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What PPD Does Workers Compensation Pay for Neck Surgery?

Surgery may be necessary if you suffer a serious neck injury at work.  The decision about whether you need neck surgery and which type of surgery would be best for your should be made by you and your doctor.

Doctors perform many different types of neck surgery to relieve pain from work injuries.  Some of the most common types of neck surgeries performed in workers compensation cases include:

  • Cervical discectomies,
  • Cervical fusions, and
  • Cervical laminectomies

If workers compensation pays for your neck surgery, you may very well end up with some degree of permanent impairment as a result of your neck injury.  Under Georgia law, you should receive permanent partial disability benefits when you suffer a permanent impairment as a result of a work related injury.  These permanent partial disability benefits provide some compensation for the permanent loss of use from your injury.

In this article, I am going to focus specifically on permanent partial disability benefits for neck injuries under Georgia law.  If you would like to find out more about permanent partial disability benefits (including when the insurance company pays them and when you should receive your rating), I would suggest reading this article.

Doctor x ray neck arm injuryWhat should my permanent partial disability rating be for my neck surgery?

That depends.  Georgia law requires doctors to use a certain book to assign your permanent partial disability rating.  Currently, doctors have to use the 5th Edition of the American Medical Association’s Guide to the Evaluation of Permanent Impairment.

This book is over 600 pages.   The spine is covered in Chapter 15 of that book.  Most workers compensation neck injuries are rated using that chapter.

There are a few different ways that doctors might rate a neck surgery, but the most common method is the Diagnosis-Related Estimates Method which is known as DRE.  Using this method, neck injuries fall into one of five different categories.  Almost all neck surgeries fall into Category III, IV, or V.

DRE Cervical Category III ratings of 15 to 18 percent to the body as a whole

This is usually the lowest category rating that you see following neck surgery in a Georgia workers compensation case.  The part of the category that talks about surgery says, “individual had clinically significant radiculopathy, verified by an imaging study that demonstrates a herniated disk at the level and on the side expected from objective clinical findings with radiculopathy or with improvement of radiculopathy following surgery.”

So, what does that mean? The definition has three important parts.  The first is radiculopathy.  This likely means you have pain, weakness, or numbness radiating from your spine into another area of your body as a result of nerve compression.

The rest of the definition of this rating is a little more confusing.  It discusses an imaging study which verifies a herniated disk that is the likely cause of the radiculopathy.   This would typically be an MRI which shows a herniated disk where the doctor would expect it.

In the case of surgery, it also says this rating covers “improvement of radiculopathy following surgery”.  If surgery improves or cures the radiculopathy, it is not clear whether you have to have the MRI showing the herniated disk in order to get a Category III rating of 15 to 18 percent to the body as a whole.

DRE Cervical Category IV ratings of 25 to 28 percent to the body as a whole

The most common workers compensation neck surgeries that result in Category IV ratings are cervical fusions.  The language that covers cervical fusions under Category IV is, “… the individual may have loss of motion or a motion segment due to a developmental fusion or successful or unsuccessful attempt at surgical arthrodesis; radiculopathy as defined in cervical category III need not be present if there is alteration of motion segment integrity.”

Surgical arthrodesis refers to cervical fusion.  So, a workers compensation injury that requires a cervical fusion surgery should result in at least a Category IV rating of 25 to 28 percent to the body as a whole.

This is the case even if the cervical fusion is completely successful and completely relieves all radiculopathy.  The AMA Guides make this clear by giving an example of an individual who has a successful, one level cervical fusion which completely resolves the radiculopathy in the individual’s arms.  The example indicates that person would qualify for a Category IV rating of 25 percent to the body as a whole.

Physical therapist neck injury crutchesDRE Cervical Category V ratings of 35 to 38 percent to the body as a whole

Category V ratings are pretty rare.  One situation where a Category V rating comes up is when the neck injury requires an individual to use adaptive devices to compensate for the symptoms from the injury.

The AMA Guides do not fully spell out what they mean by adaptive devices, but they do give a general example.  The example indicates that an individual who had a cervical fusion and still has radiculopathy but has to use adaptive devices to grip and turn objects would qualify for a Category V rating.

The question is how significant the adaptive devices needs to be.  Would it be enough if you have to use a jar opener or other gripping device because of weakness in your hands and arms or does it require something more significant? The AMA Guides are not completely clear so it leaves room to argue that you may qualify for a Category V rating if you continue to have significant impairment in your arms after treatment.

Are there other ways to assign PPD ratings for neck surgeries?

Yes.  Some of the other methods include Corticospinal Tract Impairment and the Range-of-Motion Method.  These methods are seen less frequently than the DRE method.

Corticospinal tract impairment comes up when you have neck surgery to repair a spinal cord injury.  This impairment rating method focuses on how your neck injury effects your use of the following body functions:

  • Arms
  • Legs
  • Bowel
  • Bladder
  • Sexual Function
  • Breathing

The Range-of-Motion method focuses more on combining the particular diagnosis along with measurements of spinal range of motion.  It is used much less frequently than the DRE Method, so I am not going to discuss it in detail here.

What if I believe the workers compensation doctor may have assigned the incorrect PPD rating?

Your workers compensation authorized treating physician usually assigns the PPD rating.  The insurance company usually pays PPD benefits based on that rating.  So, if your authorized treating physician assigns the wrong rating, you will not receive the benefits you should.

Fortunately, actions can be taken to correct an incorrect PPD rating.  Some of the options include:

  • Pointing the incorrect rating out to the authorized treating physician and having a revised rating issued
  • Getting an opinion from another physician with the correct rating
  • Going to court and proving the correct rating to a workers compensation judge

Which one of these actions is best to take will depend on the particular facts of your case.  For example, the doctor who issued your rating may not respond very well to being told that you think the rating they issued is wrong.  Also, going to court will probably not help if you do not have the evidence to support your argument.

Also, you need to understand that there are deadlines known as statutes of limitations that apply to payment of PPD benefits.  This means that waiting too long to get the rating corrected could result in the insurance company not having to pay the correct amount of benefits.  So, be sure that you do not wait if you think your waiting is incorrect.

What other issues will likely come up in my case if I have had neck surgery?

If you have neck surgery in a workers compensation case, these are a few of the issues you could face in the future:

  1. Will you need ongoing medical treatment for pain and other symptoms after neck surgery? If so, what time limits are there on getting that medical treatment?
  2. Will your employer continue to provide you with a suitable job?
  3. Does your injury potentially qualify for a catastrophic designation?

What if I have other questions about workers compensation?

Georgia’s workers compensation system can be very confusing.  You have to worry about getting the treatment you need and paying your bills while also worrying about not missing any deadlines that could cause you to lose your right to receive workers compensation benefits.

If you have questions, I would recommend that you try to get answers.  To find out more about how to schedule a time to talk to me about your workers compensation questions, just read this short article.

Jason Perkins is an attorney who specializes in representing injured workers.  He regularly publishes videos and write blog articles about Georgia’s workers compensation system and issues that are important to injured workers and their families.

To be notified of Jason’s new workers compensation videos, subscribe to his Georgia Workers Compensation Video Series channel on YouTube by clicking the subscribe button below.

Brittney-lee orourkeBrittney-lee orourke
05:23 18 Feb 22
Amazing! Jason and his team were very helpful and had the best communication by far. Walked me though every step with great detail and had answers for any question I had. They handled my case better then I could imagine, it was a weird case and they stayed on top of it and kept me updated every step of the way! Highly recommend this Team! Thanks so much to Jason and his Awesome team!-Brittney
China JonesChina Jones
18:58 08 Feb 22
I absolutely love this group of attorneys, when I was at my lowest they did everything they could to help me get justice for my injury. I believe if I were to have never picked my phone up and called the amazing group that helped me I definitely would not have received my idea of rights. If you have an issue and are just not sure please understand that they will help you, stay in contact, answer any question you have, and for sure get you the justice you deserve I thank them from the bottom of my heart and I will definitely refer them to anyone who has been hurt because they most definitely care about their work and clients.
Luv LocsLuv Locs
16:08 15 Jan 22
The entire law office was attentive and responsive to all of my concerns dealing with my workers compensation case.
moombimoombi
21:14 02 Jan 22
If you must get a lawyer involved, you’d do well to work with Jason Perkins and his team at Perkins Studdard Law.They were thorough in gathering information and in sharing all the steps in the workers comp process specific to my case. Jason and the team were responsive to my bevy of questions and concerns.I appreciated the informative videos and consultations provided by Jason over video meetings and multiple phone calls.I hope I’m never injured on the job again. However, if I am and if my employer responds as my previous employer did, I’ll contact Perkins Studdard Law immediately to handle the case.
Dana BessDana Bess
23:57 10 Dec 21
Everyone at Perkins Studdard was kind and professional. They were always extremely responsive and answered all questions that I had and followed up to make sure I had an understanding of what was going on along with emailing videos to explain every step of my case so I would know what to expect and be prepared. Jason is a very genuine person and I trusted him with my case. He answered so many questions for me even before I retained him as my WC lawyer. I highly recommend him and his associates at Perkins Studdard.
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