“Permanent disability” is defined as the irreversible damaging effects from the work-related injury that caused the worker to not be able to perform the normal functions which could be done before the injury.
The purpose of “permanent disability” (P.D.) benefits is to compensate the injured worker for the irreversible loss of some function because this loss has now hampered and disadvantaged the worker from competing in the open labor market.
In order to qualify for P.D. benefits, your medical condition must reach a point of stability called “permanent and stationary” (P&S) status or sometimes called “maximum medical improvement” (MMI). Once you reach this P&S status, your primary treating physician will issue a final P&S report which will contain a statement of your level of permanent disability including such items as:
*work restrictions or limitations (e.g. “the injured worker cannot lift heavy items any more beyond 25 lbs.);
*whether you can return to your usual and customary job or not;
*the percentage of “whole person impairment” (WPI). For example, Dr. Smitten’s report states that “Johnny Great has 8% WPI to the lumbar spine after the injury because he is in Diagnosis-Related Estimate category 2 given his unverified radiculopathy running from the lumbar spine through both lower extremities.”
With this report in hand which contains the percentage of WPI, your legal representative or you should be able to qualify you for and estimate the value of your P.D. benefits.
Please note: Even though the doctor may state that you have an 8% WPI, it does not mean that your percentage of permanent disability is 8%. It just means that you or your legal representative may now use the 8% WPI and run it through a “rating formula” to arrive at a final P.D. percent and hence a dollar amount. See below for the percentage of P.D. corresponding to dollar value. OR YOU CAN CALL US FOR A FREE CONSULTATION AND WE CAN ANSWER YOUR QUESTIONS. Don’t try to rate it yourself or you could shortchange yourself. Call us!!!!!
Just how much money you get will depend on your percentage of permanent disability. See the chart below:
The P.D. benefits are normally due to start within 14 days after your “temporary and total disability” payments have ended and the doctor states you have reached “P&S” or “MMI” status and that you are ascribed some percentage of WPI.
The P.D. benefit check should come every two weeks after the prior payment. If the first P.D. payment was issued on January 2, 2017, the next payment will be due on January 16, 2017, and the next one will be due on January 30, 2017, and so on and so on.
According to the California Labor Code, P.D. benefits are to stop when the carrier pays up to the amount which it reasonably estimates to be the P.D. value or when the entire amount of P.D. award is reached. The duration and stop date will depend on the percentage of P.D. in your case. For example, if you have 1% P.D. (or $870.00), then payment will stop after 3 weeks after the initial payment because you get $290.00 per week (i.e. $290.00/week x 3 weeks = $870). If, however, your P.D. rating is 35% (or $48,140.00 based on 166 weeks x $290.00/week), then these benefits will stop after 166 weeks from the initial P.D. payment. That is, P.D. payments will last for some 3 years and 2.5 months.
Mr. Sunny Bunny is a construction worker and he injured himself on February 2, 2017 after lifting a heavy cement block causing a disk in his back to slip out. He had surgery on February 28, 2017 and his primary treating surgeon performed surgery to his back. The doctor put him on “total and temporary disability” (i.e. not able to work at all) for some months while in recovery. By October 10, 2017 the doctor found his condition to have reached stability point (i.e. permanent and stationary) and issued a report which rated to be 35% P.D. (or $48,140.00). Within 14 days after October 10, 2017 (or October 24, 2017), the insurance carrier has to commence the payment of P.D. benefits at $290.00 per week payable at every two-week interval (or $580.00 biweekly) until the amount of $48,140.00 is exhausted after 166 weeks have passed.
P.D. rate: This is the amount the injured worker is entitled to per week. The P.D. rate is calculated at two-thirds of the average weekly earnings before tax subject to the maximum of $290.00 per week.
Date of Injury
01/01/14 & after
For example, Willy Wookie earns $600.00 per week on average pre-tax, his P.D. rate would
P.D. rate would be:
(2/3) x (Average Weekly Earnings Pre-tax)
(2/3) x ($600.00)
$400.00 but since the maximum is $290 per week, he
will only receive $290.00 per week.
P.D. Amount: this is the amount of money corresponding to the percent of permanent disability in the chart (see above). For example, the percentage of P.D. at 26% will yield the P.D. amount of $30,957.50.
In general, the purpose of a life pension is reserved for the workers who are so seriously injured that they cannot return to the work force. The law recognizes that if the worker cannot return to work at all due to the work injury, then the just thing to do is to award him or her a life pension.
To qualify for a life pension, a doctor must find that the worker has sustained a “permanent disability” level of 70% or more. For example, the loss of vision in both eyes or the loss of both arms will qualify for a life pension. Please note that the higher the percent above 70% the more the weekly pension will be.
If you do not agree with the P.D. percent ascribed to your case, please note that the action to take will depend on the reasons as there is no automatic response to each scenario. The response is as varied as a matrix.
In general, if the primary treating physician has issued a report which you think does not accurately reflect your true level of “permanent disability” then you can do several things. You may ask for a state assigned neutral doctor called “panel qualified medical examiner” to review your case and examine your condition. You may ask your doctor to reconsider his opinion. You may ask for secondary treating physician. You can take his deposition. You may simply take the matter to court and try to rebut the doctor’s opinion by giving your own testimony to the judge.
Note: We do not recommend that you try to handle the matter by yourself because to point out the doctor’s error or to dispute his/her opinion, you will have to use the “American Medical Association’s Guide to Rating Impairment” 5th edition (aka AMA Guides) and try to convince the doctor to change his opinion. Unless you are an expert in the AMA Guides, we do not recommend that you try this by yourself.
CALL US FOR A FREE CONSULTATION!!!!!!
We will explain things to you for free at no charge and then let you decide if you wish to retain our services or not. We are Board Certified Specialists in workers’ compensation laws and we are familiar with this subject matter.