Let's break down everything you need to know about permanent disability benefits, how they differ from temporary wage benefits, and what you can expect if you find yourself dealing with a permanent injury.
Once your injury is deemed permanent, the nature of your benefits changes significantly. This transition happens when you reach what’s known as Maximum Medical Improvement (MMI). MMI means your doctor, or sometimes the insurance company’s doctor, has determined that your medical condition has stabilized and is not expected to improve further with treatment. Essentially, you’ve plateaued, and any remaining issues are considered permanent.
Knowing if you qualify for permanent disability payments is a critical step. Generally, if you have a permanent injury due to a work-related accident, you should be eligible for some form of permanent disability compensation. However, certain factors can influence this eligibility.
Qualification Criteria:
To qualify, your injury must be classified as permanent, which usually happens when you reach Maximum Medical Improvement (MMI). This is the point where your condition has stabilized, and further medical treatment is unlikely to improve your health. At this stage, your doctor, or sometimes an insurance company doctor, will assess your injury and determine its permanency.
Wage Earning Capacity:
One key factor in determining qualification, especially for non-schedulable injuries, is your wage earning capacity. If you’re able to return to work and earn the same or more than you did before your injury, you might not receive permanent disability payments. This is because your ability to earn a living hasn’t been significantly impacted. However, if your injury reduces your ability to work or forces you to take a lower-paying job, you could qualify for benefits based on your loss of wage earning capacity.
Exceptions:
There are exceptions. For instance, if you have a neck or back injury but are able to return to work at your previous salary or higher, you may not receive permanent disability payments despite having a permanent injury. The logic here is that your earning capacity hasn’t been diminished, so there’s no compensable lost time.
Overall, most workers with a permanent injury will qualify for some level of compensation, but the specifics can vary widely based on the nature of the injury and its impact on your ability to work. Understanding these criteria can help you navigate the process and ensure you receive the benefits you’re entitled to.
Calculating permanent disability benefits can be complex, as it depends on whether your injury is classified as schedulable or non-schedulable. Each type has its own method for determining compensation.
Schedulable Injuries:
For schedulable injuries, which affect extremities like arms, legs, hands, feet, fingers, and toes, the calculation is relatively straightforward. Each body part is assigned a specific value on a schedule that indicates the number of weeks of benefits you’re entitled to for a total loss of use.
For example, a 100% loss of use of an arm might entitle you to 312 weeks of benefits. If your loss of use is partial, the number of weeks is proportionally reduced. So, a 10% loss of use of an arm would result in 31.2 weeks of benefits. The compensation rate is typically two-thirds of your gross average weekly wage at the time of your injury, up to a statutory maximum.
Non-Schedulable Injuries:
Non-schedulable injuries, involving core body parts like the head, neck, and back, are more complex. Here, the compensation is based on your loss of wage earning capacity. Doctors will assess the extent of your physical impairment and provide a report. The insurance company’s doctor might do the same, and the judge will review both reports and testimonies to decide on the level of your disability.
An additional factor in these cases is your vocational background. The judge will consider how your injury affects your ability to find gainful employment, taking into account your skills, education, and work history.
For instance, a highly educated individual with versatile skills may find it easier to get a new job despite the injury, potentially lowering the disability rating. Conversely, someone with limited skills may find it harder, possibly increasing the rating.
Example Calculations:
• Schedulable Injury: If you have a 20% loss of use of your hand, and a hand is valued at 244 weeks for a 100% loss, you would receive 48.8 weeks of benefits.
• Non-Schedulable Injury: If you have a 50% loss of wage earning capacity due to a back injury, you might be entitled to benefits for a certain number of weeks, which is determined based on your case specifics and the judge’s decision.
Credits for Prior Payments:
Insurance companies can take credit for any temporary benefits you’ve already received. For example, if you are entitled to $50,000 in permanent benefits but have already received $20,000 in temporary benefits, you would receive $30,000 in permanent benefits.
Understanding these calculations helps ensure you receive the compensation you deserve based on the severity of your injury and its impact on your ability to work.
When pursuing disability benefits, avoid common mistakes that can undermine your case. Do not exaggerate or fake symptoms (malingering), as doctors are trained to detect this, and it can damage your credibility with judges and insurers.
Focus on the specific injury being evaluated during medical exams instead of unrelated complaints that could dilute your case. Ensure you document any discrepancies in medical reports, especially after independent medical examinations (IMEs), and share them with your attorney. Lastly, be sure to provide honest and consistent effort during evaluations, as any sign of dishonesty can negatively affect your claim.
To strengthen your disability claim, work with a knowledgeable workers' compensation doctor who can provide effective treatment and properly document your injuries. Partnering with an experienced attorney who knows how to present medical evidence, cross-examine insurance company doctors, and highlight the strengths of your case will also be essential.
After independent medical examinations (IMEs), take detailed notes on discrepancies or missing details in the report and share them with your lawyer to prepare for cross-examination. By staying honest and organized and collaborating closely with your doctor and attorney, you can maximize your chances of securing fair benefits.
Dealing with permanent disability benefits can be a daunting process, but understanding your rights and the steps involved can make it more manageable.
If you ever find yourself overwhelmed or unsure about any part of your workers’ compensation case, don’t hesitate to reach out. I’m here to help guide you through this process and ensure you get the benefits you deserve. Feel free to give me, Rex Zachofsky, a call anytime at 212-406-8989. Let’s work together to get you back on track.
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