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.
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 a Fall River, MA Workers Compensation 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.