A doctor may have talked to you about permanent partial disability (PPD) benefits. Or, you may have heard about PPD benefits from a friend.
Regardless of how you learned about them, you probably have some questions about how PPD benefits work. This article provides some information about PPD benefits generally but focuses more specifically on PPD ratings for shoulder injuries.
Permanent partial disability benefits, otherwise known as PPD, are one of the three basic types of Georgia workers compensation benefits. The other two are wage loss benefits (temporary total and temporary partial disability) and medical benefits.
A permanent partial disability rating is meant to evaluate whether you have any permanent disability as a result of your injury at work. If you do not have any permanent impairment, you may not have a PPD rating.
If you do end up receiving a PPD rating, you will probably receive some permanent partial disability benefits at some point in the future. The time that it takes for you to receive benefits can vary because you do not receive them while you are receiving temporary total or temporary partial disability benefits.
This article will focus specifically on permanent partial disability ratings for shoulder injuries. If you want a more complete article about PPD benefits generally, this article provides a more in depth discussion of PPD benefits in general.
How is my shoulder permanent partial disability rating determined?
Your workers compensation authorized treating physician usually will determine your permanent partial disability rating for your shoulder injury. Georgia law requires them to use a book published by the American Medical Association called the Guides to the Evaluation of Permanent Impairment.
In Georgia, the law requires doctors to use the fifth edition of that book. Once your doctor determines that you have reached maximum medical improvement, they should evaluate you for a PPD rating.
For a shoulder injury, AMA Guides will often require your doctor to use a few different factors to determine your PPD rating. Some of these factors include:
- Whether you have had shoulder surgery
- If you had shoulder surgery, what type of surgery did you have
- Is your range of motion more limited than it was before your injury
- Do you have less strength in your shoulder and/or arm than you did before your injury
Certain shoulder impairments have specific ratings under the AMA Guides. For example, a total shoulder replacement shoulder result in a 24% upper extremity rating if it is done as an implant or a 30% upper extremity rating if done as a resection. But, most injuries require doctors to use a combination of different measurements to determine what your shoulder PPD rating should be instead of assigning an exact rating for a particular type of injury or treatment.
Once I get a PPD rating, when will my permanent partial disability benefits start?
The primary factor in when your PPD benefits start is whether you are still out of work as a result of your injury. If your injury continues to keep you out of work, you are probably still receiving workers compensation wage loss benefits (TTD or TPD).
Under Georgia’s law, the insurance company does not have to pay you permanent partial disability benefits while you are still receiving TTD or TPD benefits. So, it could be some time before your PPD benefits start if your injury still keeps you out of work.
This does not necessarily mean that you need to get back to work so you can receive your shoulder PPD benefits. The number of weeks you receive PPD benefits is limited based on your rating. So, rushing back to work to receive PPD benefits will probably hurt you at some point in the future.
What happens if I get a PPD rating when I am not receiving TTD or TPD benefits?
In this situation, your PPD benefits will start pretty quickly. The workers compensation company has a limited time to start paying your PPD benefits once they receive your doctor’s PPD rating.
Also, Georgia PPD law has a presumption that works in your favor. The law presumes that the insurance company receives your PPD rating within 10 days of when the doctor issues it. This means you usually do not have to prove that the insurance company actually received the PPD rating.
Does workers compensation give me a higher PPD rating if I have shoulder surgery?
Not necessarily. Many times there is a specific base PPD assigned to certain types of shoulder surgery.
But, surgery is not the only factor. Other factors like range of motion and strength may affect your PPD rating.
Surgery can certainly help improve your strength and range of motion. Because of that, it is certainly possible to have a lower PPD rating after shoulder surgery than you would have before it. If this does happen, the good news is that it should mean that the surgery provided you significant relief from your shoulder injury.
Yes, you can contest the PPD rating. To get a higher PPD rating paid, it is very likely that you would have to go to court and get a judge to decide that a higher rating is appropriate.
To succeed in this, you will likely need additional evidence in the form of an opinion from another doctor (or more than one other doctor) that said that the PPD rating should be higher. Also, if you have not already done so, I would recommend that you strongly consider hiring a workers compensation attorney before going to court.
What if I want to settle my shoulder injury case?
PPD benefits are not the same as a workers compensation settlement. A workers compensation settlement is an agreement with the insurance company for them to pay you a certain amount of money and you to give up your case in exchange.
It can often be a good time to consider settlement when you receive a PPD rating. This article I wrote provides a lot more information about Georgia workers compensation settlements.