Whether you're dealing with a temporary setback or a permanent disability, knowing how impairment ratings work can make a significant difference in your case. I'm going to break down the essentials of impairment ratings, shedding light on what they mean, how they're calculated, and why they're so important for your workers' compensation claim.
An impairment rating in workers' comp is like a snapshot of your disability at a specific moment. It covers different situations—temporary, permanent, or ongoing partial disability—but in New York, it usually refers to permanent partial disability.
Basically, it measures how much your injury affects your long-term ability to work. A serious back injury might lead to permanent partial disability, while a hand or foot injury could be classified as a schedule loss of use. These distinctions matter because each type of impairment is calculated differently when determining your benefits.
Impairment ratings play a big role in workers' comp because they directly impact the benefits you get. They help determine your Loss of Wage Earning Capacity (LWEC), which is just a fancy way of saying how much your injury affects your ability to make a living.
Take two people with the same back injury—one has a college degree and speaks multiple languages, making it easier for them to find work, while the other doesn’t have those advantages and might struggle more. Even if they both have a 50% physical disability, the first person’s LWEC might be 30%, while the second’s could be 70%. That difference can seriously affect how much compensation they receive.
So, your impairment rating isn’t just about the injury itself—it also factors in your skills and background. That’s why it’s such a key part of figuring out the benefits you’ll get as you recover and plan for the future.
Impairment ratings usually come into play when you reach Maximum Medical Improvement (MMI), which basically means your condition has stabilized and isn’t expected to get much better with further treatment. At this point, a doctor will assess your injury to figure out the extent of your permanent disability.
In New York, doctors follow the Workers' Compensation Board’s Medical Treatment Guidelines to evaluate different injuries—whether it’s your head, neck, back, or limbs. A few key factors go into this assessment:
Since impairment ratings aren’t always clear-cut, doctors can disagree. Your doctor might say you still need treatment and haven’t hit MMI yet, while the insurance company’s doctor might claim you have and give you a lower impairment rating. That’s where having a good lawyer can make a big difference—helping you navigate these disputes and making sure your rating truly reflects your condition.
When you have multiple injuries, figuring out your impairment rating gets a bit more complicated. It all depends on how serious each injury is and whether you're able to work.
If you’re dealing with, say, a back injury and a shoulder injury, each one is evaluated separately, but how they impact each other also matters. Here’s how it works:
Severity & Type of Injuries: Each injury is assessed on its own. A serious back injury might qualify for Permanent Partial Disability (PPD), while a less severe shoulder injury could be categorized as a Schedule Loss of Use (SLU).
Work Status: Whether or not you're working plays a big role. If your injuries keep you from working altogether, you could be eligible for ongoing PPD benefits. But if you’re back at work and earning less because of your injuries, you might get benefits to help cover the lost wages. For example, if your back injury limits you to part-time work, you could receive compensation to make up for the reduced income.
How Injuries Combine: Sometimes, multiple injuries together impact you more than they would separately. For example, head and neck injuries combined could make it much harder to work than just one of them alone.
Strategic Approach: Deciding which injury to focus on for compensation can make a difference. If your back injury is serious but doesn’t stop you from working, it might not bring extra financial benefits. But if your shoulder injury is milder yet keeps you from working full-time, seeking compensation for that could be more beneficial.
Head injuries—like concussions or traumatic brain injuries (TBIs)—get special attention, focusing on neurological exams, advanced imaging (like MRIs with DTI), and symptoms such as memory loss, cognitive issues, and mood changes. Unlike other injuries that mainly consider range of motion, head injuries are more about how they affect your brain function and daily life.
For injuries to the back, neck, or limbs, range of motion is a big factor since it directly impacts your impairment rating. If you have a preexisting condition, your rating might be split between the old and new injury, but you can argue that your workplace injury is the main issue—especially if your old condition never affected your ability to work before.
Being upfront about prior conditions is key, and a good lawyer can help frame your case to show how your injury really impacts your life, making sure you get the compensation you deserve.
If you don’t agree with your impairment rating in your workers' comp case, you have options to challenge it. First, talk to your doctor—if something was missed, they might need to take another look. If needed, you can get a second opinion, but check with your lawyer first to make sure it’s done the right way legally.
If a judge has already made a decision based on the rating and you think there was a mistake in how the law or facts were applied, you can file an appeal. Just keep in mind, appeals are about legal or factual errors, not just being unhappy with the outcome.
To build a strong case, you’ll need solid medical records and evidence, which your lawyer can help organize. Having a good lawyer on your side is crucial—they can guide you through the process, fight for your rights, and make sure your disability is properly recognized so you get the compensation you deserve.
If your condition gets worse after you've been given an impairment rating, you might be able to get it reevaluated—but you’ll need to prove there’s been a significant change. This could mean things like increased mobility issues or new complications that weren’t there before.
To back up your claim, you’ll need updated medical records, like new test results or treatment notes. The next step is filing with the Workers' Compensation Board, and a lawyer can help make sure everything is done correctly. Since getting approval isn’t always easy, having solid medical evidence and legal support is key to showing how your condition has worsened and making sure you get the benefits you deserve.
Getting the best possible impairment rating in your workers' comp case can make a big difference in the benefits you receive. Here are some practical tips to help you get the best outcome:
Be Honest and Upfront: Always be open about any past injuries or medical conditions. If you try to hide something and it comes up later, it could hurt your case and even lead to fraud accusations. Being transparent helps build trust with your doctor, the insurance company, and the court.
Give Your Best Effort During Evaluations: When you're being assessed—whether by your own doctor or the insurance company’s—always put in full effort. Don’t exaggerate your pain or hold back during range-of-motion tests. Doctors can usually tell if you’re not trying, and if they suspect you’re faking or exaggerating, it could negatively impact your rating.
Keep Track of Everything: Save all medical records, doctor’s notes, test results, and any communication related to your injury. The more detailed your documentation, the stronger your case will be, making it easier for your lawyer to show how your injury affects your daily life.
Get a Good Lawyer: An experienced workers' comp lawyer knows the system inside and out. They can help you navigate the process, make sure your impairment rating is fair, and fight to get you the maximum compensation possible.
Communicate Clearly with Your Doctor: Make sure your doctor understands exactly how your injury affects your work and daily life. If something is limiting you, speak up—don’t assume they already know. The more details your doctor has, the more accurate their assessment will be.
Know What to Expect: Learn how impairment ratings are calculated and what factors doctors consider. Understanding the process can help you prepare for evaluations and make sure nothing important gets overlooked.
Follow Your Treatment Plan: Stick to your doctor’s recommendations and follow through with physical therapy, medications, or any other prescribed treatments. Not only does this help with your recovery, but it also shows you’re taking your injury seriously, which can support your case.
Be Ready for Hearings: If your case goes to a hearing, you’ll need to explain your injury, treatment, and how it affects your life. Your lawyer will guide you on what to expect, but being prepared can make a big difference in how your case is presented.
Navigating these waters can be tricky, but you don't have to do it alone. Feel free to give me, Rex Zachofsky, a call at 212-406-8989. Let's chat about your situation and see how we can get you the compensation you deserve.
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