Disability ratings are important factors in a worker’s comp claim. They help the organization determine the benefit amount an employee qualifies for. They are based on a medical evaluator’s medical condition report.
This article will discuss disability ratings and how they are calculated so you have a better understanding of the process.
What are Disability Ratings?
Disability ratings represent the “average detriment to earning capacity”. It measures how the disability affects the worker’s ability to make money.
Some workers are completely unable to return to work. Some may be able to continue working but must take a lower-paying position that is not as physically taxing.
Disability ratings are determined after a doctor diagnoses you with a permanent disability. At this point, your condition will be considered a maximum medical impairment (MMI). However, that does not mean your condition cannot worsen or improve.
Patients are often reassessed every few years to determine if their injury has improved or worsened. Changes can affect your payment amount.
Disability ratings are assigned on a scale of 0% to 100% at 10% increments.
How are Disability Ratings Calculated?
Disability ratings are based on the medical evaluator’s condition report. They account for your injury date, your age, your occupation, how much of the disability is caused by your job, and your reduced future earning potential.
The rating is determined after an examination by your treating doctor. They will write a Pamp;S report that rates your impairment, and the extent to which you have lost normal use of the injured parts of your body. Disability ratings are based on American Medical Association guidelines.
How Does Disability Rating Determine Payouts?
Your payments are determined by three factors: your disability rating, your wages at the time of the injury, and the date of the injury.
Your disability payments will equal two-thirds of your weekly wage at the time of your injury. Minimum and maximum rates may apply and will vary depending on your location.
However, some factors affect the amount you collect.
If your employer has over 50 employees and offers you at least 12 months of regular, modified, or alternative work, your benefits will decrease by 15%. If your employer is unable to offer you alternative work, your benefits will increase by 15%.
The work will be considered ‘regular’ if it offers the same wages and benefits as your old job and is within a reasonable commuting distance of where you lived at the time of the injury.
The work will be considered modified or alternative if it pays at least 85% of the wages of your old job and is within a reasonable commuting distance of where you lived at the time of your injury.
Permanently disability benefits are not subject to federal or state income tax.
When Do I Begin Receiving Permanent Disability Payments?
You will be eligible for disability payments as soon as your doctor finds evidence of a permanent disability. If you have been receiving temporary disability checks, workers comp will send your first disability payment 14 days after your last temporary disability payment was sent. If you were not receiving temporary disability, your first check will be sent 14 days after a doctor determines your injury is permanent.
After the initial payment, PD checks are sent out every 14 days.
When Do PD Payments End?
PD payments end when your total disability award is paid off or when your case has been settled.
What If I Don’t Agree with My Disability Rating?
If you don’t agree with your disability rating, you may contact your claims administrator to discuss your concerns. If the claims administrator does not agree with you, you can request a worker’s compensation judge to review your claim.
You may also request that the State Disability Rater rates your disability. You can use this rating to adjust your benefits. If you disagree with the State Disability Rater, you can file an appeal.
What does “Permanent and Stationary” Mean?
Permanent and Stationary is a term used to describe medical conditions that have stabilized. It is assigned to workers who have reached maximum medical improvement (MMI) after receiving temporary disability payments.
The doctor will write the patient a Permanent and Stationary (P&S) report that describes your medical condition, work restrictions, and future care recommendations. The report is sent to the claim’s administrator for future benefits considerations.
What If I Disagree with the P&S Report?
If you don’t agree with the P& S report, you may change to another doctor within your employer’s medical network. If you don’t agree with the new doctor, you may seek other medical opinions. However, you may not be covered for additional care. The procedure varies from state to state.
You may also get in touch with the insurance company within 30 days and let them know you disagree with the report and why. They may reconsider the rating.
What is the Insurance Company Disagrees with the P&S Report?
The insurance company may also disagree with the P& S report. In these cases, the company may request a medical–legal evaluation conducted by a Qualified Medical Examiner or Agreed Medical Examiner.
The evaluation may override your treating doctor’s report and may affect your benefits.
Disability ratings weigh heavily on the benefits you receive. Now that you know how they are calculated, you can determine if you are receiving a fair payment amount. Good luck getting the benefits you deserve.