The objective of the medical providers in every workers’ compensation claim is to assist the injured employee in recovering 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
- Internal tissue damage
Medical Providers Use Disability Guide Rating
Medical providers are not left on their own to judge an employee’s impairment level. 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, 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 a 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.
Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.
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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.