Many injured workers, even those who recover and return to work with no wage loss, will have a permanent partial disability from their industrial accident.
Though often inadequate considering the permanency of the occupational injury and its effect on livelihoods, these payments to workers with permanent partial disabilities can be a significant source of income for you and your family.
Indeed, these permanent partial disability benefits are a large percentage of total cash payments in the workers compensation system. For example, various studies have concluded that permanent partial disability payments account for more than half of all income benefits paid to injured workers.
This article explains how to get permanent partial disability benefits in workers comp, focusing on Virginia.
But despite this focus, the information below will help you understand the benefits available for partially disabled workers under their state’s law.
I hope you find this guide to permanent partial disability benefits helpful.
And do not hesitate to contact my office if you have questions about workers comp law in Virginia or would like a free consultation with a top-rated work injury attorney.
We help injured workers negotiate top-dollar settlements for their occupational injuries and illnesses. And we are ready to pursue benefits for you.
In workers comp, the acronym PPD stands for permanent partial disability.
Permanent partial disability means a permanent impairment from a compensable work accident that restricts the body’s function or use of its members, lessening the employee’s working ability.
Permanent partial disability benefits are one of the four types of workers compensation benefits that provide cash to injured workers.
The other three types include temporary total disability (TTD), temporary partial disability (TPD), and permanent and total disability (P&T).
Any work-related injury that causes enduring and partial disability may qualify for permanent partial disability benefits.
Common examples of occupational injuries resulting in the payment of permanent partial disability benefits include:
Examples of injuries that usually do not result in permanent partial disability benefits include:
You (the injured worker) have the burden of proving by a preponderance of the evidence that you are entitled to permanent partial disability benefits through workers comp.
By law, you must present evidence of two things to get compensation for permanent partial disability.
First, that your occupational injury has stabilized so that your doctor can determine the injury’s permanent effects.
Second that you have a disability rating (also called a permanent impairment) that quantifies your functional loss of use of the affected body parts.
First, you must show that your treating physician has declared that you have achieved maximum medical improvement (MMI) for your work injury.
You have reached MMI when there is no reasonable expectation that medical care will provide functional improvement, only symptom relief, such as pain management.
Workers compensation law does not place a time limit on how long you have to reach MMI to get permanent partial disability benefits.
You must, however, file a claim for permanent partial disability within the applicable statute of limitations, which is discussed later in this article.
A narrative report (or disability letter) from your doctor stating that you have reached MMI is usually sufficient to meet your burden for this element.
Some of you, however, will not need a separate report because your physician will write the MMI declaration in your medical records.
Providing testimony at a workers comp hearing about what you can no longer do because of the occupational injury is insufficient to get permanent partial disability benefits.
Instead, you must present evidence that quantifies the degree of permanent injury and what you can no longer do because of the work-related injury.
Typically, injured workers present proof of permanent partial disability through disability ratings.
These disability ratings, also called permanent partial impairment ratings), require you to undergo a functional capacity evaluation (FCE) to assess permanent disability.
During the FCE with an impairment rating, you will answer questions about your subjective complaints and complete physical tests (for example, range of motion and strength).
Then the examiner will use this data to rate your percentage of loss of use of the affected body parts.
The Commission 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.”
Because the Commission is not limited by set guidelines or tables, you can use various methods to try to prove you have permanent disability resulting from your workplace injury.
That said, I recommend obtaining a permanent partial disability rating using the AMA Guides to the Evaluation of Permanent Impairment. The AMA Guides were initially published in the Journal of the American Medical Association (JAMA) and have been updated over the years. There are several editions.
The AMA Guides provide a standardized tool to convert medical information about permanent impairments due to work-related injuries into numerical values. Some people have criticized different aspects of the AMA Guides, but they are still widely used in workers compensation.
In some situations, a formal disability rating is not needed to obtain compensation for permanent partial impairment.
For example, the Commission can assess permanent partial disability without a rating for injuries involving the amputation of one or more limbs or digits (fingers, toes). All you need to do is ask your treating orthopedic surgeon to complete this Amputation Chart.
In addition, the Commission can visually assess severe impairment from disfigurement or scarring, such as burns or surgical scars.
The case law states that the extent of disfigurement is a legal question, not a medical determination.
No.
The workers comp laws, available benefits, and administration and adjudication of disputes vary by state.
An employee with a broken leg in one state may, therefore, receive tens of thousands of dollars more in permanent partial disability benefits than an employee with an identical injury and wages in another state.
Despite this variability, the methods used by states to assess the extent of permanent disability tend to fall into one of these four categories:
Workers comp and occupational medicine divide permanent partial disability into two categories: partial disability to the whole person (unscheduled) and disability to scheduled members (body parts).
Unscheduled disability refers to permanent partial impairment due to injuries to the head, brain (including concussion), neck, back, and thoracic spine.
The term scheduled injuries refers to compensation for loss of use (total or partial) of body parts listed under the state’s statutory schedule for loss of use of the body part.
Most states use a schedule of body parts to determine which injuries are eligible for compensation for permanent partial disability.
Virginia is one such state.
Code Section 65.2-503 is Virginia’s permanent partial disability statute.
This code section includes a schedule of body parts and the number of weeks available for permanent partial disability (total or partial) for each body part.
Here is the permanent partial disability chart for occupational injuries and diseases in Virginia:
The Act addresses compensation for partial amputation injuries involving the digits on the hand or foot.
The loss of more than one phalanx of a thumb, finger, or toe is considered the loss of the entire thumb, finger, or toe.
Yes, in most states you can receive permanent partial disability payments for functional loss of unscheduled (unlisted) injuries.
Virginia, however, does not pay benefits for unscheduled benefits.
You will not, therefore, receive permanent partial disability for injuries to the back, neck, head, spine, or teeth – with one exception.
You have a viable claim for PPD for unscheduled losses if the unlisted injury affects a scheduled member.
For example, a low back injury often results in pain in the leg, and an upper back injury might cause pain in the shoulders and arms.
As odd as it may seem, workers comp values some body parts more than others.
The arbitrary scheduled loss of members results in discrepancies in settlement amounts and payouts of permanent partial disability awards. Indeed, this is natural, as the higher the value placed on your injured body part by the General Assembly, the more your case is likely worth.
You should, therefore, seek a disability rating for the injured body part affected by the occupational accident and assigned the highest number of PPD benefits (by week).
For example, suppose you suffer a work-related wrist injury.
In this situation, you may choose to get a disability rating for the hand or arm.
The workers comp schedule of loss provides more weeks for loss of use of the upper extremity than the hand; therefore, you will likely receive more compensation for partial disability with an impairment rating for the arm.
But remember to read the case law before deciding what type of rating to get.
Unless the wrist injury impacts the use of your arm toward the elbow and above, the Commission may refuse to recognize permanent partial disability of the entire extremity and require you to present evidence limited to functional loss of only the hand.
Generally, no.
The Act, however, allows medical practitioners to consider pain when evaluating permanent partial disability.
Pain can be a factor in increasing your disability rating if you have proof that the pain affects the functional use of the injured body part.
I recommend asking the person rating the permanent impairment to address the effect of pain in a narrative report.
Now we will examine how the permanent partial disability calculation works in practice.
Presuming you have proven a compensable work accident, reached MMI, and obtained a rating for your loss of use, you are ready to calculate your PPD award.
The first step is calculating your pre-injury average weekly wage (AWW).
Next, you calculate 66 2/3 of your AWW. This number is your compensation rate.
Then you multiply your compensation rate by your percentage of disability and the number of weeks assigned to the injured body part under the loss schedule.
This number equals your permanent partial disability payout.
Here is an example:
You injure your right shoulder on the job.
You earned $1200 per week when you were hurt, making $800 your compensation rate.
When you reach MMI, you obtain a 40% permanent partial disability rating.
Under these facts, you would get a permanent partial disability award of $64,000 ($800 x 200 weeks x .40).
Determining the average award for permanent partial disability is challenging for several reasons:
Acknowledging these difficulties, in my experience, the average workers comp permanent partial disability award ranges from $20,000 to $50,000 (or more).
Data from studies in other states and the Workers Comp Research Institute supports my PPD payment range.
Several factors increase the likelihood that you will get PPD benefits after your work injury stabilizes, such as:
It depends.
In Virginia, you always have the option of receiving compensation for permanent loss of use (total or partial) in a lump sum.
The question is whether you will have to agree to a four percent deduction to get the PPD payments in a lump sum.
If the number of weeks of permanent partial disability benefits has passed since you reached MMI, you will receive the PPD payments in a lump sum.
If, however, the Commission enters the award of permanent partial disability soon after you reach MMI and the number of weeks of PPD owed has not expired, the employer may pay the benefits weekly unless you accept the four percent deduction.
Here is an example:
You reached MMI for a knee injury on January 1, 2022.
Based on the disability rating, you are entitled to 26 weeks of PPD benefits.
If the parties resolve the claim for PPD after July 1, 2022, you will receive the payment in a lump sum.
But if the parties enter into an award for PPD within a few weeks of you reaching MMI, the employer will pay your permanent partial disability compensation weekly.
Yes.
Your employer is responsible for a visit to a physician for the sole purpose of providing a disability rating to support a claim for permanent partial disability benefits.
This rule, however, is a new one in Virginia.
In October 2021, the Workers Compensation Commission delivered its opinion in Kenneth Elliott v. Sam Green Vault Corporation. This decision reversed longstanding, existing case law holding that a permanent partial disability assessment is not medical treatment. And therefore, employers are not responsible for paying for such assessments.
In Elliott, the majority of the Commission gave several reasons for holding employers responsible for the payment of permanent partial disability ratings:
Based on these past rulings, the majority of the Commission saw no reason to exclude the treating physician’s effort to assess the degree of permanent injury so an injured worker may receive a benefit available under the Act.
The Commission, therefore, “cannot portray such an FCE” as “medical treatment for the purpose of suspending the compensation of the claimant who refuses to attend or fails to cooperate while concurrently denying that the same evaluation qualifies as medical treatment when it is needed for the claimant to secure compensation justly due under the Act.”
Here is why:
Under the old case law, a claimant can seek an opinion from any medical provider the claimant is willing to pay to complete a permanent partial disability assessment.
This freedom increases the likelihood that the claimant will receive a high permanent partial disability rating. And such a rating leaves the employer with little choice but to pay for its own assessment to combat the high rating.
The employer, therefore, does not save money on litigation costs in this situation.
Further, such a scenario forces the Commission to weigh the often wildly disparate disability ratings from competing expert witnesses with little familiarity with the injured worker.
“Both assess the injured worker’s physical capacities – the former in terms of what, if any, residual capacity remains and the latter in terms of what has been lost. And both are a necessary antecedent to the awarding of compensation granted in the Workers’ Compensation Act.”
Sometimes one of the litigants disagrees with the permanent partial disability rating.
For example, you might pick a doctor known for providing high partial impairment ratings to claimants.
If the employer knows the doctor’s reputation for suspiciously high disability ratings, it will likely reject the rating.
Indeed, the insurer may disagree with the impairment rating even if you chose a trusted and credible permanent partial disability examiner. Many insurance claim adjusters and defense attorneys presume that if you chose the doctor, the disability ratings overstate your functional loss of use.
In response, the employer may request you attend a defense medical examination (also called an IME, or independent medical exam). The purpose of sending you to this exam is to obtain a lower disability rating that the insurer can use to dispute your PPD claim.
When there are two or more disability ratings and the parties cannot agree on what impairment rating to use, you will have to ask the Commission to resolve your PPD claim.
Typically the Commission will take one of the following actions when there are conflicting permanent partial disability ratings:
or
Either party may appeal the permanent partial disability benefits decision to the full commission if they disagree with the judge’s opinion.
In my experience, protracted litigation regarding compensation for partial disability is rare because the difference in potential outcomes is slight.
Yes, payments for permanent partial disability are not dependent on actual wage loss (past or current) from the occupational injury.
As stated by the Court of Appeals of Virginia, permanent partial disability benefits are for the loss of “human capital.”
If you have a scheduled permanent bodily impairment, workers comp will conclusively presume that the injury affected your earning capacity, even if you do not have actual wage loss and have returned to light duty employment or full duty without restrictions.
The Commission may, however, consider your ability to work when determining the extent of your loss of use of the injured body part and permanent partial disability in disputed cases. For example, the Commission may give more weight to a lower permanent impairment rating if you’ve shown an ability to work and use the injured body part in employment.
Yes, compensation for permanent partial disability is available to injured workers with a preexisting condition (osteoarthritis, degenerative disc disease) or a past work injury.
You will, however, need the health care provider that gives you the disability rating to apportion the percentage between the preexisting condition and the occupational injury.
Further, you should present evidence showing what you could do before the work injury, including the release of medical work restrictions. This evidence can increase the portion of the impairment percentage assigned to the accident you seek PPD benefits for.
Workers compensation statutes of limitations govern how long you have to file each type of claim.
If the Commission has entered a Medical Only Award in your case, but never awarded wage loss benefits, the statute of limitations for filing a claim for permanent partial disability benefits is three years from the date of the accident.
If you have received wage loss payments pursuant to an Award Agreement, the statute of limitations for filing a claim for compensation for permanent loss of use is three years from the date you last received wage loss benefits under the Commission’s Award Order.
Many of you have either had or will require surgery to heal your work injury.
Deciding whether to settle your workers comp claim before or after surgery.
Likewise, choosing the right time to get a permanent partial disability rating can be challenging.
Generally, I recommend getting a disability rating before undergoing a partial or total joint replacement. The law allows this under the rationale that the employer should not benefit from increased function due to the implantation of a prosthesis.
In addition, I recommend waiting to seek compensation for permanent partial disability until you have returned to work for at least six months (if you return at all).
Going back to work might reveal additional problems with your recovery, resulting in a higher disability rating.
No, which is why you should not hesitate to file a protective claim for permanent partial disability payments.
Though you must file a PPD claim within the applicable statute of limitations, you do not have to try the case or resolve it within that same period.
Indeed, some of you, especially those with catastrophic injuries requiring surgery such as lumbar fusion, may not reach maximum medical improvement within three years of the accident date.
Citing Rule 1.3 of the Rules of the Workers Compensation Commission, the insurance defense attorney may push for a hearing on the PPD claim before you reach MMI or obtain a disability rating. This rule gives the Commission discretion to dismiss a claim for benefits when a claimant does not file supporting medical evidence within 90 days of filing the claim.
But Commission policy and case law supersede Rule 1.3 when it comes to claims for permanent partial disability benefits. The Court of Appeals of Virginia said so in Target Corp. v. Velasquez, Record No. 0576-12-4 (Va. Ct. App. 2013) (unpublished).
Under the current case law, a “claimant simply has to prove that he has a permanent disability that existed within the limitation period” and that resulted from a compensable accident. You do not have to submit medical evidence establishing a permanent disability when you file the claim or even within the limitation period. Instead, you can obtain supporting evidence and present it when you ask the Commission to hear your PPD claim.
I recommend, therefore, that you file a protective claim for permanent partial disability benefits when you submit an initial claim for medical and wage loss benefits. If you do it this way, you will have one less deadline to worry about with your workers comp case.
Filing a protective claim for permanent partial disability benefits (also called an assertion of rights) is easy. All you have to do is ask the Commission not to refer your claim to the hearing docket until you submit a separate request.
The treating doctor’s declaration that you have reached maximum medical improvement is not only a good time to obtain a permanent partial disability rating but also a trigger to consider settlement.
For example, many cases settle when the injured worker gets rated for permanent partial disability because
Often injured workers and insurance companies (Travelers, The Hartford, Liberty Mutual) or claim administrators (Sedgwick CMS, ESIS, Gallagher Bassett) stipulate to the permanent partial disability benefits owed.
But a stipulation resulting in the award of compensation for permanent loss of use is not the same as negotiating a lump sum settlement.
Resolving the claim for PPD benefits by stipulation instead of settlement enables you to continue receiving medical care at the employer’s expense.
In addition, depending on the other facts of your case, you may have the right to file a change in condition application seeking the reinstatement of wage loss benefits.
Yes.
In Virginia, you do not have to be eligible for lawful employment to receive compensation for permanent partial disability.
Yes.
PPD benefits are available even if the employer alleges and proves an unjustified refusal of vocational rehabilitation services, medical attention such as surgery, or light-duty procured by the employer.
No.
A speculative statement that you will likely have permanent impairment due to the work injury is insufficient to get PPD benefits.
You need an actual disability rating and a declaration that you have achieved MMI.
Yes.
The number of weeks you receive temporary disability and permanent partial disability benefits cannot exceed 500 weeks.
No.
Reaching MMI and obtaining a PPD rating will not affect your temporary total benefits if you continue receiving them.
Yes.
The Act permits injured workers to receive temporary partial and PPD benefits simultaneously.
Your simultaneous payments, however, will count as two weeks against the maximum allowable period of 500 weeks of indemnity benefits.
Sort of.
Some of you might qualify for PPD benefits for disfigurement/scarring and loss of use of the same injured body part.
You can receive PPD for both of these items.
However, a past award for disfigurement to an extremity will result in a dollar-for-dollar reduction in subsequent awards for loss of use of the same body part.
Unfortunately, some of you will have a permanent partial disability that prevents you from returning to your pre-injury job and makes it difficult, if not impossible, to find other work.
If you fall into this category, you have options to get additional income:
First, you may qualify for permanent and total disability benefits, which the law does not cap, if you have severe loss of use of multiple limbs due to a work accident. Usually you will need a 30% loss of use or more to qualify for these benefits.
Second, you may qualify for additional temporary total or temporary partial disability benefits if you have not received a total of 500 weeks of indemnity benefits.
Receiving PPD benefits extends the statute of limitations for claims to reinstate wage loss payments.
Third, you may also be entitled to Social Security disability benefits (SSDI or SSI) for permanent partial disability due to a work accident.
The Social Security Administration (SSA) evaluates claims for disability insurance benefits using a different analysis than workers comp. And it does not consider causation (what resulted in the injury or condition) unless alcohol or substance abuse is causing your impairment.
Depending on your age (the older you are, the easier it is to qualify), education, and transferable job skills, you may be eligible for SSDI benefits after a disability hearing before one of the SSA’s administrative law judges.
I regularly help injured workers qualify for Social Security Disability Insurance (SSDI) benefits after receiving a disability rating for their work injuries. You can receive both benefits (PPD and SSDI) at the same time.
Claims for compensation for permanent partial disability are rarely straightforward in Virginia.
But an experienced and skilled lawyer can help you get the maximum amount of permanent partial disability benefits available for your work injury and functional loss (or scarring and disfigurement).
My firm can help get PPD benefits and increase your case’s settlement value by:
You have nothing to lose by calling me for a free consultation: (804) 251-1620 or (757) 810-5614
My firm represents injured workers in claims arising from all industrial accidents. So, no matter where you were hurt or what type of injury you suffered on the job, I can help you get the cash and medical coverage you deserve.