Permanent Disability Rating System in Workers Comp

 

The Workers Comp Permanent Impairment Rating Evaluation Determines How Much You Will Receive in Permanent Partial Disability Benefits and Affects the Settlement Value of Your Claim

 

When your doctor places you at maximum medical improvement for your work injury, it is time to determine your level of permanent disability. Your level of permanent impairment helps you, your attorney, and your employer’s insurance company determine whether you will be able to return to your pre-injury work, whether you are capable of returning to a different, lighter exertional level job, and the value of your permanent partial disability benefits.

 

Your level of impairment, or damage due to the work injury, is evaluated by a physician or licensed examiner and turned into a percentage rating. This rating determines the amount of permanent disability payments you will receive and helps your attorney evaluate an appropriate workers compensation settlement amount.

 

This article explains the permanent impairment evaluation and rating process in Virginia workers’ compensation cases. If you have questions, or want a free consultation with one of the best workers compensation attorneys in the state, contact Corey Pollard at (804) 251-1620 or (757) 810-5614 or by completing the form to your right. We look forward to helping you and your family.

 

Understanding the Difference Between Disability and Impairment in Workers’ Compensation Cases

 

So what do we mean by permanent impairment? And how is it different from disability?

 

The term “disability” is used often in workers’ compensation claims and has a specific meaning.

 

Under the Virginia Workers’ Compensation Act you have “disability” if your work-related injuries cause a reduction in your earning capacity. For example, you receive temporary total disability payments if you have a complete loss of your wage-earning capacity and temporary partial disability benefits if you return to a lighter job but make less.

 

You can have permanent impairment, however, without having a reduction in your earning capacity. The American Medical Association’s (AMA’s) Guides to the Evaluation of Permanent Impairment, 6th Edition, defines an impairment as “a significant deviation, loss, or loss of use of any body structure or body function in an individual with a health condition, disorder, or disease.”

 

Further, disability can be temporary or permanent. For example, a person with a fractured arm may be unable to work for several months due to disability but eventually return to work with no problems once the broken bone heals.

 

Impairment, however, is permanent. And the AMA Guides define a permanent impairment has one that has reached maximum medical improvement and is unlikely to change substantially in the future regardless of medical treatment provided. In other words, it doesn’t matter what you do and what type of treatment you get, your impairment will remain roughly the same.

 

What Does Permanent Impairment Measure in Workers’ Compensation Cases?

 

The AMA Guides state that impairment ratings are “a physician-driven first approximation of a process that attempts to link impairment with a quantitative estimate of functional losses in” the worker’s “personal sphere of activity.” This means the AMA Guides measure an injured worker’s extent of impairment compared to normal functional capacity, rather than compared to a specific type of work activity.

 

Though this definition of permanent impairment does not address work limitations directly, many state workers’ compensation systems, including Virginia, will accept and consider the definition found in the AMA Guides when resolving disputes over the level of impairment an injured employee has.

 

What Permanent Impairment Measurement System Does Virginia Use in Workers’ Compensation Cases?

 

To obtain benefits for permanent impairment and loss of use of a specific body part, an injured employee must establish that he has reached maximum medical improvement and that his functional loss of capacity can be quantified or rated.

 

When an injured employee seeks compensation for permanent partial loss of use of a body part in Virginia, the Workers’ Compensation Commission must rate the percentage of his or her incapacity based on the evidence presented.

 

Medical evidence, including a medical rating of an injured employee’s disability, is not conclusive and is subject to the Commission’s consideration and weighing. Indeed, the Commission has stated that it is not “limited by specific loss schedules or by various published guides which determine incapacity on the basis of a percent of motion or function of a member. Rather, the Commission may consider the nature of disability, the circumstances under which a [body part’s] use would be permanently affected, alternate use of a [body part] in other employments for which the claimant may be qualified, the effect of pain on use capacity, and such pertinent considerations as would permit the Commission to make a reasonable determination of permanent loss or loss of use in each case.”

 

That being said, the Commission often gives weight to impairment ratings derived from the AMA Guides to the Evaluation of Permanent Impairment. If you are seeking permanent partial disability or permanent total disability benefits, or are evaluating your claim for settlement, you should get a permanent rating evaluation using the AMA Guides to give yourself the best chance of success.

 

Who Should Perform the Impairment Rating Evaluation?

 

A physician who is familiar with the AMA Guides and has experience providing and calculating impairment ratings in workers’ compensation cases should evaluate you. Preferably, you will be evaluated by a physician who has undergone training in how to apply the AMA Guides and received certification by the American Board of Medical Specialties.

 

Usually we ask the injured worker’s treating physician to provide an impairment rating pursuant to the AMA Guides. This is the medical professional with the most knowledge of your condition, diagnosis, and symptoms. And usually the Commission will give great weight to the treating doctor’s opinions regarding the level of permanent impairment.

 

Some physicians, however, will not perform impairment evaluations. In these situations we refer our clients to other licensed physicians with whom we have established relationships and who have knowledge of how to apply the AMA guides and calculate permanent impairment.

 

What Happens at the Work Comp Impairment Rating Evaluation?

 

Here is the workers compensation impairment rating process in Virginia:

 

1. Your attorney schedules an impairment rating evaluation with your treating physician or a doctor hand picked by the attorney.

 

2. Your attorney sends a detailed letter to the doctor conducting your permanent impairment evaluation that explains the history of your accident and injuries, the treatment you have received, your symptoms, and how the Workers’ Compensation Commission evaluates various methods for calculating permanent impairment ratings. Your attorney will attach all relevant medical records to support your permanent impairment.

 

3. You arrive at the impairment rating evaluation and get examined by the doctor. He or she will render all appropriate medical tests to determine your level of permanent impairment. This includes taking measurements of your range of motion and assessing your credibility.

 

4. The doctor reviews his or her notes from your impairment rating evaluation along with your medical records reflecting all the treatment you’ve undergone since the workplace accident.

 

5. The doctor uses the AMA Guides to calculate your level of permanent impairment based on a number of factors, such as procedures performed, loss of range of motion, and pain, and suffering. You are given a rating from 0 to 100. A rating of 50 percent impairment or more to two body parts increases the likelihood that the Commission will find you qualify for permanent total disability benefits. This means you are not capped at 500 weeks of indemnity benefits and may receive payments at two-thirds of your pre-injury average weekly wage for the remainder of your lifetime.

 

6. The doctor sends a copy of the impairment rating evaluation report to your attorney.

 

7. Your attorney files a copy of the impairment rating with the Commission and sends a copy to the insurance company.

 

8. The insurance company reviews the impairment rating and decides whether to send you to a doctor of its choosing to build conflicting evidence.

 

9. Your attorney negotiates a settlement with the insurance company or requests a hearing seeking permanent partial disability payments.

 

10. Your case settles or the Commission enters an order awarding benefits after reviewing the impairment rating evaluations and listening to your testimony. This may require a workers compensation hearing before a deputy commissioner.

 

How Specific Does the Impairment Rating Need to Be?

 

Virginia does not recognize “whole person” impairment ratings. The doctor must evaluate your permanent impairment and loss of use as it relates to a specific arm, leg, hand, foot, finger, or toe. Otherwise the Commission may not award benefits.

 

Who Pays for the Workers Compensation Permanent Impairment Rating Evaluation?

 

Though some insurance carriers will voluntarily pay for the impairment rating evaluation if recommended by a treating physician, they are not required to do so under Virginia law. You will have to pay for the impairment rating out of your pocket unless you’re represented by a work injury lawyer who will advance your litigation costs, like Corey Pollard.

 

Get the Most Accurate and Complete Impairment Rating Possible in Your Workers’ Compensation Case

 

Each year impairment ratings lead to billions of dollars in payments in state workers’ compensation systems. So insurance companies are always looking for ways to reduce the impairment rating you receive – either by repeatedly questioning the doctor who issued the rating with the hope that he or she will reduce it or by sending you to a doctor on the insurance company payroll for a second opinion.

 

Further, insurance companies often try to get you away from your treating physician during the impairment rating evaluation process. In their opinion many treating physicians turn into advocates for their patients and inflate ratings. But unless the insurance company pays for the impairment rating, you get to choose the doctor. And even then, your attorney can still get an impairment rating from the treating physician.

 

If you have questions about your case or are looking for a top-rated attorney, call us today. We represent injured employees throughout Virginia – and we are ready to help you get every penny you’re owed for your workplace accident.

Corey Pollard
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