How to pursue a permanent partial disability payout from workers’ comp if you can’t go back to your old job. Get a fair workers’ comp settlement.
Workers’ compensation insurance provides benefits to eligible workers injured on the job.
Standard benefits include coverage for medical and therapy bills, medications, reimbursement for costs of transportation to and from doctor appointments, and partial replacement of your average weekly wage.
The goal is to help injured workers heal and return to their jobs as quickly as possible.
Many workers suffer an injury that will never get better with treatment. In workers’ comp terms, a Permanent Partial Disability (PPD) means your permanent injury keeps you from returning to the type of work you were doing before you got hurt.
How to Qualify for Permanent Partial Disability (PPD)
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.
Permanent partial disability (PPD) means an injured employee 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.
Qualifying Steps for Permanent Partial Disability:
- The treating physician must determine that the injured worker’s injuries will not get any better with further treatments, called Maximum Medical Improvement (MMI)
- The treating physician, or another doctor approved by workers’ comp, will determine an Impairment Rating. The impairment is a percentage measurement of the worker’s loss of use of a body part or function. For example, a 50% hearing loss.
- The worker’ comp board will refer to the state’s “disability schedule.”
- PPD benefits are typically calculated by using the worker’s weekly wage benefit, the scheduled weeks, and the impairment rating.
Most Workers’ Comp Injuries Become PPD Claims
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 loss of use of a body part or function 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
- Loss of vision or hearing
- Carpal Tunnel Syndrome
- Nerve damage to the shoulder and neck areas
- Amputation of fingers, toes, or entire limbs
- Post-Traumatic Stress Disorder (PTSD)
Not all states have workers’ comp coverage for PTSD. In most states that do cover PTSD, the workers’ compensation laws limit coverage to specific workers, such as for first responders.
Reaching Maximum Medical Improvement
A determination of permanent partial disability can only be made after you reach Maximum Medical Improvement (MMI). This happens when your primary doctor decides your medical condition is stable and won’t improve with further treatment. This can take a number of weeks or months or even years.
Reaching MMI doesn’t mean your medical treatment is complete. You may require ongoing medical 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.
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 PPD benefits or settlements to injured workers like you. They’d 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.
Workers’ Comp Impairment Ratings and Settlements
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 an impairment rating on guidelines established by the American Medical Association’s “Guides to the Evaluation of Permanent Impairment.”
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.
Your disability impairment rating will have a huge impact on the amount of any workers’ compensation settlement.
The workers’ compensation board hearing your claim considers several factors when calculating the dollar amount of your disability settlement. These factors include the impairment 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.
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.
Disability Schedules and PPD Ratings
After determining the overall disability percentage, the board refers to their state’s mandated disability schedules.
Many states rely on a schedule that assigns a number of weeks to each body part or function. Your settlement is based on your weekly wage benefit for the allocated number of weeks and the percentage of your impairment rating.
For example, let’s say your weekly workers’ comp wage benefit is $500. The schedule for your state allows 100 weeks of benefits for a hand. If you have an impairment rating of 50% for your hand injury, your lump sum will be calculated as follows:
$500 x 100 weeks = $50,000. At a 50% impairment rating, the PPD settlement lump sum payment would be $25,000 ($50,000 x 50%).
Lump Sum and Structured Settlements
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.
Example: Permanent 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 a 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.
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, see 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 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 legal advice of an experienced workers’ compensation lawyer is crucial.
Your employer may be sympathetic to your injury, but your employer’s workers’ comp insurer won’t be. In many cases, they will do everything legally possible to obstruct your claim during the hearing process.
Insurance companies don’t like to pay out money. The amount at stake in a workers’ comp disability claim can be in the hundreds of thousands 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 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. Many states limit attorney fees in worker’s compensation cases.
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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