A serious injury or illness can happen to any time to a working person. Although most workers don’t worry about the linger impact of a work-related injury or medical condition, the U.S. Bureau of Labor Statistics (BLS) says that more than four million job-related illnesses or injuries happen each year. As a result, more than 50,000 workers suffer permanent disability each year.
Disability is considered either temporary or permanent. A temporary or short-term disability eventually goes away, but a permanent disability lasts years or for the rest of the suffering person’s life:
Workers experiencing a short-term disability eventually recover from them. They return to their jobs without lingering effects or injuries.
Workers who are permanent disabled never fully recover from work-related injuries and illnesses. These individuals require ongoing medical treatment to manage their disability.
Permanent Disability Benefits
When a worker is injured on the job or in performing tasks related to his job, the employer must provide a workers’ compensation claim form. Completion of the form creates a workers’ comp case.
In some states, such as California, failure to file a workers’ compensation form within 12 months of the injury may preclude the injured worker from receiving any benefits. A physician must issue a permanent disability (PD) rating based on how much the injury will affect the worker’s ability to perform his or her duties.
The permanent disability rating is used to assess the worker’s degree of injury or illness that resulted from the occupational environment. Permanent disability rating is sometimes called a permanent impairment rating. Both permanent disability rating and/or permanent impairment rating are used to express the severity of the disabled person’s permanent impairment.
The worker’s age, injury date/time, and his or her future earnings potential are considered. The permanent disability rating largely determines the amount of compensation benefits the disabled worker receives.
Disability Rating Disputes
If a disabled worker disagrees with the reviewing doctor’s assessment, he or she may request a second opinion from a “qualified medical examiner,” or QME. The worker’s employer is required to pay for the QME. After requesting a second opinion, the injured worker has 10 days from the date he or she is given the application to submission. If the form isn’t completed within the maximum 10-day period, the claim administrator may choose the medical examiner.
The injured worker’s attorney can assist in identifying the QME or the worker may be examined by an “agreed medical evaluator,” or AME.
Permanent Disability Payments
If the examining doctor determines the worker is permanently disabled, a claims administrator initiates estimated payment of benefits before the final disability percentage is calculated.
Permanent disability benefits are available in addition to temporary disability (TD) payments received by the worker. In California, the law says that permanent disability payments must start no later than 14 days after temporary disability benefits cease. Thereafter, the permanently disabled individual receives bi-monthly PD benefits.
Resolving Permanent Disability Claims
After the disabled individual’s permanent disability calculation is determined, the workers’ comp court considers the proposed settlement or awards benefits. If a doctor is required for the permanently disabled individual, the judge must consider the future costs of medical care in the award.
Two types of settlements may be considered: 1) a compromise & release (C&R) settlement or 2) a stipulations with request for award (Stip) settlement:
A C&R settlement pays the disabled victim a lump sum for the permanent disability. This type of settlement reduces or removes the administrator’s future liability for future medical costs or payments.
A Stip settlement also includes a lump sum payment for permanent disability plus payments to be distributed in the future and over a period of time.
Workers Compensation Benefits and Disability Benefits
A permanently disabled worker may be eligible to receive disability benefits and workers comp benefits. It’s important for the disabled worker to file for Social Security Disability (SSDI) benefits as soon as possible.
Permanent disability benefits received under workers comp and SSDI are separate benefits programs. If the disabled worker receives both workers comp and SSDI, the Social Security Disability payment may be reduced. The law says that the combined workers comp benefits plus SSDI benefits received by the disabled worker may not be greater than 80 percent of his or her current monthly earnings.