Permanent Disability Benefits

Sacramento Work Injury Lawyer

Permanent Disability Benefits

Most workers fully recover from job injuries but some continue to have medical problems. Permanent disability (PD) is any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached. If your injury or illness results in PD you are entitled to PD benefits, even if you are able to go back to work.

PD benefits are limited. If you lose income, PD benefits may not cover all the income lost. If you experience losses unrelated to your ability to work, PD benefits may not cover those losses. See the DWC fact sheet on PD for more information.

How is PD identified?
A doctor determines if your injury or illness caused PD. After your doctor decides your injury or illness has stabilized and no change is likely, PD is evaluated. At that time, your condition has become permanent and stationary (P&S). Your doctor might use the term maximal medical improvement (MMI) instead of P&S.

Once you are P&S or have reached MMI, your doctor will send a report to the claims administrator telling them you have PD. The doctor also determines if any of your disability was caused by something other than your work injury. For example, a previous injury or other condition. Assigning a percentage of your disability to factors other than your work injury is called apportionment.

What happens to the doctor's report?
If you were evaluated by a QME, the QME’s report is sent to the claims administrator and to the DWC’s Disability Evaluation Unit (DEU). A rater from the DEU will use the QME’s report and the Employee Disability Questionnaire that you filled out and gave to the QME at the time of your appointment to calculate your PD rating. If you have an attorney, the rating can be done by either the DEU or a private rater.

You or the claims administrator also has the right to have the report of your primary treating physician (PTP) rated, but this does not happen automatically. You must request a rating of the PTP’s report by completing a Request for Summary Rating Determination of Primary Treating Physician’s Report and sending it to the DEU with a copy of the PTP’s report.

The process used to calculate your rating can vary, depending on your date of injury or other factors. The PD rating is used in a formula that determines the benefits you’ll receive.

You have a right to receive a copy of the QME’s report as well as the reports from your PTP. Read the QME’s and PTP’s reports carefully. Make sure they are complete and do not leave out important information. If you believe there are factual errors in the QME’s comprehensive report, you can request a factual correction of the report, but you must do so within 30 day of receipt of the report.

The QME will review the request and will issue a supplemental report indicating whether factual correction is necessary to ensure accuracy of the report and how any changes affect the QME’s opinions.

What if I don't agree with the doctor?
If you or the claims administrator disagrees with your doctor’s findings you can be seen by a doctor called a QME. You request a QME list (called a panel) from the DWC Medical Unit. The claims administrator will send you the forms to request a QME. Your employer will pay for the cost of the QME exam. You have 10 days from the date the claims administrator tells you to begin the QME process to submit your request form to the DWC Medical Unit. If you do not submit the form within 10 days, the claims administrator will do it for you and will get to choose the kind of doctor you’ll see.

There are other specific and strict timelines you must meet in filing your QME forms or you will lose important rights. Read DWC Information and Assistance Unit guide 2 for more information.

When you receive the list of QMEs from the DWC Medical Unit you have to select a doctor, set up an exam and tell the claims administrator about your appointment. If you do not make the appointment within 10 days, the claims administrator may pick the doctor and make the appointment for you.

If you have an attorney, he or she can help you pick a QME or you can be evaluated by AME. An AME is the doctor your attorney and the claims administrator agree on to do your medical examination. In this case you should discuss your options with your attorney.

Can I get more detail about the PD rating and how it is calculated?
After your examination the doctor will write a medical report about your impairment. Impairment means how your injury affects your ability to do normal life activities. The report includes whether any portion of your disability was caused by something other than your work injury. The doctor’s report ends with an impairment number.< Next, the impairment number is put into a formula to calculate your percentage of disability. Disability means how the impairment affects your ability to work. Your occupation and age at the time of your injury and your future earning capacity are all also included in the calculation. Then, any portion of your disability caused by something other than your work injury is taken out of the calculation. Your disability will then be stated as a percentage. Your percentage of disability equals a specific dollar amount, depending on the date of your injury and your average weekly wages at the time of injury. A rating specialist from the DWC DEU Unit may help calculate your rating.

If you were injured between Jan. 1, 2005 and Dec. 31, 2012 your PD award may be increased or decreased by 15 percent, depending on whether you work for an employer with 50 or more employees and your employer offers regular, alternative or modified work.

I don't agree with the rating by the state disability rater. What can I do?
If you don’t have an attorney, you can ask the state DWC to review the rating. The DWC will determine if mistakes were made in the medical evaluation process or the rating process. This is called reconsideration of your rating. See I&A guide 3 for more information. You can also present your case to a workers’ compensation administrative law judge. Contact a state I&A officer for help. Workers with attorneys cannot request reconsideration. If you have an attorney, he or she can present your case to a judge.
How much will I be paid for my permanent disability?

PD benefits are set by law. The claims administrator will determine how much to pay you based on three factors:

  • Your disability rating (expressed as a percentage)
  • Date of injury
  • Your wages before you were injured
How and when are PD benefits paid?
PD benefits are normally paid when TD benefits end and your doctor indicates you have some permanent effects from your injury. The claims administrator must begin paying your PD payments within 14 days after TD ends. The claims administrator picks which day to pay you and will continue to make payments every two weeks until a reasonable estimate of your disability amount has been paid.

If you have not missed any work, PD payments are due when the claims administrator learns the injury has caused a permanent disability.

Why am I receiving so many notice letters?
By law, the claims administrator must keep you up to date by sending letters that explain how PD payment amounts were determined, when you will receive PD payments, why PD payments will be delayed and why PD benefits won’t be paid.
Is the claims administrator required to pay a penalty for delays in PD payments?
Yes. If the claims administrator sends a payment late, he or she must pay you an additional 10 percent on a self-assessed basis. This is true even if there was a reasonable excuse for the delay and even if the claims administrator sends a letter explaining the delay. You could be awarded a substantial extra payment if there was no reasonable excuse for the delay.
After the amount of PD in a claim is determined, there is usually a settlement or award for benefits. This award must be approved by a workers’ compensation administrative law judge. If you have an attorney, your attorney should help you obtain this award. If you don’t have an attorney, the claims administrator should help you obtain the award. You can also get help from the I&A officer at the local DWC district office. If your doctor said further medical treatment for your injury or illness might be necessary, the award may provide future medical care.

You can resolve your whole claim through one lump sum settlement called a C&R . A C&R may be best when you want to control your own medical care and/or you want a lump sum payment for your permanent disability. A C&R usually means that after you get the lump sum payment approved by the workers’ compensation judge, the claims administrator will not be liable for any further payments or medical care.

You can also agree to a settlement called a stip or stipulation. A stip usually includes a sum of money and future medical treatment. Payments take place over time. A judge will review the agreement.

If you cannot agree to a settlement with the claims administrator, you can go before a workers’ compensation administrative law judge, who will decide your permanent disability award. A judge’s finding is called a F&A. The F&A generally consists of a sum of money and a provision for the claims administrator to pay for approved future medical treatment.

If you agree to a stip or receive an F&A, the amount of your PD benefit will be spread over a fixed number of weeks. If you C&R your case you get a lump sum payment. If you have PTD, you are eligible to receive payments for the rest of your life.

In all of these situations your PD payments will likely begin before the final decision about the amount of your PD is reached. That’s because, once your doctor says you have permanent disability, the claims administrator will estimate how much you should receive and begin making payments to you before the final percentage of disability has been calculated.

When the actual amount of PD due has been determined, the amount due over the original estimate will be paid.

Find more information about permanent disability in the factsheet.

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Have you suffered a serious work injury? Contact workers’ compensation attorney at the Law Office of Roy Yang for FREE consultation about your California workers compensation claim benefits. Give us a call at (916) 269-9100 to speak with a Sacramento work injury lawyer today.

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