Permanent partial disability benefits can be one of the most difficult workers compensation benefits to understand. You should receive them if you have a permanent impairment as a result of your work injury.
But many people do not even know about permanent partial disability. Usually, people find out about it when:
- They receive a form from their doctor or the workers compensation insurance company mentioning permanent partial disability,
- A permanent partial disability check arrives in the mail, or
- Their authorized treating physician mentions a permanent partial disability rating
I have spoken with too many people who should have received a permanent partial disability rating who never did. If your doctor does not give you a permanent impairment rating or the insurance company does not start paying you permanent partial disability benefits, you need to take action and ask questions.
There are workers compensation deadlines that can prevent you from receiving the permanent partial disability benefits you should. So, do not wait to take action.
Hopefully, the doctor and insurance company will do what they should and you receive a rating. When this happens, you should start receiving permanent partial disability checks.
When this happens, it is normal to have questions. Here are some common questions I am asked about PPD ratings:
- Is this check a settlement check?
- If you cash the check, will it end your workers compensation case?
- Can you keep going to the workers compensation doctor?
- Is the check amount correct? If not, how can you get it changed?
- How long will you keep receiving checks?
Permanent Partial Disability Benefit Overview
People with serious injuries often suffer permanent impairment. Permanent partial disability benefits are how the workers’ compensation system pays you for permanent impairment that you have because of your work injury.
You only receive permanent partial disability benefits if you have some permanent impairment from your injury. Because of this, the doctor will probably not give you a permanent partial disability rating until the doctor places you at “maximum medical improvement”.
Maximum medical improvement means the doctor thinks your injury is as good as it is going to get. When you reach maximum medical improvement, the doctor should give you a permanent partial impairment rating.
Permanent Partial Disability vs. Other Benefits
In Georgia, there are different types of disability benefits based on the severity and permanence of your applicable injury. Permanent Partial Disability (PPD) benefits are one common type, but it’s important to understand how they compare to Temporary Total Disability (TTD) and catastrophic designation (Georgia’s version of Permanent Total Disability (PTD) benefits).
- Temporary Total Disability (TTD): With this type of worker’s compensation benefit, you receive TTD wage loss benefits when you are unable to work at all due to your injury. These weekly benefits pay a portion of your lost wages while you’re recovering and unable to work. In Georgia, these temporary disability benefits stop:
- when you return to work,
- when there is suitable light duty work available,
- when your authorized treating physician release you to full duty work without restrictions, or
- when you reach the time limit for receiving benefits.
- Catastrophic Designation: Certain types of injuries qualify for a catastrophic designation. One example is where you suffer an injury so severe that it prevents you from returning to any type of work Catastrophic designation in Georgia provides eligibility for certain types of benefits that are not available in other claims. Even if your claim is designated as catastrophic, you may still be eligible for Permanent Partial Disability (PPD) benefits.
The main difference is that TTD benefits are designed to replace lost income, while PPD compensates you for your permanent physical impairment after recovery, even if you can still work. Understanding these distinctions helps ensure you file a workers’ comp claim for the right benefits. Many people are eligible for both types of benefits.
How Does the Doctor Come Up with a Rating
When you reach this point, the workers compensation law requires your doctor to use a book that is published by the American Medical Association to determine your impairment rating. This book is called the Guides to the Evaluation of Permanent Impairment.
Georgia law currently requires doctors to use the 5th edition of that book. This book attempts to provide ratings for any type of injury suffered to any part of the human body. I have a copy of this book in my office so I can review the ratings my clients receive and make sure they are correct.
Using this book, the doctor will determine a permanent partial disability rating. This rating will either be to a specific body area (finger, hand, upper extremity, etc.) or to the “body as a whole”.
The Impact of Preexisting Medical Conditions
If you have a preexisting medical condition, it may affect how your Permanent Partial Disability rating is calculated in Georgia. The key issue is whether it impacts the same body part or system that was injured at work. Workers’ compensation law recognizes that someone with a previous injury or chronic condition might still be entitled to compensation for additional physical damage caused by their workplace injury.
When a medical professional evaluates your injury for a PPD rating, they will consider your overall level of impairment. If the injury aggravated any residual damage, the doctor may attempt to separate the impairment caused by the work-related injury from that caused by the preexisting or chronic condition.
For example, if you had a previous back injury and your current work injury further harmed your back, the doctor might only assign a percentage of impairment related to the job-related injury. However, if it substantially worsened your condition, you could be compensated for the increased severity of your impairment.
This distinction can be difficult to assess, and disputes may arise over how much of your impairment is due to the work injury versus your preexisting condition. It’s important to ensure your doctor’s rating reflects the full extent of your impairment, not just the percentage they think is related to the workplace injury. If you feel the rating is too low because your preexisting condition was not properly considered, you may need to challenge the rating through the appeals process.
In these cases, gathering clear medical evidence and consulting with a legal professional can help ensure your PPD rating takes into account how the work injury has impacted your overall condition, including any aggravation of preexisting issues.
The Role of Independent Medical Examinations (IME)
An Independent Medical Examination (IME) plays an important role in workers’ compensation cases, particularly when there is a disagreement over your injury or your permanent disability rating. An IME is conducted by a doctor who is not directly involved in your treatment and often requested by the workers’ compensation insurance company to get a second opinion on your condition.
During an IME, the doctor will review your medical records, assess your current health, and possibly perform tests to evaluate the extent of your permanent injury or impairment. The purpose of the IME is to provide an assessment that can be used to determine your eligibility for cash benefits or the accuracy of your PPD rating.
One of the main concerns with IMEs is that they tend to be requested by the insurance carrier, which might lead to a lower rating than your treating physician assigned. If the IME results differ significantly from your doctor’s assessment, it can affect the benefits you receive. In such cases, you have the right to challenge the IME findings, and it’s often a good idea to seek legal advice from a workers’ compensation attorney to ensure your PPD rating is accurate and fair.
In some instances, you may disagree with the rating given by the treating physician. There are ways that you can get your own second opinion done if you believe the treating physician’s PPD rating was incorrect.
When Permanent Partial Disability Benefits Start
Before you can receive PPD benefits, you first have to had a permanent partial disability rating. Your doctor should give you that as I explained above.
Also, under Georgia law, your employer does not have to start paying you permanent partial disability benefits until you stop receiving temporary total and temporary partial disability benefits. If your temporary total disability benefits stop and the doctor has not yet given you a PPD rating, the law requires your employer to request a rating.
Once you stop receiving temporary total disability benefits and have a PPD rating, the law requires your employer to start paying PPD benefits. Your employer must start paying the benefits within twenty one days.
So, if your doctor has not given you a PPD rating yet when your temporary disability benefits stop, it may be a month or more before you start receiving PPD benefits. If you already have a rating, you should start receiving those benefits quicker.
How Long Are Permanent Partial Disability Benefits Paid
When the workers compensation insurance company starts paying permanent partial disability benefits, they can pay it in two different ways:
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- They can pay the entire amount in one lump sum payment
- They can pay benefits the benefits on a weekly basis
It is rare that insurance company pays the benefits in a lump sum. It is much more common that they pay weekly checks.
If the employer starts paying you weekly benefits, the amount per week will be the same as what you receive for temporary total disability benefits. If you have not checked to make sure that your temporary total disability amount is correct, be sure and check out this article that explains the proper ways for calculating that amount.
The number of weeks that you will receive benefits will depend on a couple of things:
- How high a disability rating the doctors gives you; and
- What part of your body was rated.
Different Types of Ratings and What They Mean
Georgia’s workers compensation law has 14 different types of permanent impairment ratings. The law defines each rating by the number of weeks payable for a 100% impairment to each body part:
- Body as a whole – 300 weeks
- Arm – 225 weeks
- Leg – 225 weeks
- Hand – 160 weeks
- Foot – 135 weeks
- Thumb – 60 weeks
- Index finger – 40 weeks
- Middle finger – 35 weeks
- Ring finger – 30 weeks
- Little finger – 25 weeks
- Great toe – 30 weeks
- Any toe other than great toe – 20 weeks
- Traumatic loss of hearing – 75 weeks per ear
- Loss of vision of one eye – 150 weeks
So, the number of weeks mentioned above is what you would receive for each body part if you had a 100 percent loss of that body part. For example, you would receive 25 weeks of benefits if you lost your entire little finger because Georgia law establishes 25 weeks for a 100 percent impairment of the little finger.
Do I receive benefits if my permanent partial impairment rating is less than 100 percent?
Yes. Almost all permanent partial impairment rating are less than 100 percent. When you receive a rating less than 100 percent, you receive the percentage of the maximum weeks of benefits you would have received for the body part that was rated.
An example should explain that concept better. The “body as a whole” is the most common rating. Let’s say you receive a rating of 15% to the body as a whole. How is your payment for this rating calculated?
The maximum number of weeks for a “body as a whole” rating is 300 weeks. So, a 15% rating entitles you to 15 percent of the 300 weeks of benefits. Doing the math on this results in you receiving 45 weeks of permanent partial disability benefits for the 15 percent rating to the body as whole.
The value of that rating depends on your workers compensation check amount. If your workers compensation check was $675 per week, a 15% rating to the body as a whole would be worth $30,375. If your check amount was $300 per week, that 15% rating to the body as a whole would be worth $13,500.
What about permanent impairment ratings that are not to the body as a whole?
The same method works for calculating those ratings as well. You determine the number of weeks of permanent partial disability benefits by taking the percentage of the permanent impairment rating and taking that percentage of the maximum weeks of benefits for that type of rating.
The following table shows you the number of weeks of benefits for a 15 percent rating to each one of those 13 other body parts
- Arm – 33.75 weeks for a 15% rating
- Leg – 33.75 weeks for a 15% rating
- Hand – 24 weeks for a 15% rating
- Foot – 20.25 weeks for a 15% rating
- Thumb – 9 weeks for a 15% rating
- Index finger – 6 weeks for a 15% rating
- Middle finger – 5.25 weeks for a 15% rating
- Ring finger -4.5 weeks for a 15% rating
- Little finger – 3.75 weeks for a 15% rating
- Great toe – 4.5 weeks for a 15% rating
- Any toe other than great toe – 3 weeks for a 15% rating
- Traumatic loss of hearing – 11.25 weeks per ear for a 15% rating
- Loss of vision of one eye – 22.5 weeks for a 15% rating
Again, the value of each of these ratings would depend on your weekly workers compensation check amount. You should receive your workers compensation check amount for the number of weeks of benefits owed for the rating.
Will Cashing A Permanent Partial Disability Check End My Case?
Sometimes, the insurance company pays your permanent partial disability benefits in a lump sum. Other times, they pay these benefits weekly. Regardless of which way they pay them, acceptance of permanent partial disability checks does not settle or end your case.
In order to settle your workers’ compensation case in Georgia, the following things would need to happen:
- You sign paperwork agreeing to settle your case for a certain amount of money;
- An insurance company representative signs that same paperwork; and
- A judge at the Georgia State Board of Workers’ Compensation approves that settlement paperwork.
When the insurance company pays you a check for permanent partial disability benefits, they are simply paying you something they owe you under the law. Settlement is different. Settlement involves an agreement to give up your case in exchange for money.
Although acceptance of this check will not settle your case, you should remember that time limits (called statutes of limitation) may affect how long you have to pursue additional workers compensation benefits. The rules on these deadlines are tricky.
Many people find it difficult to determine how long they have to pursue additional benefits for wage loss, medical care, or permanent partial disability. Waiting too long often means that you do not receive the impairment benefits that you should, so speak to a Georgia workers’ compensation attorney ASAP.
Contesting an Incorrect Permanent Partial Disability Rating
Another concern many people have about accepting permanent partial disability benefits is that the disability rating may be incorrect. They also believe that accepting the permanent partial disability check may mean that they legally agree with the rating.
You can still disagree with the permanent partial disability rating the doctor gave you even if you accept some or all of checks that the insurance company pays you. Generally, the way that you would contest the amount of a PPD rating is by filing a Form WC-14 requesting a workers’ compensation hearing.
But, remember that there are deadlines that apply to requesting additional workers compensation benefits. So, do not wait to ask questions and take action when you believe you have not been paid properly.
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 medical 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 maximum compensation benefits. If you disagree with your rating, you may be concerned about how to manage the dispute resolution process. And what about attorney fees if you need to hire a lawyer?
If you have questions, I would recommend that you try to get answers from an experienced attorney. To find out more about how to schedule a time to talk to me about your workers’ compensation questions just read this short article.
Related: The Importance of Legal Representation for Veterans’ Disability Claims
