You may be able to receive permanent disability benefits through workers’ comp when a work-related injury or illness has left you with a lasting medical problem. But first, you’ll have to go through a medical and legal process to demonstrate that your medical condition isn’t likely to change and that it either prevents you from working at all or limits your ability to work and earn money.
The first step toward getting any kind of workers’ comp benefits is to show that you meet all of the basic eligibility requirements:
Also, you must follow your state’s rules for getting medical treatment from a workers’ comp treating doctor.
You generally won’t be considered for permanent disability benefits until your treating doctor says you’ve reached a plateau in your recovery—meaning that your condition isn’t expected to improve further with more treatment, at least in the near future. In workers’ comp lingo, this is usually called “maximal medical improvement” (MMI), or sometimes “permanent and stationary.”
The amount of time it takes to reach MMI can vary widely—anywhere from a month to a few years after you were first hurt or became ill. The nature of your injury or illness will have the biggest impact on how long it takes. Even if you don’t completely heal from a broken leg—for instance, if you continue to have trouble walking on uneven surfaces—your condition will probably stabilize more quickly than if you got cancer from on-the-job exposure to toxic chemicals. But other factors can play a role too, including the medical treatments that are available and whether the insurance company has been dragging its feet on approving surgeries or other expensive procedures.
Some states, like Texas, assume that employees have reached MMI when they’ve been getting temporary total disability benefits for a period of time (usually 104 weeks).
Once your doctor says you’ve reached MMI, the process will begin to determine whether you have any permanent disability and, if so, how much. This is also generally the point when you’ll stop receiving temporary disability payments if you’ve been off work and those benefits haven’t already run out. (Several states have a time limit on temporary total disability benefits.)
The rules for determining permanent disability vary considerably from state to state. Usually, your treating doctor will say whether you have a lasting medical condition or lost function (referred to as an impairment) that resulted from your work-related injury or illness. An impairment could be anything from a bad back to a severed finger to opioid dependency from painkillers that you had to take for a serious orthopedic injury.
Depending on the rules in your state, the insurance company may request an independent medical examination (IME) to assess your permanent impairments. You might also be able to ask for an IME if you disagree with another doctor’s opinion.
States have different criteria for using the medical information about impairments to decide whether injured employees have permanent disabilities that affect their ability to perform certain tasks—or even to work at all. Most commonly, the result of the process is what’s called a permanent disability rating, expressed in a percentage.
You don’t necessarily have to prove that you can’t work at all in order to receive total permanent disability benefits. For instance, you may be considered totally and permanently disabled if you have certain kinds of injuries (for instance, if you lost both eyes or both legs). You may also qualify if you have a combination of permanent impairments that add up to a 100% disability rating.
If your disability rating is less than 100%, you may be able to receive some kind of partial permanent disability benefits, although states have different systems for compensating employees who have lasting effects from their injuries. (Learn more about how to get permanent partial disability through workers’ comp.)
Once the insurance company hears from a doctor that you have a permanent disability, the company should begin sending you checks for permanent disability benefits shortly (usually about two weeks, as required by state law). But if there’s a dispute—over the amount of permanent disability or whether you have any lasting impairments—you should contact a workers' compensation lawyer as soon as possible. The rules and the process are complicated, and insurance companies (and their lawyers) do everything they can to keep their costs down by denying or minimizing permanent disability benefits. You need an experienced attorney on your side to protect your rights and your future.
You should also know that permanent disability benefits don’t necessarily last the rest of your life. If you’re totally and permanently disabled, you’ll usually be entitled to a lifetime pension (though a few states cut off payments at a certain point for all but the most serious disabilities). When it comes to partial permanent disability, however, most states limit how long the benefits last.
Whether the benefits are for partial or total permanent disability, some states allow you to opt for a lump-sum payment in a workers’ comp settlement. Here again, it would be wise to speak with a workers’ comp attorney before you agree to a settlement to make sure you don’t unwittingly sign away important rights.