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Determining Your Permanent Disability Rating

If you have been seriously injured at work, your doctor will inform you at some point in your treatment that you have achieved the maximum level of improvement that you can reasonably expect. In workers’ comp terminology, you have reached a stage known as maximum medical improvement (MMI), and your condition is now permanent and stationary (P&S). At that point, you are no longer eligible for temporary disability (TD) benefits and you begin the process where the state determines whether you will receive permanent disability (PD) benefits.

Your doctor then assigns you a permanent disability rating in terms of a percentage of healthy function, which corresponds to a monetary value. The state also uses your physician’s disability evaluation report to determine whether your award should contain funds for future medical treatment and if you are able to return to work.

At this point, arrangements are made for a comprehensive medical evaluation to generate a final disability rating. Often, either the injured worker or the insurance company disagrees with the physician’s initial disability rating. The question may then be referred to a Qualified Medical Examiner (QME). During this process, the two sides open several issues for negotiation:

  • The disability rating
  • The award for future medical care
  • Permanent work restrictions
  • Apportionment

This last item is very important, because it can significantly reduce a worker’s PD award. Apportionment is the process by which physicians determine what approximate percentage of the partial disability is work related and what percentage is likely the result of non-work activity. Workers’ comp only pays the percentage of PD that is work related. So, for example, if a worker has emphysema, and the physician apportions 60 percent to exposure to caustic chemicals at work and 40 percent to smoking, the worker will only receive 60 percent of the monetary value of the disability rating.

As you can see, there are many variables that rely on factual determinations as well as educated opinions. This makes arriving at a fair and accurate permanent disability rating very tricky. For reliable advice on this and other workers’ compensation issues, call the Tous Law Group at 714-602-4473 or contact our Orange County office online to schedule a free consultation.

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