Permanent Disability in Workers’ Compensation
Permanent Disability (PD) is any lasting disability from your work injury or illness that affects your ability to earn a living. If your injury or illness results in PD you are entitled to PD benefits, even if you are able to go back to work.
A doctor decides if your injury or illness caused PD. The doctor’s report is then turned into a PD rating. The process used to turn the doctor’s report into a rating can vary depending on your date of injury and other factors. The PD rating determines the benefits you’ll receive.
Permanent & Stationary / MMI
After your doctor decides your injury or illness has stabilized and no change is likely, PD is evaluated. At that time, your condition has become permanent and stationary (P&S). Your doctor might use the term maximal medical improvement (MMI) instead of P&S.
Once you are P&S or have reached MMI, your doctor will send a report to the claims administrator telling them whether you have any PD. The doctor also decides if any of your disability was caused by something other than your work injury, such as a previous injury or another condition. This is called apportionment.
The claims administrator may ask you to fill out a form describing your disability.
If you or the claims administrator disagrees with your doctor’s findings you can be seen by a doctor called a Qualified Medical Evaluator (QME). If you are represented by an attorney, you may have an Agreed Medical Evaluator on your case. Your employer or the workers’ compensation insurance carrier will pay for the cost of the QME exam.
How is Permanent Disability calculated?
First, after your exam, the doctor will write a medical report about your impairment. Impairment means how your injury affects your ability to do normal life activities. The report includes whether any portion of your impairment was caused by something other than your work injury. The doctor’s report ends with an impairment number. Next, the impairment number is put into a formula to calculate your percentage of disability. Disability means how the impairment affects your ability to work. Your occupation and age at the time of your injury affect your PD calculation. There are other factors.
You may have to see the doctor several times before your permanent disability can be determined. Once your permanent disability has been determined, any portion of your disability caused by something other than your work injury is taken out of the above calculation.
Permanent Disability Rating
Your disability will then be stated as a percentage. Your percentage of disability equals a specific dollar amount, depending on the date of your injury and your average weekly wages at the time of injury. Even then, the insurance company can object and refuse to agree with the doctor’s determination. An experienced workers’ compensation attorney is crucial in all aspects of your case, especially where determining permanent disability.
Once there is an AME/QME on your case, that does not mean you stop treating with your primary treating physician (PTP). In fact it is important that you continue treating and that the doctor issues reports.
Once your doctor says you have PD, the claims administrator will estimate how much you should receive and begin making payments to you, even if the final percentage of disability has not been calculated. PD benefits are paid in addition to temporary disability (TD) benefits you received.
The claims administrator must begin paying your PD within 14 days after TD ends and continue the payments until a reasonable estimate of your disability amount has been paid. If you have not missed any work, PD payments are due from the date the doctor says you are P&S. PD benefits continue to be paid every two weeks on a day picked by the claims administrator until a reasonable estimate of your disability amount has been paid. When the actual amount of PD due has been determined, the amount over the estimate must be paid.
If you were injured and have ratable permanent disability, as of Jan. 1, 2013 PD payments are not due if you return to modified, alternative or regular work with your employer at 85 percent of your wages or return to work for any employer at 100 percent of your wages. When you receive your PD award, you will then receive an adjusted payment beginning with the last date TD was paid or when you made a maximum medical recovery, whichever is earlier.
Can I settle my case?
After the amount of PD in a claim is determined, there is usually a settlement or award for benefits. This award must be approved by a workers’ compensation judge. If your doctor said further medical treatment for your injury or illness might be necessary, the award may provide future medical care.
For the best results in your work injury claim, always consult with an experienced workers’ compensation attorney. Workers’ comp consultations are always free with Attorney Nikki Jacobson.
Nikki Mehrpoo Jacobson
Attorney at Law
Certified Specialist Workers’ Compensation Law
The State Bar of California Board of Legal Specialization