Find out if your workers’ comp injury qualifies for a permanent partial disability settlement, and why the insurance company will fight to keep you from getting it.
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 doctor appointments, and partial wage reimbursement.
The goal is to help injured workers heal and return to their jobs as quickly as possible.
But what happens when you’ve been hurt so badly that you can never go back to your job?
Workers’ Comp and Permanent Partial Disability
Permanent partial disability (PPD) means an injured worker will never be able to go back to the kind of work they were doing when they were injured.
PPD is one of four disability categories used in workers’ compensation cases to define an injured worker’s ability to return to work.
Definition of Workers’ Comp Disability Categories
- Temporary Total Disability completely prevents you from working for a limited amount of time.
- Temporary Partial Disability prevents you from doing some, but not all, of your job duties for a limited amount of time.
- Permanent Total Disability prevents you from ever returning to work, whether for your current employer or another employer.
- Permanent Partial Disability is a permanent injury that partially impairs your ability to work.
Permanent partial disability claims are the most common work injury claims, representing over half of all workers’ comp claims filed each year in the United States. PPD can result from a wide range of work injuries, from physical injuries to mental health problems.
Permanent partial disability can be caused by traditional physical work injuries like herniated disks, burns or amputations. It is also caused by occupational diseases, such as lung disease from asbestos poisoning or toxic fumes.
The most commonly reported PPD injuries are:
- Back injuries (most common of all)
- Knee injuries
- Vision loss
- 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)
Reaching Maximum Medical Improvement
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.
The cost of ongoing medical care is normally covered by your workers’ comp medical benefit.
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.
If you haven’t already consulted a workers compensation attorney, now’s the time. From here on out, the insurance company will fight you every step of the way.
The IME doctor is not interested in what’s best for you. Anything you say to the IME doctor or staff can be used against you. Don’t expect the doctor to spend more than a few minutes looking you over. You will not get any treatment or medical advice.
The workers’ compensation insurance company does not want to pay large disability settlements to injured workers like you. They would like nothing more than for the IME doctor to give them an excuse to shut down your claim.
These doctors are supposed to be independent, but there’s a conflict of interest. Doctors employed by insurance companies may be under pressure to conduct IMEs in favor of insurance company standards.
Your Workers’ Comp Disability Rating
In most cases, the insurance company’s 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 permanent partial disability 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.
Doctors performing IMEs usually base a PPD percentage on guidelines established by the American Medical Association’s “Guides to the Evaluation of Permanent Impairment.”
To better understand the guidelines, you can purchase a copy of the Guides online or check with your local library.
The guidelines are updated as medical standards change, so make sure you are using the Guides edition that is accepted by your state’s workers’ compensation board.
Your disability rating will have a huge impact on the amount of any workers’ compensation settlement.
If you disagree with the IME doctor’s rating of your disability, contact an attorney.
Fighting for a Fair Disability Settlement
Workers’ compensation benefits will cover the medical costs related to your workplace injuries and provide a weekly wage replacement benefit, usually for about two-thirds of your base pay.
Benefits may also include a lump sum or structured settlement award for an on-the-job injury resulting in a permanent partial disability.
The workers’ compensation board hearing your claim considers several factors when calculating the dollar amount of your disability settlement.
They include the percentage disability rating assigned by the IME doctor, your age, level of education, work history, and suitability for other employment.
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.
Example: Eye Injury While Welding
Charlie was a trained spot welder and well-respected employee at a local manufacturing company. He’d held the job without incident for three years.
While welding a metal frame together, a sliver of metal shot 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.
Charlie filed a workers’ comp claim for his medical bills, medications, and for wages lost while he was recovering.
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 injury is considered permanent partial disability.
The workers’ comp insurance company offered a lump-sum settlement to Charlie. They wanted to settle his claim before it went to the workers’ comp board.
But Charlie’s attorney rejected that offer and took it to the board.
The attorney argued that Charlie wasn’t suited to office work, and if he hadn’t been partially blinded on the job, he would have worked as a welder for another 35 years until he reached full retirement age.
Based on his projected lost wages and future medical costs, Charlie was awarded a permanent partial disability settlement that was four times the amount first offered by the insurance company.
Don’t trust the insurance company to provide accurate or complete information about you, your health, and your lost earning potential to the workers’ compensation board.
Your financial future is at stake. This is why you need an experienced personal injury attorney to fight for you.
After determining the overall disability percentage, the board refers to their state’s mandated disability schedules. These schedules match your percentage of disability (also called impairment) to a specific dollar amount.
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.
The settlement offer may include payment of future injury-related medical bills or may require you to pay your own bills after the settlement.
Talk with your attorney about the pros and cons of the disability settlement offer. Your attorney may be able to negotiate a better settlement with the insurance company.
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 cannot be forced to pay.
Combining Disability Awards and Social Security
If you’re receiving Social Security disability benefits and you are also approved for a workers’ compensation settlement, you must notify Social Security.
The Social Security Administration (SSA) does not permit double payments for the same disability.
The SSA formula for calculating offsets to disability payments takes into account your age, work history, and your contributions to the Social Security system throughout your working lifetime.
For more information, visit the Social Security Administrations publication How Workers’ Compensation and Other Disability Payments May Affect Your Benefits.
When Hiring an Attorney Makes Sense
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 advice of an experienced attorney is crucial.
Your employer may be sympathetic to your injury, but your employer’s 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 workers’ comp disability 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.
Reputable personal injury attorneys don’t charge work injury victims for the initial consultation. You can meet with more than one before choosing the attorney who will fight for you.
Don’t let the insurance company keep you from a fair disability settlement for your case. Act now to protect your workers’ compensation benefits.
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