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.
- What are permanent partial disability benefits?
- Will I get a permanent partial disability rating for my shoulder injury?
- How is my permanent partial disability rating determined?
- Will I receive a workers compensation settlement in addition to my PPD rating?
This article provides some helpful 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 should receive some permanent partial disability benefits at some point in the future. The time that it takes for you to receive benefits varies because you do not receive them while you are receiving temporary total or temporary partial disability wages loss benefits. Since many people receive wages loss benefits for some time, it can be some time after you receive a rating before you start receiving PPD 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. This book is the Guides to the Evaluation of Permanent Impairment.
In Georgia, the law requires doctors to use the fifth edition of that book. Once your workers compensation doctor determines that you have reached maximum medical improvement, they should evaluate you for a PPD rating.
For a shoulder injury, the 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.
Other injuries or surgeries do not have specific PPD ratings defined under the AMA Guides. These 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 (temporary total disability or temporary partial disability).
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. If they do not start benefits on time, they should pay you a late penalty.
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. This presumption really helps because otherwise insurance companies could just claim that they did not receive the rating from the doctor.
Does workers compensation give me a higher PPD rating if I have shoulder surgery?
Not necessarily. Sometimes, there is a specific base PPD rating assigned to certain types of shoulder surgery. In this situation, the surgery you have will factor into your PPD rating.
But, surgery is not the only factor. Other factors like range of motion and strength often factor into your PPD rating.
Surgery can certainly help improve your strength and range of motion. Because of that, many times people have a lower PPD rating after shoulder surgery than you would have before it. While this could mean you have a lower PPD rating after surgery, the good news is that lower PPD rating should also mean that your shoulder is doing much better.
Yes, you can contest the PPD rating. The PPD rating is the opinion of the doctor. Like anyone else, a doctor can make a mistake in giving you a 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 need additional evidence in the form of an opinion from another doctor (or more than one other doctor) indicating a higher PPD.
Any time you go to court about your case, you have to follow certain rules to get your evidence presented to the judge. If your evidence is not presented correctly, you will lose your case. I would recommend that you strongly consider hiring a workers compensation attorney before going to court.
Are there time deadlines for getting PPD benefits paid?
Yes. Georgia’s workers compensation law has many different time limits called statutes of limitations that can prevent you from receiving the benefits you should. There is a statute of limitations that specifically applies to permanent partial disability benefits.
That part of the law indicates that you have to request permanent partial disability benefits within four years of the last payment of temporary total disability benefits or temporary partial disability benefits. This law can really hurt you if you are not familiar with it or do not understand it well. In some situations, people who did not have an attorney have received tens of thousands of dollars in PPD less than they should have because they did not know that their doctor gave them the wrong PPD rating.
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. Settlement can help you be done with workers compensation and put your injury behind you.
Many people have misunderstandings about settlement. Here is an article I wrote about Georgia workers compensation settlements that should provide you with some helpful information.
You have to make sure that you make the right decision and do not settle your case for too little. Settlement is final which means you can almost never change it once your settlement have been approved. Be sure to talk to me or another workers compensation attorney before you settle your case.