Many people who are injured whilst working are subsequently treated with immediate medical attention and go on to make a full recovery. They may require workers’ comp to cover some medical bills and perhaps a few days’ or weeks’ pay, but it ends there.
Unfortunately, however, for some, their work injuries create lasting and even permanent effects. These less fortunate employees are eligible for permanent disability benefits through workers’ compensation.
Permanent disability benefit eligibility
A workers’ compensation doctor will determine whether you are eligible for permanent disability benefits. At some stage during your recovery treatment, your doctor will diagnose that your condition has improved as much as it can or will. Most states refer to this critical point as having reached ‘maximum medical improvement,’ (MMI).
Upon reaching MMI, your doctor will examine you to determine the extent to which your injuries have left you with any permanent limitations or restrictions. For example – after lifting heavy equipment for years at work, you suffered a shoulder tear, and despite physical therapy and even surgery, you still can’t completely rotate your shoulder or lift anything that weighs more than 20 pounds. Your treating doctor would assign you a disability rating, recorded as a percentage representing the degree of permanent restriction you have suffered in your shoulder.
Depending on the nature of your injuries and your state’s laws, your doctor may go straight for a rating of ‘whole person impairment’ instead. It is quite common to receive this rating when suffering an injury involving the back, neck, head, internal systems or organs. For example, if a coal worker develops black lung disease and suffers a significantly limited respiratory function, they may receive a whole person impairment rating of 40%.
How are permanent disability benefits calculated?
Often, the most complicated workers’ compensation benefits to calculate are that of Permanent Disability. Every state uses its own independent methods for determining the amount payable, and this depends upon whether the disability sustained is partial or total, as well as whether it’s scheduled or unscheduled. There are also plenty of courses available too.
What is permanent total disability?
Most states categorise a permanent and total disability as one in which the employee is prevented from working again in any kind of gainful employment. This categorization is reserved for the most debilitating and serious of conditions, such as the loss of both arms and legs, or total blindness. Permanent total disability is typically paid at the same rate as benefits for temporary total disability, except that they are paid for the rest of the recipient’s life.
What is permanent partial disability?
All other disabilities that are permanent are considered to be partial disabilities. In the majority of states, permanent partial disabilities are broken down into either scheduled or unscheduled losses.
Scheduled loss
A scheduled loss is one that is included on a list within the state’s workers’ compensation laws. Such state schedules typically encompass disabilities sustained to the extremities – usually broken down by fingers, toes, feet, hands, legs, arms, eyes and ears. Each body part has a specific number of weeks’ payments assigned to it (or, in a small number of states, a dollar amount is specified). Most states will then multiply the number of weeks by the disability rating assigned to the worker.
For example, let’s say that the state schedule has assigned 65 weeks of benefits for the loss of a finger. If you received a disability rating of 10% from your doctor for the loss of your finger, you would receive benefit payments for 6.5 weeks (65 x .10). In some states, workers would receive their temporary disability benefit rate during that time. In other states, their weekly amount would be calculated differently or be subject to a lower capped amount.
Unscheduled loss
Losses that aren’t included on a state’s list are called ‘unscheduled losses’ and are typically more complicated to calculate. Some states will compensate for these disabilities by using a whole person impairment-based calculation. For example, a worker who has received a 100% whole person impairment rating may be worth 350 weeks, therefore, if you were to receive a 50% whole person impairment rating for an injury to your back, you would receive 175 weeks of benefits.
Some states, however, don’t approach unscheduled losses with an impairment-based calculation. Some will measure the actual wages lost to the worker due to the impairment, by comparing the worker’s pay before and after the injury was sustained. Other states will measure the loss of future capacity to earn money, using several factors for consideration, such as the worker’s age, training, education and experience.
It’s important to remember that every state has its own unique workers’ comp rules, and your state may hold some variations to the rules outlined in this article, so it’s important to determine what your state’s rules are. Alternatively you can contact a workers’ compensation lawyer or the workers’ compensation agency in your state.
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