Workers Comp Disability Rating Explained

Workers Comp Disability Rating

The last thing anybody wants is to be involved in a workplace accident that causes a serious injury. However, when such accidents do take place, having loads of facts and information on hand can allow all parties to work through the ever-so-complicated insurance and legal systems. In such cases, determining the extent of someone’s injury is especially important. This information is key to make decisions such as

  • When will the injured party be able to return to work?
  • Would they be able to do some light work?
  • What benefits will be received?

For instance, the injured individual may claim that they will not be able to resume their original tasks, but their employer may say that the employee is still fit to come to work and perhaps do a different job duty. The doctor may place work restrictions on the injured worker such as maximum time to stand or maximum weight lifted.   

Post Injury Evaluations

After a serious workers compensation injury has occurred, there is usually a period of time when the injured worker recovers until they reach what is called maximum medical improvement (MMI).  There is no set time, it takes as long as it takes so long as improvement is occurring.  During this time the injured worker may be off work or offer modified duty under a return to work program.  After the injured worker gets to a point where the doctor feels they have reached MMI then it is time to determine the extent of the disability.    In situations like these, a variety of evaluations and tests are usually ordered to find out the extent of the worker’s injury. For instance, an IME (independent medical exam) could be ordered by the injured worker in addition to the medical exam performed by the insurance company’s doctor.

This evaluation is made by a 3rd party medical professional chosen by the injured person. Other tests performed to evaluate a patient’s condition include a Functional Capacity Evaluation to determine if an injured employee will be able to complete certain tasks at work. Evaluations and tests safeguard all parties when someone gets injured, making sure everyone gets some resolution.

Understanding Disability or Impairment

A major issue that usually comes up after someone gets injured is impairment or disability. This issue impacts a functioning area of one’s body, rendering them unable to use it properly.  This can include mental or physical disabilities caused by illness or injury. These can either be temporary or permanent, mild or severe.

The way disabilities and impairments are evaluated can impact an individuals’ ability to perform certain tasks, affecting their compensation, benefits, social security claims and whatnot. It is vital to keep 2 specific distinctions in mind when considering disability or impairment. These are:

  • Partial vs Total Disability
  • Permanent vs temporary Impairment

When a worker is permanently impaired, they are usually awarded and go after a larger benefit amount. However, these disabilities are subject to something known as workings comp disability rating. The more severe an injury is, the higher the compensation could be. The terms impairment and disability are often used interchangeably; however, when it comes to the matter of benefits, their meanings can be entirely different.

  • Disability means the restrictions and limits on the ability of people to complete certain tasks.
  • Impairment refers to the problem affecting the physical condition or neurology of a person.

Disability & Impairment Examples

For instance, if a person who works in food delivery suffers a terrible back injury, they will be unable to drive or carry the food to the address. The back condition will be considered as impairment while their inability to drive would be considered as disability.

Another individual who experiences the same issue impacting their back could be able to work desk jobs and may not be termed disabled. This is because they can continue their work. They may also not be eligible for the same benefits the food delivery worker would get because their condition prevented them from working.

Usually, workers tend to be honest when it comes to their injuries; however, mislabeling and insurance fraud are real concerns for insurers and employers. Some workers tend to exaggerate the extent of their injuries to claim bigger benefits. Of course, this increases the cost of insurance for employers.  There are also cases where quantifying the extent of an injury or level of pain is quite challenging and this is precisely where a worker’s comp disability rating can come in handy.

Understanding Workers Comp Disability Rating

It is worth keeping in mind that workers comp disability ratings can vary from state to state, so it would be best to make sure you determine your state’s rules and regulations. When an employee encounters a work-related illness or injury, the worker’s compensation department or board in the state they are in will assign them a number that determines their degree of disability.

This is essentially a percentage that determines their level of disability, helping to decide the right amount the injured or ill employee may receive. When assigning ratings to ill or injured parties, doctors use the AMA’s “Guide to the Evaluation of Permanent Impairment.” That said, the following states have their separate guides to assign impairment ratings:

  • Wisconsin
  • Utah
  • Oregon
  • North Carolina
  • New York
  • Minnesota
  • Illinois
  • Florida

Employees don’t get any workers compensation benefit and get a 0% disability percentage if they do not have any illness or injury. However, if a worker suffers a devastating injury, there is a high likelihood of them receiving a disability rating above 0%. Here are common terms used by doctors for determining a degree of disability.

  • Mild: This usually means a patient’s disability is around 25%
  • Moderate: This usually means the injury or illness has left the patient disabled by 50%
  • Marked: This term indicates that a patient’s disability is around 67%
  • Total: Doctors used this term when someone is completely disabled.

To better understand what all goes into a disability rating, and why it matters – here is an example.

Disability Rating Example

What your employees will be paid is based on pay, the body part that is injured, and the disability rating.

Chad earns $700 a week working for a trucking company in Iowa. He was in an accident that resulted in a broken shoulder and nerve damage in the hand. After medical treatment, he still has a loss of mobility in his shoulder, but his hand was completely healed.

It was determined that a 60% disability rating should be assigned to the shoulder injury. A shoulder is valued at 400 weeks in Iowa. So, for 400 weeks Chad would be paid $280,000 – but now you have to take the 60% into account. 60% of the $280,000 is $168,000 – Chad will be paid $168,000. When it comes to the hand, a 0% rating is applied as there is no loss of the hand and it is fully healed.

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