability ratings.
Following your certification of permanent partial disability by the workers’ compensation board, you’ll receive an offer of a lump sum or structured settlement. A lump sum is a one-time payment representing full closure of your claim. A structured settlement offers the same amount as the lump sum, but is paid in monthly installments over several years.
Once you accept a settlement award and sign the release form, you waive all rights to any future reimbursement for your disability. This means that if you aggravate your injury or your condition worsens, your employer and his workers’ comp insurance company can not be held liable.
PPD Awards and Social Security Disability Payments
If you are receiving disability benefits from the Social Security Disability Administration (SSDA) and you are also approved for a workers’ compensation settlement, you must notify Social Security.
The SSDA does not permit double payments for the same disability. They have the right to deduct a specified amount from your workers’ comp monthly payments. The SSDA formula for calculating reductions takes into account your age, work history, and your contributions to the Social Security system throughout your working lifetime.
Americans with Disabilities Act
The Americans with Disabilities Act (ADA) offers civil rights protections to persons with disabilities. These protections cover disability, race, color, sex, national origin, age, and religion. The ADA also guarantees equal rights for disabled persons in employment, transportation, public accommodations, government services, and the media.
The Americans with Disabilities Act specifically includes workers who are disabled due to an on-the-job injury while employed at a company that has 15 or more workers. Under the ADA, if your disability limits you from performing duties which are not critical to your job, your employer must reassign those non-critical duties to another worker.
If the duties are critical to your job, the ADA requires your employer to make “reasonable accommodations” to help you. Some examples of reasonable accommodations are:
- Wheelchair-friendly work environments
- Voice-assisted computer keyboards
- Work communications and other documents in Braille
- Telecommunications Devices for the Deaf (TDD/TTY machines)
If you are disabled and believe your employer has discriminated against you, contact the United States Department of Justice, Civil Rights Division for Americans with Disabilities, ADA.gov.
Hiring an Attorney
Many workers’ compensation injury claims can be handled without a personal injury attorney. These include soft tissue injuries such as sprained ligaments, torn muscles, whiplash, and minor abrasions. But when it comes to serious injuries that may be disabling, the counsel of an experienced attorney is crucial.
Your employer may be sympathetic to your injury, but his workers’ comp insurance company won’t be. In many cases they will do everything legally possible to obstruct your claim during the hearing process.
Insurance companies do not like to pay out money. The amount at stake in a PPD claim can be in the hundreds of thousands, even millions of dollars. Experienced workers’ comp attorneys understand disability ratings and how they apply to your claim. They are familiar with the judges, hearing officers, and state attorneys, and know which doctors are reputable. They remain current on newly published legal opinions and the latest in medical literature.
Most workers’ comp attorneys work on a contingency fee basis. Their fees are normally set by state law, often at no more than 25 percent of the settlement award. While most attorneys will fight for their clients regardless of the amount of legal fees paid, they have an additional incentive – more money for you equals higher pay for them.
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Visitor Questions on Issues with Work Injury Claims
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I tore my medial meniscus in my left knee while working. Surgery was performed and I went through some rehab. While my knee wasn’t back to 100%, I was released back to work (injury in July, surgery in August, released to work in November). In early December I told my employer I still wasn’t sure... Read More.
I work for a large retailer and was told by a manager to do something that was outside the scope of my job description. I did as I was told and while I was doing it two of my fingers were crushed. I had to have surgery and was told that there was a good... Read More.
I was injured on the job in October 2010. I have Sciatica, three herniated discs, and spinal stenosis as a result of my accident. I applied for SSI disability insurance in 2012 and was approved for my injuries. I filed a workers’ compensation claim in July 2013. Does the fact that I filed my claim... Read More.
I was injured on my job and tore my right bicep nearly 5 years ago. The company’s insurance company covered my hospital and doctor bills at the time. A coworker recently informed me that I am also entitled to a cash settlement, as I lost 10 to 15 percent of the use of my right... Read More.
In 1996 I had a back injury lifting while doing my job duties. I was 26 years old. It was diagnosed as a herniated disk. I never even missed 1 day of work for the injury, but I continued treatment and physical therapy. Within 3 months I had the insurance company wanting to settle. I... Read More.
I was employed for 24 years when I was injured at my workplace. I had to have a wrist fusion to my right wrist due to a work related injury. Due to the fact I can no longer perform the job I was doing when this injury happened, I was let go. I am receiving... Read More.
In 2011 I was injured, and by 2013 it was determined that I had a radial nerve entrapment (stated by the judge and NYS occupational disease). I had surgery in 2014 and I’m still getting physical therapy. My hand does not completely open yet, it’s numb at the surgery site, and I get a burning... Read More.
I herniated a disc on the job 1/31/2012. I reported it two days later as the pain was worsening. Initially I started to improve, but on the 12th of February I awoke with the most excruciating pain in my lower back which radiated down my left leg. I went to the ER. I called EH... Read More.
I work for a national chain bakery. Approximately 5 months ago I injured my back. I was a trayer, which is someone who grabs 5 loaves of bread at a time. It’s very fast and repetitive work, stacking the 15 lb trays of bread from the floor up to a foot above my head. It... Read More.
I just found out that someone at work is pursuing a workers’ comp case for his shoulder by using the word “repetitive.” Four years ago I had major shoulder surgery because of the same repetitive situation, but refused to consider it as work related. I see this as preferential treatment and discrimination. In 2012 I... Read More.
I am a delivery driver for an IV company. In September 2012, a lady pulled out in front of me while driving and I couldn’t avoid her. I hit her car, totaling both automobiles, and she lost her life. Since then I have been on anti-depressants and find it hard to deal with feeling like... Read More.
I work at a major pet store and was bitten by a dog in Sept 2013. The dog bit me right in between my index and middle finger on my right hand, which is my dominant hand. Over the past several months, I have seen a regular doctor, done physical therapy through her office, then... Read More.
In 2008 I tore my rotator cuff at work. I have since had 3 repair surgeries,. After all 3 surgeries it tore again, prompting a 4th surgery. This time they did a lat. muscle transfer and used pigskin patches to fix the tear. I still have a partial tear in the rotator cuff and pain... Read More.
I was working construction I injured my arm. When I went to step up on the catwalk with my left leg, my right leg slipped and I began to fall under the catwalk. I reached up with my left arm and grabbed the handrail to catch myself. I felt a big pop and was then... Read More.
My neck was injured at work due to lack of headsets (provided by the Court). I worked for for 3 years. I had to have a full disc replacement at c5-c6 in 2010. The insurance company is offering a “compromise and release” (unknown amount), but I am still taking pain relievers to ease the pain... Read More.
I fell down the company’s parking lot stairs and had a traumatic head injury with an injury to my face. The company immediately started a workers comp claim and all medical bills were paid. I also received wages and monies for expenses (gas, etc.). Currently, 2 months later, I have a permanent scar above my... Read More.
I was working cleaning grills when I was burned. Now I have a scar on my arm. I am only 17 which I think is too young to be cleaning this type equipment anyways. I was cleaning above the flat grill and slipped. My forearm landed straight on the hot part of the grill and... Read More.
I injured my shoulder at work 15 years ago. I have had 3 operations on my shoulder and still suffer pain. I was awarded workman’s compensation in VA. I was released to go back to work under specific restrictions without any date that my restrictions would be lifted. The company has respected these restrictions, but... Read More.
I’m 65 years of age. I tore my bicep muscle at work while I was reaching up and carrying files. The doctor suggests I shouldn’t have an operation due to my age. So it appears I will be living with a huge bulge in my upper left arm with pain radiating to the top of... Read More.
My husband worked as a driller on an oil rig and severely injured his neck, requiring surgical repair. He has not regained his physical abilities to perform his prior duties and may never be able to work that type of job again. His company has offered to find another area of work within the company,... Read More.
My workers compensation claim was made in the State of Maryland. After falling at work due to the negligence of another employee in December of 2009, I was ready to finalize the settlement tomorrow. Last year, my employer told me that I could no longer fulfill the duties of my position and basically told me... Read More.
My husband suffered a broken leg at work. A mud motor rolled off the forklift and hit my husband’s leg and broke it. He had to have surgery and screws were placed in his leg. He then needed an additional surgery to remove the screws in his ankle because they were grinding into his bone... Read More.
My husband had a slip and fall at work and broke his wrist. He fell down two flights of stairs. The pain in his wrist and arm was intense, but after tons of tests the doctors still couldn’t find anything wrong. We went without being paid for over a year due to his injury. My... Read More.
I have a work related injury issue I would like your comments on… I had a very moderate ankle sprain which I have doctors’ notes for. I know I had not been tardy 3 months prior to the tardy I was terminated for. However, the work I missed that was “excused” went AGAINST my attendance... Read More.
My husband fell at his workplace about 15 years ago. He was taken care of medically and later left the job. It appears that he sustained quite an impact in the fall because he now suffers from seizures. Prior to his recent neurological diagnosis he was uninsured and would see clinic medical doctors who would... Read More.
I was injured on the job in September of 2010. I was released to go back to work in February 2011. I have not heard from the insurance company since. I have a 15% disability to my arm due to the accident. I am still working for the original company that I was at when... Read More.
I was injured in 2008 with a damaged bicep tendon and herniated disc (5-6 cervical disc). I’ve had three surgeries to my right shoulder to move the bicep tendon, closed manipulation, and acdf. I was an LPN when injured and I have reached MMI (Maximum Medical Improvement). I took the FCE (Functional Capacity Exam) with... Read More.
I was injured on my job in January 2011. A forklift dropped a 1/4 ton concrete slab on me. I was left with permanent damage and I’m now totally disabled. I haven’t received any workmans comp payments either. I’m inquiring about two subjects: 1. Should they give me a lifetime open medical claim and some... Read More.
Two years ago I was injured at work requiring me to have rotator cuff surgery. During surgery they found out I also had a complete tear of the bicep. I continue to have pain but I’m not a wimp. I’ve kept working and have not been back to the doctors for a year. Recently the... Read More.
I am wondering if I have a case. About a year ago I had an accident at work. I went up to a cream tank that was pressurized and at the time not labeled at all. Not knowing it was under pressure I unscrewed a 3′ cap to look inside and it blew off, hitting... Read More.
I cut my thumb at work and it was not my employer’s fault. But now my thumb has no feeling in it and feels weird, like it’s itchy all the time. It’s been about eight months since the injury. I go to doctor this week for the last time. He told me that workers comp... Read More.
I was injured at a coal mine and placed on long term disability while I went back to school through Vocational Rehab. During that time I received a workers compensation settlement for permanent partial impairment. This settlement was paid out monthly and offset benefits from long term disability payments. Is this how this should have... Read More.
I fell and was injured on poorly designed steps. Others have also fallen there. The property owners have since changed the steps. I herniated my L5 vertebrae and went to a neurosurgeon, but he was not ready to operate. The workers comp doctor said that I was “7% whole body permanent disability.” What does this... Read More.
My husband fell at work and broke his kneecap. After two operations he was told he has a permanent disability. He consulted with unemployment and it was determined there are no jobs that he is qualified for. We went to a lawyer and it has been over a year and we are getting the run... Read More.
I am 48 years old and from the state of MT. I slipped on the stairs and broke my hip while at work in 2009. I underwent treatments and surgeries since 2009 but nothing seems to have improved my condition except for minor details. The insurance has taken care of all the expenses so far.... Read More.
I signed the workers comp settlement and now I found out my Social Security Disability is going to be like 80% lower. I should have gotten a lawyer to advise me on what to do. I did not know they would lower my check so much. So now my SSD check will be about $200... Read More.
I have a question about workmans comp settlements being offered by the adjuster 10 years after the accident… In 1999 I was injured from lifting a heavy steel beam with three other men. We had to round a corner and one man let go, putting extra weight on my body. Severe pain shot through my... Read More.
I hurt both of my knees, calf and back because of a faulty bus brake. I have been off work for a little over a year, and I was just given an opportunity of “light duty” the past 2 months. I was unable to complete the light duty so I’m back home. I have seen... Read More.
I have a workers comp disability question: I work in retail. I have been experiencing pain in my right shoulder. I started experiencing the pain while a cashier. I must have strained lifting a heavy item. I never did file a workers comp form because it quit hurting so I figured I was fine. Well... Read More.
I am employed as a learning support aid in a PA elementary school. I was asked to attend a field trip because the assigned person was absent. I went to a homestead recreation and assisted with a second grade class. I found a very small tick on my left shoulder and immediately removed it. A... Read More.
I want to know if doing an FCE (Functional Capacity Evaluation) is to my benefit for a large settlement for a workers comp injury? I injured both my shoulders. I’ve had 3 surgeries on each shoulder. I’ve been off of work for over 3 of the last 5 years. Thanks for any help you can... Read More.