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The Orange County workers’ compensation injury attorneys at DiMarco | Araujo | Montevideo have put together the following resource to help those who have questions regarding permanent disabilities and how the workers’ compensation system handles them. We have made it our goal to help people who have been hurt at work since the late 1970s in whatever way we can. We would be happy to set up a free initial consultation and case evaluation to assist you with your specific job injury. Contact us at any time at (714) 783-2205 to discuss your questions and areas of concern. We are an experienced Orange County law firm that has helped thousands of injured employees with their workers’ compensation claims, third-party cases, and personal injury cases.
Permanent disability is any effect(s) of a work injury that leads to lasting disability which results in a reduced earning capacity even after MMI (maximum medical improvement) has been reached. You are entitled to permanent disability (PD) benefits if you have a permanent disability from your work injury or job illness. This is true even if you are able to go back to work. Permanent disability benefits are limited. If you lose income, permanent disability benefits may not cover all the income that is lost. If you experience other losses unrelated to your ability to work, PD benefits will not be able to cover them, either.
A doctor determines if and when your work injury or illness has caused a permanent disability. Once your doctor decides your injury or illness has stabilized and no improvement beyond the current condition is likely, permanent disability is then evaluated. It is at that time that your condition has become permanent and stationary (P&S). Another term your doctor might use is maximal medical improvement (MMI) instead of P&S. Once you have reached MMI, your doctor will send a written report in a letter to the claims administrator telling them you have PD.
In the doctor’s written report that is completed once you are P&S or you have reached MMI, the doctor determines if any of your disability was caused by something other than your work injury or job accident. This could include a previous injury or other condition. This determination is called apportionment.
If you are representing yourself and you do not have an attorney, the doctor’s report is sent to the claims administrator and to the DWC’s DEU (Disability Evaluation Unit). A disability rater from the DEU will use the doctor’s report to calculate your PD rating. If you have an attorney, you may choose to have the rating done by either the DEU or by a private rater. The process used to calculate your rating may vary widely depending on when you were injured, your type of injury and other factors. The PD rating is important because it determines which benefits and how much of them that you will receive. You do have a right to receive a copy of the doctor’s report. You can also request copies of all medical reports. Read the doctor’s report carefully to make sure that it is complete and to see if you agree with the doctor’s conclusions. Information that is left out of the written report could result in loss of some of your benefits.
If you, your Orange County work injury attorney or the claims administrator happens to disagree with the doctor’s findings, you have the right to be seen by a doctor called a qualified medical evaluator (QME). You request a qualified medical evaluator list (called a QME panel) from the DWC Medical Unit. To get the forms to request one, just call your claims administrator. Your employer will be the one to pay for the cost of the QME exam.
You have ten days from the date the claims administrator starts the QME process to submit your request form to the DWC Medical Unit. The claims administrator will do it for you if you do not submit the form within ten days. The claims administrator will also get to choose the kind of doctor you will see in that case. Regarding when you need to have your appointment, you need to also make the appointment within ten days. If you do not, the claims administrator may once again pick the doctor and make the appointment for you. If you have a work injury attorney, he or she can help you pick a QME or you can be evaluated by an agreed medical evaluator (AME). An AME is the doctor your attorney and the claims administrator agree on to do your medical examination.
After you are examined, the doctor will complete a written medical report about your impairment and possible permanent disability. In this case, the term impairment refers to how your job injury has and will affect your ability to do normal life activities. The written report will include a discussion on whether any portion of your disability was caused by something other than your work injury. The doctor’s written report ends with an impairment number. Impairment ratings are determined based on guidelines published by the American Medical Association (AMA). An impairment rating is used to calculate your permanent disability rating but is different from your permanent disability rating.
The impairment number is then put into a formula to calculate your percentage of disability. In this case, disability refers to how the impairment affects your ability to work. Your occupation, age and injury severity and your future earning capacity are all also included in the calculation. Any portion of your disability that was caused by something or someone other than your work injury is taken out of the calculation. Your disability will then be stated as a percentage.
Your disability percentage then factors in to the specific dollar amount you may receive depending on the date of your injury and your average weekly wages at the time. A rating specialist from the DWC Disability Evaluation Unit (DEU) may help calculate your rating.
If you do not have a lawyer working on your behalf, you can ask the state Division of Workers’ Compensation (DWC) to review the rating. The DWC will determine if any mistakes were made in either the medical evaluation process or the rating process. This is also called the reconsideration of your rating. You can also present your case to a workers’ compensation administrative law judge. Contact state information and assistance officer for help whenever you need it regarding this. Injured workers with attorneys cannot request reconsideration. The only option in this situation is that of your lawyer presenting your case to a judge.
Permanent disability benefits are set by law and cannot be changed on a case by case basis. The claims administrator will determine how much to pay you based on three factors:
Permanent disability benefits are typically paid to the injured worker once TD (temporary disability) benefits end and your doctor indicates in writing that you have some permanent effects from your injury. The claims administrator must begin paying your permanent disability payments within fourteen days after your TD payments 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 from the date the doctor says you are permanent and stationary or have reached maximal medical improvement.
Your case may also be settled by agreement between you and the claims administrator. Another possibility is that a workers’ compensation administrative law judge could make a decision in your case following a hearing. There are two basic kinds of settlements in these situations:
If your case goes to a hearing you will receive a Findings & Award (F&A). This is a written decision by a workers’ compensation administrative law judge about your case, including payments and future care that must be provided to you. The F&A becomes a final order unless it is appealed. If you agree to a stip or receive an F&A, the amount of your permanent disability benefit will be spread out over a fixed number of weeks. If you have permanent total disability, 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. The amount due over the original estimate will be paid once the actual amount of permanent disability is known.
After the amount of permanent disability in a claim is determined by the aforementioned procedures, there is usually a settlement or award for benefits. If you have an Orange County personal injury attorney, they should help you obtain this award. If you do not have an attorney, the claims administrator should help you obtain the award. You can also get help from the information and assistance officer at the local DWC office. If your doctor said further medical treatment for your injury or illness could be necessary, the award may provide future medical care.
As mentioned above, you can resolve your whole claim through one lump sum settlement called a compromise and release. A C&R may be best when you want to control your own medical care. 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 stipulation with request for award (stip). A stip usually includes a sum of money and future medical treatment. Payments take place over time. 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 findings and award (F&A). The F&A typically consists of a sum of money and a provision for the claims administrator to pay for approved future medical treatment. Regardless of where you are in this permanent disability process, we would be willing to sit down with you for a free consultation for you to be able to ask questions, learn about your options and check your strategy.
We know that you may feel overwhelmed after reading all of that information regarding permanent disabilities and all the possible outcomes and settlements. If you want clarification or help as to how the above laws and situations apply to your specific situation or if you have any other questions, please feel free to call us. All initial case consultations and evaluations are free. You will not incur any legal fees or costs for our time and assistance unless we win the case. We are ready and available to meet at our office, your home or hospital room Monday – Friday 8:30 am to 5:30 pm. If you prefer evenings or weekends, we are also available then by appointment. We are well known throughout California, Orange County, Riverside, Los Angeles, Long Beach, San Bernardino, Sacramento, San Diego, Fresno, Central California, San Jose, San Luis Obispo and the San Francisco Oakland Bay Area as hard-working and ethical workers’ compensation attorneys. We hope that this page has helped you become more informed about this complicated but critical process. Call us at (714) 783-2205 to schedule your free consultation.