Workers Compensation Benefits: Calculating Permanent Disability Benefits

Calculating California workers’ compensation permanent disability benefits requires attention to the QME report and permanent disability rating

The California workers’ compensation benefit for a permanent disability depends on several factors. Calculating these workers’ compensation benefits requires a Santa Rosa workers’ compensation lawyer to make sure the physician who prepares the key medical report does not overlook significant facts about the injury. The attorney will then work to negotiate a disability rating that favors the injured worker.

Communication Is Vital

One of the most important factors in calculating permanent disability benefits is the nature of the work that the injured worker was performing at the time of injury. Also important is the degree of permanent functional limitations suffered, as determined by a Qualified Medical Examiner (QME).

To assure that injured workers receive the benefits they are entitled to, it is important to communicate the demands of their job and the extent of their functional limitations. The injured workers’ treating physician, the QME, the claims administrator, and the injured workers’ Santa Rosa workers’ compensation attorney, all need to know the nature of the injured workers’ job duties and how the injury affects their ability to function.

When an injured worker feels pain while recovering from an injury, she needs to communicate that to her doctors. Physicians, claims administrators, and attorneys cannot accurately assess the extent of an injury without knowing how the injury is affecting the injured workers’ ability to perform ordinary tasks. If moving your head to look over your shoulder while driving in reverse is painful, your physician needs to know that. If you feel stiff when you wake up in the morning, tell your doctor. Pain and limitations of motion are all symptoms that determine the extent of a physical impairment. Failing to communicate that information may reduce the value of one’s permanent disability benefits.

The QME Report Is Critical

Maximum Medical Improvement (MMI) occurs when a physician determines that an injured workers’ medical condition has become stable, and there is no additional medical care which will further improve the condition. An injured worker whose medical condition has been declared MMI may have a permanent disability. The permanent disability might be minor or it might be substantial. That determination is generally determined by a QME. A QME’s determination that an injured worker has suffered some degree of permanent functional limitations as a result of the work injury, triggers the entitlement to receive permanent disability benefits.

The QME will write a report and determine whether or not MMI status has been reached. In addition to describing the injury, the QME report must:

• Describe the future medical care that will be needed to treat the injury.
• Describe any limitations in activity or resulting work restrictions that the injury causes (for example, “range of forward flexion in right shoulder is limited to 120 degrees” or “patient may not lift more than 20 pounds”).
• Explain whether the worker can return to his or her former job.
• Estimate the percentage of Whole Person Impairment or WPI (i.e. functional limitation) that was caused by the work injury.
• Estimate the percentage of permanent disability that was caused by something other than the work injury, if any.

The QME report serves as a basis for calculating a permanent disability rating. The permanent disability rating, in turn, is the key factor in calculating the value of any permanent disability benefits. For that reason, it is essential that the QME report accurately reflects the nature of the injured workers’ job duties and the full extent of her functional limitations. It is also essential that the QME report accurately assesses the degree to which the permanent disability was caused by work activities.

The injured worker has a right to challenge any inaccuracies in a QME report. A Santa Rosa workers’ compensation lawyer can help injured workers make that challenge if necessary.

Disability Ratings Are Often Negotiable

After the QME report is prepared, it is used to generate a disability rating. Calculating the value of permanent disability benefits is a matter of using that rating to determine benefits according to a rating schedule developed by the Division of Workers’ Compensation.

The injured workers’ Santa Rosa worker’s compensation attorney will calculate the correct rating based on the QME report. The claims administrator employed by the insurance company will also calculate a rating, which is often different.

The key to calculating the value of permanent disability benefits is to determine the disability rating. This is often done through negotiation. The insurance company will offer a lump sum settlement of the claim if the injured worker is willing to giving up the right to receive payment of future medical expenses. For a variety of reasons, injured workers often give up that right and take on the responsibility of paying for their own future medical treatment.

Another way to resolve the workers’ compensation claim is to allow it to remain open for payment of future medical expenses by the workers’ compensation insurance company. An experienced workers’ compensation attorney in Santa Rosa can be counted on to recommend the right kind of settlement in each case.

Negotiating a favorable permanent disability rating is more likely when the injured worker is represented by an experienced workers’ compensation lawyer. For help in calculating your workers’ compensation permanent disability benefits, contact Kneisler & Schondel at (707) 542-5132. You can also ask a question of our Santa Rosa workers’ compensation lawyer by using our online contact form.