Permanent Disability Benefits from a Work Injury
Permanent disability is a workers’ compensation benefit offer to injured workers who are unable to make a full recovery. When additional medical treatment is determined not to be beneficial, workers will be assigned a disability rating for their injured body part that will have a direct impact on the level of benefits that can be received. An experienced workers’ compensation lawyer can help you understand permanent disability benefits.
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When a Work Injury is Considered Permanent
The promise of workers’ compensation is that injured workers can seek medical treatment until they have fully recovered from their injuries. However, with some injuries, a full recovery simply isn’t possible. When medical treatment no longer helps in recovery and further treatment would not be beneficial (maximum medical improvement), patients are considered permanently disabled. When this happens, doctors declare injured workers as “permanent and stationary” (P&S) and produce a report. The report will contain information that will determine your “disability rating”, including:
- Details of your injuries and pain levels
- What effect your injuries have on your ability to work
- Whether you can perform your normal work duties
- Whether your permanent disability was caused in part by any factors not related to your injury at work
- What continuing and future medical care you may require
Calculating a Permanent Disability Rating
Permanent disability ratings can be a bit of a mystery. To obtain a rating, a qualified medical examiner (QME) will examine your P&S report and perform some tests following American Medical Association guidelines. The QME assigns a disability rating to each injured body part, ranging from 0 to 100. These individual body part ratings then converted into an overall disability rating called “whole person impairment” (WPI). The WPI is then adjusted for future earning capacity, general occupation, specific occupation, and age. These adjustments are done using a pre-determined mathematical formula using values pre-defined under the California labor code, so there is nothing an injured worker can do to contest their WPI rating.
Appealing a Permanent Disability Rating
While permanently disabled workers cannot contest their final WPI rating, they can contest the disability rating assigned by the QME. Though every QME follows the same guidelines in determining your disability rating, different QMEs can arrive at very different conclusions. If you are unsatisfied with your initial disability rating, you have the right to a second opinion. The first QME to assess work injuries is usually chosen by the insurance company, so it may not be a surprise that seeking a second opinion from a QME not affiliated with the insurance company can sometimes lead to a higher WPI disability rating. Our workers’ compensation experts can help you assess whether or not your initial body part disability ratings are fair and arrange a second opinion on your behalf.
Determining Permanent Disability Benefit Levels
When your initial disability ratings are determined, they are put through a pre-determined formula to determine your WPI. After the WPI is calculated, it is further adjusted for numerous factors. After those adjustments, you finally have your permanent disability rating, which will be a number from 0 percent to 100 percent. Your permanent disability rating will determine how long you are entitled to receive benefits, with each rating point extending the time you can collect permanent disability benefits by several weeks.
Benefit rates are 2/3 of your average weekly earnings (AWE), but have a minimum of rate of $160 and maximum of $290 per week in 2020. Be aware though that this is a drastically lower maximum than temporary disability benefits. Injured workers rated between 70 percent and 99 percent disabled are eligible for a lifetime pension upon the expiration of their permanent disability benefits. Injured workers with a 100 percent rating are considered to have total permanent disability and will receive enhanced benefits for the rest of their lives. Workers with total permanent disability are not subject to the $290 per week benefit cap, but instead have the same benefit cap as temporary disability benefits ($1,356.31 per week in 2021).
After being assigned a permanent disability rating, you can mathematically calculate your total benefits package. Let’s say you were assigned a 40 percent permanent disability rating, allowing you to collect benefits for 280 weeks. If your AWE is above $435, your benefit level will be $290. $290 for 280 weeks is a total permanent disability benefits package of $81,200. This figure can be taken into consideration when settling your workers’ compensation claim. While you can make similar calculations for injured workers with more than a 70 percent disability rating for permanent disability benefits, it’s not possible to do so for the lifetime pension benefit, as the value of the pension changes every year.
Get Help with Permanent Disability Benefits
An experienced work injury law firm can help you understand the complexities of permanent disability benefits offered under workers’ compensation law. The Law Offices of Scott Warmuth has been fighting for the rights and well-being of its clients since 1984. If you’ve suffered a serious work injury resulting in permanent disability, our workers’ compensation attorneys can help you. If we don’t win your case, we will not charge for our services.