If you haven't fully recovered from a work-related injury or illness but can return to work in some capacity, you may be wondering whether—and how—you can get permanent disability benefits through workers' comp. You don't necessarily have to be totally disabled or completely unable to work in order to receive permanent disability benefits. You may be entitled to permanent partial disability (PPD) benefits if, for example, your doctor has said you can go back to work with certain restrictions (like “no overhead reaching,” “no standing for more than 30 minutes at a time,” or “only sedentary work”).
Before you can qualify for PPD benefits, you need to:
You'll then continue that medical treatment until you've either fully recovered or your doctor says that your condition isn't likely to get better, even with more treatment. This is usually called “maximal medical improvement” (MMI).
When you've reached MMI, your treating doctor will generally perform a series of tests and conduct an overall physical and/or mental exam to determine whether your work-related injury or illness caused any lasting medical conditions or lost function (referred to as an impairments). Some examples of impairments:
The doctor's opinion will have a big effect on whether you're able to get any permanent disability benefits. Because of that, it's often a hot spot for disputes in workers' comp cases. Depending on the rules in your state, you and/or the insurance company may request an independent medical examination (IME) or similar neutral evaluation in an effort to counter the treating doctor's opinion about any lasting impairments.
The next stage of the process is to determine the level of permanent disability—that is, whether and how much your impairments limit your ability to perform certain tasks at work. States apply different rules and procedures for calculating and paying benefits for PPD. In many states, the doctor or an appointed professional (often called a “rater”) will use guidelines to translate impairments into a permanent disability rating. This rating, generally expressed in terms of percentages for each body part or system (like the endocrine system), is meant to describe how the impairment limits your ability to perform certain tasks or to work at all. For example, a 50% PPD rating for the lower back could seriously affect your ability to do some of your regular job requirements, like lifting heavy objects, bending over repeatedly, or driving for long hours. In that case, partial permanent disability benefits are meant to compensate you for that limitation, under the theory that it will reduce your earnings in the future.
In other states, PPD benefits may be based on the actual difference between your pre-injury wages and what you're earning after you go back to work, or on the projected difference in your ability to earn in the future.
Workers' compensation will usually cover work-related injuries that aggravated or accelerated a pre-existing condition. For instance, say you hurt your neck in a car accident several years ago. Then you recently fell off a ladder at work and seriously sprained your neck. Even though scans showed some residual damage from the old injury, the new workplace injury would probably still be covered by workers' comp. But if you don't fully recover—and part of your impairment was caused by the old injury—some states will “apportion” your permanent disability rating between the old and new injuries. In that case, your benefits may be lower than they would be if your disability were caused only by the recent injury. Certain states have special funds to help out employees who are seriously disabled from a combination of old and new injuries.
Whatever system is used to calculate the amount of PPD, states generally limit how long those benefits last. Typically, state laws set out complicated formulas for these time limits, depending on the type and degree of disability. In some states, a certain PPD rating will result in a single lump-sum payment. In most states, however, you can agree to receive a lump-sum payment for any level of PPD as part of a settlement.
After your PPD is rated, your employer's insurance company should send you a letter either offering to start your weekly or biweekly permanent disability payments or making a settlement offer for a lump-sum payment. If you've already been receiving advance payments (because a state law requires those payments to begin soon after a doctor indicates that you have a permanent disability), the company should also pay you any balance that it owes you, as well as any interest and penalties for late payments.
Before you agree to a settlement, however, consider speaking with a workers' comp attorney. If you have permanent disability from your injury, a workers' comp settlement can have serious consequences, including the possibility of reduced Social Security disability benefits and giving up your right to future medical treatment. Even before you reach that stage, if the insurance company is challenging your doctor's opinion about your permanent disability, it's critical to have a lawyer on your side to help you through the complicated process and protect your rights. Learn more about when you may need a workers' comp attorney, or request a free consultation.