Good afternoon everyone! Today, we're diving into a topic that's not just a follow-up from last week but something we get a ton of questions about—impairment ratings. If you've ever been confused about what they are, the different types, and what they actually mean, you're not alone. Impairment ratings can be a real head-scratcher. So, let's jump right in and make sense of it all. And remember, if any questions pop into your head while we're discussing this, feel free to reach out anytime. We're always here to help. Let's get started!
An impairment rating might sound like a complicated term, but it’s actually pretty straightforward once you break it down. Essentially, it’s a measure used to describe the extent of your disability due to a work-related injury. There are different types of impairment ratings to be aware of: temporary disability, permanent disability, and partial disability.
In the context of New York workers compensation, the term impairment rating usually refers to a permanent partial disability. This rating indicates the overall level of your long-term disability after you've reached a point where your condition isn’t expected to improve significantly. It’s different from temporary disability ratings, which only apply while you’re still healing, and it also varies from ratings given for permanent total disability or specific injuries to body parts like hands or feet.
Understanding your impairment rating is crucial because it directly impacts the benefits you’ll receive. So, let's explore the different categories and why these ratings matter.
When it comes to permanent disabilities in the realm of workers compensation, there are two main categories to understand: permanent partial disabilities and schedule loss of use.
Permanent Partial Disability (PPD):
This category includes injuries to the head, neck, back, and psychological or systemic conditions. These are injuries that affect your core body and can involve multiple areas. For example, if you have a significant injury to your back that prevents you from working fully, or a psychological condition resulting from a work-related incident, these would fall under PPD.
Schedule Loss of Use (SLU):
On the other hand, schedule loss of use pertains to injuries to specific extremities like your hands, feet, arms, and legs. Each body part has a predefined value assigned to it in weeks of compensation. For instance, losing the use of a thumb is treated differently from losing the use of a pinky, with a thumb being worth more weeks of compensation. SLU can also apply if you have multiple injuries affecting various extremities.
Sometimes, a very severe injury to an extremity can be classified as a permanent partial disability. For example, if an arm injury is so significant that it impacts your ability to work in the same way a back or neck injury would, it might be reclassified. However, this is relatively rare.
Impairment ratings aren’t just numbers—they play a crucial role in determining the benefits you receive from your workers compensation case. The key concept here is the Loss of Wage Earning Capacity, or ELWAC. This is how your physical disability is combined with your vocational background to calculate your overall disability level and the compensation you’re entitled to.
Here’s a practical example: Imagine two workers with the exact same back injury. Worker A has a college degree, speaks multiple languages, and has specialized training. Worker B, however, has no formal education and limited job skills. Even if both are given a 50% permanent disability rating for their back injury, their ELWAC might differ significantly. Worker A, with more education and skills, might have a lower ELWAC because they have better chances of finding alternative employment. Worker B, on the other hand, might have a higher ELWAC due to fewer job opportunities, effectively increasing their level of disability in the eyes of the court.
This rating is essential because it’s not just about your injury—it’s about how your injury affects your ability to earn a living in the future. The impairment rating, particularly for permanent partial disabilities, is a significant factor in this calculation. Your rating directly impacts the amount of compensation you will receive, so understanding and accurately determining your impairment rating is crucial.
Several factors come into play when calculating your impairment rating. These factors ensure that the rating accurately reflects not just the physical impact of your injury but also how it affects your life and work capabilities.
Vocational Background:
Your work history and skill set significantly influence your impairment rating. If you have a diverse skill set, extensive education, or specialized training, you might find it easier to find alternative employment despite your injury. On the flip side, if your job options are limited due to a lack of skills or education, your impairment rating might be higher, reflecting the greater impact on your earning capacity.
Medical Factors:
The specifics of your injury—such as its type, location, and severity—are crucial. For instance, range of motion is often a critical factor. If you have a shoulder injury, how much you can move your arm up, down, and sideways will be thoroughly assessed. Similarly, for back or neck injuries, your ability to bend, twist, and turn is evaluated.
Multiple Injuries:
If you’ve sustained multiple injuries, each one needs to be evaluated both individually and collectively. This is because the combined effect of multiple injuries can be more debilitating than the sum of the individual impairments. For example, an injury affecting both your back and an arm might significantly limit your work capabilities more than just one of those injuries alone.
All these factors are assessed using standardized medical treatment guidelines, ensuring that the impairment rating is as objective and fair as possible. These guidelines help doctors determine the extent of your impairment based on medical evidence and structured criteria.
Calculating and assessing impairment ratings is a detailed process that involves both medical evaluations and legal considerations. Here’s how it typically works:
Reaching Maximum Medical Improvement (MMI):
Before an impairment rating can be determined, you must reach what’s called Maximum Medical Improvement. This means your condition has stabilized, and you’re not expected to get significantly better with further treatment. MMI is a crucial milestone because it indicates that your injury's long-term effects can now be accurately assessed.
Role of Treating and Insurance Doctors:
Both your treating doctor and the insurance company’s doctor will play roles in determining your impairment rating. Once you reach MMI, your treating doctor will assess your impairment based on specific criteria. The insurance company might also have you examined by their own doctor, who will provide a separate assessment. These assessments can sometimes differ, with your doctor possibly rating your impairment higher than the insurance company’s doctor.
Medical Treatment Guidelines:
In New York, for example, doctors follow the New York State Workers' Compensation Board’s Medical Treatment Guidelines. These guidelines provide a standardized framework for assessing impairment. They consider various factors, including the type and extent of your injury, any surgeries you’ve had, and your range of motion.
Special Considerations:
Some injuries come with special considerations. For instance, if you’ve had multiple surgeries or if your injury includes conditions like a frozen shoulder, these factors might affect your impairment rating. These special considerations are detailed in the medical treatment guidelines to ensure that all aspects of your injury are taken into account.
Example of Assessment:
Let’s say you have a shoulder injury. The doctor will evaluate how much you can move your shoulder compared to the normal range of motion. If a shoulder should ideally move 180 degrees forward and you can only move it 90 degrees, this limitation will significantly impact your impairment rating.
By combining these medical evaluations with your vocational factors, a comprehensive impairment rating is calculated. This rating not only reflects your physical limitations but also how these limitations affect your ability to work and earn a living.
Let’s break down how impairment ratings are calculated for different types of injuries, using specific examples to make it clearer.
Schedule Loss of Use (SLU):
For extremity injuries—like those to your hands, feet, arms, or legs—the impairment rating is based on a schedule of loss of use. Each body part is assigned a specific number of weeks of compensation, which is used to calculate your benefits. Here are a few examples:
- Thumb: If you lose total use of your thumb, it’s worth 75 weeks of compensation. Partial loss of use is calculated as a percentage of these 75 weeks.
- Index Finger: Complete loss of use of your index finger is worth 46 weeks of compensation.
- Pinky Finger: Total loss of your pinky is worth 15 weeks of compensation.
The compensation for these losses is then calculated based on your average weekly wage up to a statutory maximum. For example, if you have a 50% loss of use of your thumb, you’d receive compensation for 37.5 weeks (50% of 75 weeks) at your compensation rate.
Non-Schedule Loss (Permanent Partial Disability):
Injuries to the core body, such as the head, neck, and back, are assessed differently. These non-schedule injuries are rated based on how they affect your overall function and ability to work. Here’s an example:
- Back Injury: Suppose you have a herniated disc at L5-S1. The doctor will assess your range of motion, pain levels, and any functional limitations. Let’s say you’re found to have a 40% permanent partial disability. This rating reflects how much your back injury limits your ability to perform work-related tasks and impacts your overall employability.
In these cases, the impairment rating influences the calculation of your Loss of Wage Earning Capacity (ELWAC), which in turn determines the benefits you receive.
Combining Multiple Injuries:
If you have multiple injuries, each injury is assessed individually, and then their combined impact is evaluated. For example, if you injured both
your back and your shoulder, each injury would be rated separately. However, the overall impact on your ability to work is considered when determining your final compensation.
When you have multiple injuries from the same accident, assessing your impairment rating becomes a bit more complex. Each injury needs to be evaluated individually, and then their combined impact on your overall ability to work and function is considered.
Individual Assessments:
First, each injury is assessed separately. For example, if you have a back injury and a shoulder injury, both will be evaluated on their own merits. The doctors will determine the impairment rating for your back based on factors like range of motion, pain, and functional limitations. Similarly, they will assess your shoulder injury using criteria like range of motion and strength.
Overall Impact:
Once the individual ratings are determined, the combined effect of all your injuries is evaluated. This is crucial because multiple injuries can have a greater overall impact on your ability to work than the sum of their individual impairments. For instance, having both a severe back injury and a shoulder injury might limit your work capabilities more than either injury would on its own.
Work Status:
Your current work status plays a significant role in this assessment. If you’re unable to return to work at all due to your injuries, you might be eligible for ongoing benefits. Conversely, if you can return to work but at reduced hours or in a less demanding role, this will be taken into account when determining your compensation.
Lawyer’s Role:
Navigating multiple injuries and their impact on your impairment rating is complex and requires a thorough understanding of workers compensation laws and medical guidelines. This is where having a skilled lawyer becomes invaluable. Your lawyer can help ensure that all your injuries are properly evaluated, that the combined effect is accurately considered, and that you receive the maximum benefits you’re entitled to.
Navigating the legal and procedural aspects of workers compensation can be daunting, but understanding these steps is crucial for maximizing your benefits and ensuring your rights are protected.
Importance of Having a Lawyer:
One of the most vital steps you can take is hiring a competent lawyer who specializes in workers compensation. A good lawyer knows the intricacies of the law, understands medical reports, and can effectively argue your case to get the best possible outcome. They help you navigate the system, ensure all necessary paperwork is filed correctly, and represent your interests in hearings and negotiations.
Navigating Differing Medical Opinions:
It’s common for your treating doctor and the insurance company’s doctor to have differing opinions on your impairment rating. Your lawyer plays a crucial role here by cross-examining the insurance company’s doctor, presenting medical evidence, and arguing why your treating doctor’s opinion should be given more weight. This helps ensure that your impairment rating accurately reflects the severity of your injury and its impact on your life.
Challenging Impairment Ratings:
If you disagree with the impairment rating assigned by the insurance company or a judge, there are ways to challenge it. This usually involves gathering additional medical evidence, possibly from another medical professional, and presenting it in a legal setting. Your lawyer can guide you through this process, help you understand your options, and file the necessary appeals if needed.
Process and Timeframe for Appeals:
If you need to file an appeal, it’s essential to understand the process and timeframe. Appeals in workers compensation cases typically focus on whether the judge made an error in applying the law or in understanding the facts of your case. Your lawyer will draft an appeal brief, submit it to the appropriate board or court, and argue your case. The appeals process can take several months, but having a lawyer who knows the system can help streamline this and increase your chances of a successful outcome.
Settlement Considerations:
Sometimes, settling your case might be in your best interest, especially if it’s dragging on or if the uncertainty of the outcome is causing stress. Settlements can be negotiated at any point, even before reaching Maximum Medical Improvement (MMI). Your lawyer can help you understand the pros and cons of settling, what a fair settlement might look like, and negotiate on your behalf to ensure you get the best possible deal.
Several additional considerations can impact your impairment rating and the overall outcome of your workers compensation case. Being aware of these factors can help you navigate the process more effectively.
Impact of Pre-existing Conditions (Apportionment):
If you had a pre-existing condition or previous injury to the same body part, it could affect your impairment rating. This concept is known as apportionment. For example, if you injured your knee playing football years ago and then re-injured it at work, the insurance company and the judge will want to determine how much of your current disability is due to the old injury and how much is due to the new one. Your lawyer can help argue that your current disability is primarily due to the recent work-related injury, especially if you were working without issues before the new incident.
Second Opinions and Doctor Shopping:
While you are allowed to get a second opinion if you’re unhappy with your doctor’s assessment, it’s essential to handle this carefully. Going to multiple doctors to find one who will give you a favorable report, known as doctor shopping, is generally frowned upon and can hurt your case. Instead, discuss any concerns with your current doctor or your lawyer, who can advise you on the best course of action.
Settling Before Reaching MMI:
You might consider settling your case before reaching Maximum Medical Improvement (MMI), especially if you need financial stability sooner or want to avoid a lengthy process. However, settling too early can mean accepting less compensation than you might be entitled to if your condition later turns out to be more severe. Discuss the timing of any settlement offers with your lawyer to ensure you make an informed decision.
Proactive Communication:
Keeping all parties informed—your doctor, your lawyer, and the insurance company—is crucial. Be upfront about any previous injuries or conditions, as transparency can prevent issues later on. Regularly update your lawyer about your medical treatment and work status so they can make the best strategic decisions for your case.
Honesty and Effort During Medical Examinations:
When you attend medical examinations, whether with your doctor or the insurance company’s doctor, always be honest and give your full effort. Doctors are skilled at detecting when patients aren’t trying their best, and any suspicion of malingering can negatively affect your case. Showing genuine effort and cooperation during these assessments will help ensure that your impairment rating accurately reflects your condition.
Receiving an impairment rating can be a pivotal moment in your workers compensation case. Here are some pro tips to help you navigate this process effectively and ensure you get the best possible outcome.
Be Upfront About Prior Accidents and Injuries:
One of the most important things you can do is to be completely honest about any prior accidents or injuries. If you had a car accident five years ago that injured your back, or a football injury from high school, make sure to disclose this information. It’s much better to be upfront about these issues rather than having the insurance company bring them up later and accuse you of hiding something. Transparency can help minimize any negative impact these prior incidents might have on your current claim.
Give Full Effort During Medical Examinations:
When attending medical examinations, whether with your treating doctor or the insurance company’s doctor, always give your best effort. Doctors can tell if you’re not trying your hardest, and any hint that you’re not cooperating fully can lead to notations in your medical report that could hurt your case. Showing that you’re making a genuine effort ensures that your impairment rating reflects your true limitations.
Stay Consistent with Your Statements:
Whether you’re talking to your doctor, lawyer, or the insurance company, consistency is key. Ensure that the information you provide about your injury, symptoms, and limitations remains consistent across all conversations and documents. Any discrepancies can be used against you.
Keep Detailed Records:
Maintain detailed records of all your medical treatments, doctor’s visits, and any communications related to your case. This documentation can be invaluable if there are disputes about your condition or the extent of your impairment. Your lawyer can use these records to build a stronger case for you.
Follow Your Doctor’s Advice:
Adhering to your doctor’s recommendations for treatment, physical therapy, or medication is crucial. Not only does this show that you’re taking your recovery seriously, but it also helps ensure that you reach Maximum Medical Improvement (MMI) as quickly and fully as possible. Failure to follow medical advice can be used as evidence that you’re not as injured as you claim.
Consult with Your Lawyer Regularly:
Regular communication with your lawyer is essential. Keep them updated on your medical progress, any changes in your work status, and any new developments in your case. Your lawyer can provide you with timely advice, adjust your legal strategy as needed, and help you navigate any challenges that arise.
Understand the Importance of Your Impairment Rating:
Your impairment rating is a significant factor in determining your compensation. Understanding how it’s calculated and what it means for your benefits can help you make informed decisions about your case. If you have questions about your rating or the process, don’t hesitate to ask your lawyer for clarification.
Thanks for sticking with us through this deep dive into impairment ratings and workers compensation. I know it’s a lot to take in, but I hope this breakdown makes things a bit clearer for you. Navigating the world of workers compensation can be tricky, but you don’t have to do it alone.
If you have any questions or need help with your own workers compensation case, feel free to reach out to me. I’m here to help you understand your rights and get the benefits you deserve. You can call me, Rex Zachofsky, anytime at 212-406-8989. Whether you’re just starting your claim or you’re deep in the process and feeling overwhelmed, let’s chat and see how I can assist you.
Take care and stay safe out there!
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