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Benefits in Case of Permanent Disability

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Benefits in Case of Permanent Disability

permanent disabilityA majority of workers will completely recover from any injury sustained in the workplace, but a few continue to suffer from medical issues long after that terrible episode. Permanent disability under the law refers to any lasting disability that causes a reduction in the worker’s earning capacity from where it used to be because they are not able to be as productive as they once were.

You will be entitled to permanent disability benefits even if you are able to return to work after an injury or illness.

Benefits in case of permanent disability are limited though. If you incur any loss that is not related to your ability to work (loss of consortium, lifestyle setbacks, physical handicaps, for example), such a loss may not be covered under permanent disability benefits.

If you have suffered a permanent disability on the job and need the guidance of an experienced injury lawyer, call us for free, friendly and no obligation advice at 916.921.6400.

Determining Permanent Disability

Whether your injury or illness has resulted in permanent disability will be determined by a qualified doctor. An evaluation of the permanent disability will be performed once the doctor determines that your condition has become stable and if any further change is unlikely. That condition will be described as permanent and stationary. Alternatively, the doctor may call it maximal medical improvement.

Once you have reached this status, the doctor will inform the claims administrator about your permanent disability. Whether your disability occurred due to some other reason, and not because of the injury at work, will also be determined by the doctor. A part of your disability may be attributed to other factors, which is known as apportionment.

Rating Your Permanent Disability

If a QME prepared your report, they will send it to the claims administrator as well as the Disability Evaluation Unit (DEU) of the Division of Workers’ Compensation (DWC). You would have completed a questionnaire on employee disability during your doctor’s appointment, which will now be assessed along with the report of the QME by a rater designated by the DEU.

In case you have an attorney, the rating of your permanent disability can be done either by a private rater or the rater from the DEU. You also have a right to have your primary treating doctor’s report rated. You will be required to make a formal request for this rating and send it along with the doctor’s report to the DEU.

The rating of your permanent disability will be included in a formula that computes your benefits. The rating process can vary according to the date of injury or illness and other factors. You can rightfully ask for copies of the reports of the QME as well as your primary doctor. Go through these reports diligently and ensure that no vital information has been omitted.

If you think there are errors in the QME’s report, you have the right to ask for factual corrections within 30 days. Your request will be reviewed by the QME, and they will provide a supplemental report showing whether any corrections are in order and how such changes may impact the opinion of the QME.

Disagreement with the Doctor’s Report

In case you do not agree with the findings of the doctor, you can ask for a QME panel list from the DWC. The costs of the exam by the QME will be borne by your employer. Within 10 days from the initiation of the QME process, you will have to make your request to the DWC. If you fail to do it within this time, the claims administrator will select the doctor on your behalf.

You can lose some of your key rights if you do not adhere to the timelines while completing your QME forms. In case you have an attorney, they can assist you in choosing a QME. You may also get your medical evaluation done from an AME, who is a physician that the claims administrator and your attorney agree on to conduct your evaluation. You can determine your best options with your legal professional in such a case.

For more information contact me, Ed Smith, for free, friendly and no obligation advice at 916.921.6400.

Permanent Disability Rating Methodology  

Following your medical exam, the physician will prepare a medical report pertaining to your impairment. It will describe how your injury impacts your ability to perform daily routine activities. The report will conclude with an impairment number. This number will be included in a formula to compute the exact percentage of disability. This calculation will also include your age at the time you sustained the injury, the nature of your occupation, and your potential earning capacity in the future.

Thereafter, any part of your disability that occurred due to a reason other than your injury at work will be removed from the calculation. At this point, your disability will be determined as a percentage. This percentage figure will be equivalent to a dollar amount, which will depend on the injury date and your weekly wage (on average) at the time of injury. To compute this rating, a DEU rating specialist may also be involved.

If your injury occurred anytime from January 1st, 2005 to December 31st, 2012, it may result in your permanent disability award to be increased or reduced by 15 percent. This will depend on whether your employer has 50 or more workers and your employer provides regular, modified, or alternative work.

Disagreement with the Rating

If you disagree with the rating determined by the disability rater of the state, you have options to seek a review. If you have an attorney, they can take your case before a judge. In absence of an attorney, you can request the DWC for a rating review. They will conduct a rating reconsideration and determine whether any errors occurred in the process of medical assessment or during the rating process.

Payment for Permanent Disability

The amount to be paid for your permanent disability will be determined by the claims administrator, considering the following three factors:

  • Disability rating in terms of a percentage figure
  • Date when the injury took place
  • Wages earned prior to the injury

You can expect your permanent disability benefits to be paid out once your temporary disability benefits end and your permanent disability has been indicated. Within two weeks from the day your temporary disability ends, the claims administrator will start making your permanent disability payments. They will choose a day of payment and will continue to pay every 14 days until an estimated reasonable amount for your disability has been paid.

In case you have not missed any days from work, your permanent disability payments will become due from the time when the claims administrator knows that your work injury has resulted in a permanent disability. The claims administrator is required by law to keep you updated via the mail about how your payment amount was determined and when the payments will be made or why they may be delayed or denied.

If there is a delay from the claims administrator in making your permanent disability payment, they will be required to pay an extra 10 percent as a penalty. Even if the claims administrator has a valid reason and sends a letter informing you about the delay, they are still required to pay the penalty. In case they do not have a valid reason for the delay, you may be entitled to a significantly higher additional payment.

Final Claim Resolution

Once the amount in case of permanent disability claim is determined, it is typically followed by an award or settlement for benefits. A workers’ compensation administrative law judge will approve this award. You can hire an attorney who will help you obtain the proper award amount. Alternatively, the claim administrator will assist you in obtaining the award. You may also seek assistance from the I&A officer at the DWC local office.

If the physician has determined that your injury requires additional medical treatment, your award may have a provision for future medical care. You have an option to resolve your entire claim in a single lump sum settlement, which is known as C&R. This could be an ideal option in cases where the worker wants to control their own health care or wants to receive a one-time payment for permanent disability. 

The second settlement option is known as a stip or stipulation. This typically includes a specific sum of money as well as payments for future medical treatment, which will be made over time. The agreement will be reviewed by a judge. 

In either case, your payments for permanent disability will likely start before the decision of what the final amount will be has been reached. Once the physician determines you have a permanent disability, an estimate of your amount will be made by the claims administrator, who will start making the payments. Once the actual final amount of permanent disability is decided, they will pay the amount due above the original estimate or whatever the final amount is supposed to be.

If you have been paid too much, future checks/payments will be adjusted accordingly. Contact an experienced Sacramento Workers’ Compensation Lawyer for more information.

The video below discusses how you can prepare for permanent disability.

Sacramento Workers’ Compensation Lawyers

I’m Ed Smith, a Sacramento Workers’ Compensation Lawyer. Do you or someone you love need an experienced workers’ compensation lawyer to help you navigate the complexities of disability claims? Please contact me right away at 916.921.6400 for compassionate, free and friendly advice. I can also be reached online at AutoAccident.com.

We are members of the Million Dollar Advocates Forum and the National Association of Distinguished Counsel.

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 11.4.20]

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