ANSWERS TO YOUR QUESTIONS ABOUT PERMANENT DISABILITY BENEFITS - WORKERS' COMPENSATION
Permanent disability (PD) is any lasting disability from your work injury or illness that affects your ability to earn a living. If your injury or illness results in PD you are entitled to PD benefits, even if you are able to go back to work.
What is a PD rating and how is it calculated?First, after the proper exam, the doctor will write a medical report about your impairment. Impairment means how your injury affects your ability to do normal life activities. The report includes whether any portion of your impairment was caused by something other than your work injury. The doctor's report ends with an impairment number. Next, the impairment number is put into a formula to calculate your percentage of disability. Disability means how the impairment affects your ability to work. Your occupation and age at the time of your injury affect your PD calculation. If you were hurt before Jan. 1, 2013 your diminished future earning capacity shall also be a factor in your rating. Then, any portion of your disability caused by something other than your work injury is taken out of the calculation. Your disability will then be stated as a percentage. Your percentage of disability equals a specific dollar amount, depending on the date of your injury and your average weekly wages at the time of injury. A rating specialist from the DWC Disability Evaluation Unit may help calculate your rating. If your employer has 50 or more employees, and you were injured before 2013, the amount also may be affected by whether or not your employer makes a suitable return to work offer. For injuries occurring on or after Jan. 1, 2013 all permanent disability ratings will be increased by a Whole Person Impairment factor of 1.4.
How is PD paid?Once your doctor says you have PD, the claims administrator will estimate how much you should receive and begin making payments to you, even if the final percentage of disability has not been calculated. PD benefits are paid in addition to temporary disability (TD) benefits you received. The claims administrator must begin paying your PD within 14 days after TD ends and continue the payments until a reasonable estimate of your disability amount has been paid. If you have not missed any work, PD payments are due from the date the doctor says you are P&S. PD benefits continue to be paid every two weeks on a day picked by the claims administrator until a reasonable estimate of your disability amount has been paid. When the actual amount of PD due has been determined, the amount over the estimate must be paid. If you were injured and have ratable permanent disability, as of Jan. 1, 2013 PD payments are not due if you return to modified, alternative or regular work with your employer at 85 percent of your wages or return to work for any employer at 100 percent of your wages. When you receive your PD award, you will then receive an adjusted payment beginning with the last date TD was paid or when you made a maximum medical recovery, whichever is earlier.
How is my claim finally resolved?After the amount of PD in a claim is determined, there is usually a settlement or award for benefits. This award must be approved by a workers' compensation judge. If you have an attorney, your attorney should help you obtain this award. If you don't have an attorney, the claims administrator should help you obtain the award. You can also get help from the I&A officer at the local Workers' Compensation Appeals Board office. If your doctor said further medical treatment for your injury or illness might be necessary, the award may provide future medical care. There are two types of settlements. A settlement is agreed on by you and the claims administrator. You can resolve your whole claim through one lump sum settlement called a compromise and release (C&R). A C&R may be best when you want to control your own medical care and/or you want a lump sum payment for your PD. A C&R usually means that after you get the lump sum payment approved by the workers' compensation judge, the claims administrator will not be liable for any further payments or medical care. You can also agree to a settlement called a stipulation with request for award (stip). A stip usually includes a sum of money and future medical treatment. Payments take place over time. A judge will review the agreement. If you cannot agree to a settlement with the claims administrator, you can go before a workers compensation judge, who will decide your PD award. A judge's finding is called a findings and award (F&A). The F&A generally consists of an amount of money and a provision for the claims administrator to pay for approved future medical treatment.