Permanent Partial Disability Awards
When a treating physician releases the injured worker from further medical treatement, and states on the Physician Progress Report that the patient is ratable, the adjuster should schedule the injured worker for an impairment evaluation. This is also called a rating exam or a permanent partial disability evaluation (PPD exam). The rating must be scheduled with a rating doctor.assigned by the DIR if the adjuster will not agree with the injured worker's attorney which of the 144 rating doctors will do the exam. The rating uses the criteria of the AMA Guides to Evaluation of Permanent Impairment , 5th edition. Impairment is expressed in a whole person percentage. If the adjuster agrees with the rating doctor's percentage, an offer is made based on the percentage, the average monthly wage of the injured worker, and the worker's age. The injured worker can accept the award in a lump sum or installments. However, any percentage over 25% must be in installments.
Vocational Rehabilitation Lump Sum Buy-out
If the injured worker has permanent work restrictions, and his employer doesn't make a permanent job offer, a vocational rehabilitation counselor is assigned. Bi-weekly checks in the same amount are paid until retraining is done or a lump sum buy-out is chosen. If the injured worker does not want a retraining program, he may sign an agreement that ends entitlement to vocational rehabilitation under the claim forever, and he accepts a lump sum of money called a vocational rehabilaition lump sum buy-out. The insurer is rerquired to offer a minimum amount for this buy-out sum. The minimum is calculated by determining how much the insurer would have paid in bi-weekly benefits if the worker had chosed a retraining program instead. The minimum buy-out sum is 40% of that amount. It is necessary to know the PPD percentage to determine how much the insurer would have paid in maintenance to calculate the minimum buy-out. Sometimes the insurer will pay more than the minimum.
Injured workers sometimes hear about other workers who have received large sums of money after hiring an attorney to file an appeal of a denied claim. When an insurer denies a claim, or denies ongoing compensation benefits, if the injured worker's attorney is successful in getting a hearings or appeals officer to reverse the insurer's denial, then the insurer may be obligated to pay a large sum of retroactive benefits. Sometimes the insurer who denies a claim will settle an appeal before a hearing by offering the injured worker a sum of money to drop the appeal and to keep the claim denied. The advantage to the insurer is that the injured worker can never reopen the claim because it remains a denied claim. Almost any contested issue on a claim can result in a negotiated settlement for a sum of money. However it is rare to see a settlement agreement between an insurer and an injured worker who is not represented by an attorney.