The objective of the medical providers in every workers’ compensation claim is to assist the injured employee to recover completely or to the greatest degree of recovery that is possible. Unfortunately, there are injuries where the employee does not recover fully from the effects of the injury. When an employee reaches maximum medical improvement (the point where the medical provider decides there is nothing further that can be done to improve the injured employee’s medical condition), the medical provider will assess whether or not the injured employee will have a residual of the injury (a loss of body function) after the medical treatment has been completed.
If the injured employee does retain a residual of the injury after the employee has reached the point of maximum medical improvement, the residual of the injury is referred to as a permanent partial disability (PPD). The term ‘impairment rating’ is often used with permanent partial disability. An impairment rating is the measurement of the amount of permanent partial disability. If the residual of the injury is so severe that the employee’s ability to function and to be employed is totally lost, then the residual injury is referred to as a permanent total disability (PTD). This discussion will be limited to permanent partial disability.
Many Injuries Result in Permanent Partial Disability
Many injuries can result in some form of permanent partial disability. PPD can result from either a loss of physical motion or function. Some injuries can cause internal deterioration such as traumatic arthritis, bone shortening, and tissue scarring.
The PPD due to an injury can be anywhere on a broad spectrum of severity from very mild to very severe. Common types of injuries or medical treatment that can lead to PPD include:
- Simple strains
- Simple sprains
- Simple fracture
- Compound fracture
- Compound fracture with surgical intervention
- Burns
- Internal tissue damage
- Surgeries
Medical Providers Use Disability Guide Rating
Medical providers are not left on their own to judge the level of impairment of an employee. The medical providers in most states use various editions of the “American Medical Association Guides to the Evaluation of Permanent Impairment” to establish the level of PPD. In other states the medical providers are required to use a state specific disability rating guide.
The amount of financial compensation an employee receives for an impairment rating is directly tied to the level of the impairment rating. In every state, the level of financial compensation goes up in direct correlation with the level of the PPD.
Many Factors in Impairment Rating
The level of severity of the residual medical problem can vary significantly from one person to another. One injured employee with a fractured arm might end up with a 3% impairment rating for the loss of body function, while another employee with a nearly identical fractured arm might receive a 10% impairment rating to the arm. The reason for this is there are numerous factors that impact the level of the impairment rating an employee receives after reaching maximum medical improvement. Some of the factors include:
- The health of the employee prior to the injury
- The level of physical fitness of the employee prior to the injury
- The age of the employee
- The occurrence of injuries to other body parts at the time of the workers’ compensation accident
- The nature and extent of medical treatment post accident
- The activity level of the employee post-accident
- The personal habits of the employee including smoking, alcohol use and illicit drug use
- The employee’s sleeping habits
- The emotional state of the employee and the stress level of the employee
To illustrate, a 30 year old male construction worker in excellent health and excellent physical conditioning prior to the injury and with no bad personal habits, could receive a 5% PPD for a leg fracture. A 60 year old janitor who never exercises, who is 50 pounds overweight, has diabetes, smokes a pack of cigarettes a day and rarely gets a full night of sleep due to the alcohol in his system, could receive a 20% PPD for an identical leg fracture. The janitor’s overall poorer state of health results in a less complete recovery, and the higher level of loss of body function.
Each Injury Addressed on Actual Symptomatic Findings
Each injury will have to be addressed on the actual symptomatic findings. Every person heals or recovers differently so while these ratings are commonly used they should not be considered absolutes.
It is difficult for employers to have an impact on the level of PPD once an employee is injured. Employers can impact PPD by having a wellness program in place before an employee is injured. By improving the employee’s overall state of health before an injury, the loss of body function due to an injury will be reduced.
Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, and founder of COMPClub an interactive training program teaching workers’ comp cost containment best practices. Through this platform he is in the trenches on a monthly basis with risk managers, brokers, consultants, attorney’s, and adjusters teaching timeless workers’ comp cost containment strategies, as well as working with members to develop new tactics and systems to address the issues facing organizations today. This unique position allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.
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