Worker’s compensation is a type of insurance providing medical and wage benefits if you get sick or hurt at work. Every state has requirements mandating workers’ compensation. The specific wage and medical benefits vary depending on where you live.
Worker’s compensation is characterized as social insurance. Business owners are protected from civil liability when they have worker’s compensation insurance if their employees are hurt on the job.
There are limitations to the benefits for both workers and employers, though.
A business is responsible for purchasing this type of insurance, which is underwritten by an insurance company or by publicly supported state funds in some locations.
Coverage includes medical expenses, rehabilitation costs, and lost wages if an employee is injured or becomes ill in the course and scope of their employment role. There are also death benefits paid to families if an employee is killed at work.
If you’re hurt at work, you have to visit a health care professional right away. A doctor then provides a medical report to support your claim. You can begin the claims filing process with your employer’s insurance company.
You’ll receive a disability rating as part of your worker’s compensation claim. The following are things to know about disability ratings.
An Overview of Disability Ratings
When you experience an injury at work, as mentioned, you need to first get medical treatment. When you go to see a doctor about your injury, they might instruct you to take time off work altogether. Your health care provider could also put restrictions on what you can do at work.
During this time, you’ll potentially receive temporary disability benefits as a way to make up for lost wages.
When your recovery plateaus and ongoing treatment isn’t going to help any further, your health care provider determines you’ve reached maximum medical improvement or MMI. At this point, once you reach MMI, you are evaluated for a permanent disability rating.
Doctors will perform physical exams at this time, testing a patient’s ability to function and do normal activities. An exam to determine a disability rating might look at balance, lifting capacity, and range of motion. Then, there is a set of guidelines used to calculate a permanent disability rating.
The permanent disability rating is also called an impairment rating.
Your workers’ compensation treating doctor usually does the evaluation and assigns a rating. The rating is based on a set of guidelines, and the permanent disability rating is sometimes also referred to as an impairment rating.
If the insurance company disagrees with the assigned rating, they can then ask you to undergo an independent medical exam or IME.
The IME doctor does another evaluation and gives a new rating. The two ratings you receive might conflict with one another, and if this happens, a worker’s compensation judge will make a decision on the appropriate rating or order additional exams.
Sometimes, the insurance company might work with you to average both ratings and come up with an agreement for a settlement.
How Does the Doctor Make a Determination on Disability Ratings?
A doctor has to follow a set of guidelines to determine your level of permanent disability. Most states go by the American Medical Association’s Guides to the Evaluation of Permanent Impairment. Some states follow modified guidelines or have their own.
Based on guidelines, a doctor comes up with a disability rating which is a percentage. A disability rating can be assigned for certain body parts. For example, you could have a higher disability rating for one of your feet than your arms.
The disability rating can also be a whole person impairment. That’s expressed as a percentage of disability to the whole body. Whole person impairment is called WPI.
WPI ratings are used for things like internal injuries to organs or head injuries.
A lot of states will use hybrid systems to rate permanent disabilities.
The Relevance of Your Rating
Your disability rating will determine how much you’re eligible to receive permanent disability benefits. Every state has varying rules on the available benefits and they’re worth.
In some states, it may be that a disability rating is used for the calculation of how many weeks of benefits you’re entitled to receive. In other states, the disability rating might associate with a dollar amount.
If your injury permanently impairs you in any way, then you have permanent impairment. That doesn’t automatically mean you receive an award for permanent impairment, and in some states, low levels don’t qualify for monetary awards.