Key Takeaways
- In Georgia’s workers’ compensation system, your Permanent Partial Disability rating sets how many weeks of income benefits you receive for permanent loss of function based on the body part injured and the percentage assigned.
- Doctors use the AMA Guides to measure permanent impairment, which means your rating depends on objective findings like treatment, range of motion, strength, and test results, not pain alone.
- You have the right to seek an impartial medical evaluation through options like an Independent Medical Examination, a change of physician, or an out-of-pocket consultation.
- A second opinion may increase, confirm, or lower your impairment rating, and disagreements between doctors may be resolved by an Administrative Law Judge.
- Reviewing your report, requesting medical records, and seeking legal guidance before making your next step can affect how your claim is handled.
If you’ve been hurt at work in Georgia, your Permanent Partial Disability (PPD) rating plays a direct role in how much compensation you receive. This rating is supposed to reflect the lasting impact of your injury after you’ve reached a point where your condition is not expected to improve with further medical treatment. Insurance companies rely on this rating when calculating disability benefits, so even a small difference in percentage can change the total amount you’re paid.
You might feel something is off after receiving your rating. Maybe the doctor spent only a few minutes examining you. Maybe your daily pain and limitations don’t match the number you were given. If this happens to you, can you get another opinion on your Permanent Partial Disability rating? In this article, we’ll explain how PPD ratings work, how you can pursue a second opinion, and what steps you can take to protect your workers’ compensation claim.
What Is a PPD Rating?
A Permanent Partial Disability rating is a percentage assigned by a workers’ compensation doctor to measure lasting impairment after a work injury. It doesn’t measure pain in a general sense. Instead, it reflects loss of function in a body part or system after you reach Maximum Medical Improvement, which means your condition is not expected to improve further with treatment.
Doctors in Georgia use the American Medical Association’s Guides to the Evaluation of Permanent Impairment when assigning this rating. Specifically, Georgia law requires doctors to use the Fifth Edition of this book. These guides set rules for measuring loss of motion, strength, and other objective findings. For example, a shoulder injury may be rated based on reduced range of motion, while a back injury may involve spinal function and nerve involvement.
It’s important to separate impairment from wage loss. A Permanent Partial Disability rating measures medical impairment through loss of function, not your ability to return to your job or earn the same income. Two injured workers with the same rating could have very different work restrictions and wage loss.
How PPD Ratings Work in Georgia Workers’ Compensation
In Georgia, your Authorized Treating Physician usually assigns your Permanent Partial Disability rating. This doctor is selected from your employer’s posted panel of physicians or through a proper change of physician request. Once you reach Maximum Medical Improvement, your doctor evaluates your condition and assigns a percentage based on the AMA Guides.
Georgia workers’ compensation law uses a schedule that assigns a set number of weeks of disability benefits to each body part. For example, an arm is worth up to 225 weeks, while a leg is worth up to 225 weeks as well. If your doctor assigns a 10 percent impairment to your arm, you would receive 10 percent of 225 weeks, which equals 22.5 weeks of wage loss benefits at your weekly compensation rate.
Sometimes, your doctor will rate a specific body part. In other cases, the doctor may assign a rating to the body as a whole. Often, doctors will provide alternative ratings. For example, a doctor might assign a rating of 8 percent to the upper extremity and 5 percent to the body as a whole.
Insurance companies rely on the assigned rating when calculating what they owe, so the number placed in your medical report has a direct impact on how long you receive payments. If you have multiple ratings for the same injury, it can be confusing to determine what rating the insurance company should pay. Often, the rating that the insurance company select when paying you makes a big difference in the amount of money you receive. If you have multiple ratings for the same injury, you need to make sure the insurance company pays the correct one that results in the maximum benefits to you.
Why Do Workers Question Their Permanent Partial Disability Rating in Georgia?
The number assigned by your workers’ compensation doctor should match your level of permanent impairment, yet many injured workers notice gaps between their daily limitations and what appears in the report. When that happens, it’s reasonable to take a closer look at how the rating was determined. Below are some common concerns:
- Short Medical Exams: Some evaluations last only a few minutes. A brief exam can miss reduced strength, limited range of motion, or nerve-related symptoms that affect how your body functions each day.
- Mismatch With Daily Limitations: You may have trouble lifting, standing, or sitting for extended periods, yet receive a low impairment percentage. If your daily restrictions are not reflected in the rating, the number may not capture your actual condition.
- Pain Not Fully Considered: Pain can interfere with sleep, movement, and basic tasks. However, PPD ratings rely on measurable loss of function, so pain without objective findings may not be fully included.
- Incomplete Medical Documentation: If your workers’ compensation doctor did not review all prior treatment notes, imaging results, or specialist reports, the rating may be based on limited information.
- Inaccurate Use of the AMA Guides to the Evaluation of Permanent Impairment: If your workers’ compensation doctor does not use the guides correctly, the rating you receive may be much lower than it should be. Georgia law requires that workers’ compensation doctors use the AMA Guides, so it is important to make sure they are used correctly.
When these issues come up, many injured workers start looking into whether they can get another opinion. A second evaluation can help confirm the original rating or reveal problems that should be addressed before PPD benefits are finalized.
Can You Get a Second Medical Opinion on a PPD Rating?
Yes, you can get a second medical opinion on your PPD rating in Georgia. The path you choose affects how much influence that opinion has on your workers’ compensation claim. Some options are recognized within the workers’ compensation system, while others may serve as supporting evidence only.
- Independent Medical Examination (IME): The insurance company has the right to send you to a doctor for an IME. This doctor reviews your records, examines you, and may assign a different impairment rating. You can also request an IME in some situations and make the insurance company pay most or all of the cost. The opinion from an IME doctor can be used in a disability rating calculations dispute and may be presented at a hearing. It can also sometimes help in getting your authorized treating physician to modify your PPD rating.
- Change of Physician Request: You can request a new authorized treating physician through the Georgia State Board of Workers’ Compensation, by agreement with the insurance company, or by changing on the panel of physicians in limited situations. If approved, your new doctor can evaluate your condition and assign a new PPD rating. This route can carry strong value because the doctor becomes your authorized medical care provider within the system. But, it can involve delays in getting a new authorized treating physician approved.
- Consulting Another Doctor on Your Own: You may choose to see a doctor outside the approved panel and pay out of pocket. This doctor can review your condition and provide an impairment rating. However, the insurance company is not required to accept that opinion, although it can still be used as evidence if your case goes before a judge.
How Can a Second Opinion Affect Your PPD Rating?
A second opinion can change the direction of your workers’ compensation claim. The new evaluation may support your concerns, or it may confirm the original rating. The result depends on the medical findings and how they are documented. Potential outcomes include:
- Higher Rating Assigned: A second doctor may find greater loss of function than the first evaluation reported. This can lead to a higher percentage, which increases the number of weeks you receive PPD benefits under Georgia law.
- Same Rating Confirmed: The new evaluation may match the original rating. This can make it harder to dispute the percentage, since two doctors reached the same conclusion based on your medical condition.
- Lower Rating Given: There is a risk that another doctor will assign a lower percentage. If that happens, the insurance company may rely on the lower number when calculating PPD benefits.
- Dispute Presented to a Judge: If doctors disagree, your case may go before an Administrative Law Judge. The judge reviews both opinions, along with your medical records and testimony, before deciding which rating to accept.
A second opinion can help you challenge a rating that seems too low, but it can also introduce new issues. Also, the second opinion doctor will also often give opinions on other issues in your workers’ compensation case. So, you could get a higher PPD rating but also a report that negatively affects your ability to get medical treatment and wage loss benefits. The outcome depends on the quality of the medical evaluation, the records reviewed, and how clearly your condition is documented.
What Steps Should You Take if You Disagree With Your PPD Rating?
If you believe your PPD rating is too low, you can take action. Start by reading the report from your doctor in full. Look at the body part listed, the percentage assigned, and the explanation tied to the AMA Guides. Check for missing information or findings that don’t match your condition.
Next steps are as follows:
- Request Your Medical Records: Ask for copies of all treatment records, imaging results, and prior evaluations. Compare those records to the disability rating report to see if anything was left out or misstated.
- Speak with a Workers’ Compensation Attorney: We can review your rating, your records, and the steps already taken in your case. This helps determine if the rating is consistent with your medical history and what options are available to challenge it. An attorney can also determine the best option for you to challenge the rating when multiple options are available.
- File for a Change of Physician: If your current doctor doesn’t address your concerns, you can request a new authorized treating physician through the State Board. A new doctor can perform an evaluation and assign a different rating if the findings support it.
- Prepare for a Hearing if Needed: If the insurance company refuses to accept a different rating from your physician’s choice, your case may go before a judge. At that point, medical reports, testimony, and supporting records are reviewed to determine the final rating.
What Mistakes Should You Avoid When Challenging a PPD Rating
Certain mistakes can limit the impact of a second opinion or create problems that are hard to correct later. Knowing what to avoid helps you protect your position.
- Accepting the Rating Too Quickly: Some injured workers assume their assigned rating can’t be changed. If you accept it without question, you may miss the chance to challenge it.
- Seeing a Doctor Outside the Approved Panel: You can visit another doctor on your own, but that second opinion may not have the same authority as one from an authorized physician.
- Waiting Too Long to Act: Delays can make it harder to gather records or request a new doctor. Acting early gives you more control over how your case develops. There are also deadlines known as statutes of limitations that affect your ability to get PPD benefits.
- Assuming Pain Equals a Higher Rating: PPD ratings are based on measurable impairment under the AMA Guides. Pain alone doesn’t increase the percentage unless it is supported by objective findings.
- Skipping Legal Advice Before Taking Action: Filing a WC-200 to request a new doctor, attending an IME scheduled by the insurer, or paying for an out-of-pocket evaluation can all affect which medical opinions are considered later. Speaking with a workers’ compensation attorney before taking any of these steps is critical too help prevent you from making decisions that harm your access to medical care and wage loss benefits.
When Should You Talk to a Workers’ Compensation Lawyer About Your PPD Rating?
You should speak with a workers’ compensation lawyer as soon as you receive a PPD rating that doesn’t match your condition. They can compare the rating to your medical records, imaging, and treatment history. This helps identify errors or missing findings before benefits are finalized.
You should also reach out if your medical provider spent very little time on your evaluation or failed to address key symptoms. For example, if your report does not include a range of motion measurements, nerve testing results, or prior MRI findings, that can affect the percentage assigned. We can review the report line by line and determine if it follows the AMA Guides used in Georgia.
Talk to a Georgia Workers’ Comp Attorney
You can challenge your PPD rating in Georgia. Your rating affects how many weeks of disability benefits you receive, so it is worth reviewing it closely. If the report leaves out test results, misstates your limitations, or does not follow the AMA Guides, those issues can be addressed.
At Perkins Studdard LLC, we review your rating report, compare it to your full medical file, and identify gaps that could affect your compensation. Our legal team can prepare and file a WC-200 to request a new authorized treating physician, advise you before attending an IME, and gather supporting medical evidence if your case needs to be presented to an Administrative Law Judge. To schedule a confidential consultation and case evaluation, call (770) 285-0548.
Related:
Denied for “Degenerative Changes”? How to Fight Back in Georgia Workers’ Comp
