What if I Disagree with the Disability Rating

After an employee sustains an injury in the course and scope of his or her employment, he or she is entitled to file for workers’ compensation benefits.  These benefits cover not only a portion of their replacement wages, but also their related medical costs for the treatment of their work-related injury.  When an employee is initially injured, he or she may be deemed to be temporarily disabled by a healthcare worker.  After the injury has stabilized, i.e. determined to reached its maximum recover, the employee may then be determined to be permanently disabled.  During this determination, the employee will be assigned a disability rating.  This disability rating is significant because the permanent disability rating will determine the amount of benefits the worker will receive in the long run.

To calculate the permanent disability percentage, it is required to perform an assessment of the injured employee’s whole person impairment.  The whole person impairment is then used in a particular format  to create the disability percentage.  It is not uncommon for the employee or the employer to disagree on whether the disability rating is correct.  They may disagree on the severity of the impairment or on the type of impairment.  If you disagree with the impairment rating given to your employee by the Treating Doctor, you can request that he or she submit to a new medical examination with a Qualified Medical Evaluator (QME).  Be advised, however, that a court will not order an injured employee to just continue to submit to repeated medical examinations until the employer gets the impairment rating he or she thinks is appropriate.  Employees also need to remember that time is not unlimited to appeal the disability rating and request a new medical examination.  Accordingly, an employer should not delay in pursuing the appeal if he or she believes the rating is incorrect.  Employers also should keep in mind that simply alleging that an award is too high is not likely to achieve a favorable outcome during an appeal.  Employers should be able to articulate why an award is too high or inaccurate.  For example, if the employee alleges his or her shoulder is seriously injured, the employer may want to be able to present evidence that the employee is regularly lifting heavy boxes or pursuing heavy athletic activity.

We have extensive experience with helping business owners understand the role of disability ratings.  Call us today to discuss your business and what we can do to help.

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