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.

Temporary Versus Permanent Disability

No employer wants to see an employee hurt on the job, but even when the employer has taken meticulous steps to reduce the chances of employee injury, it is almost a certainty that an injury will eventually occur.  When the employee sustains a work-related injury, he or she will be entitled to receive a variety of benefits.  The most pressing and obvious type of benefits will be medical expenses for treatment of the injury.  Temporary and permanent disability benefits may also be awarded, so as an employer, you need to understand the difference between the two.

Temporary disability benefits are designed to help replace at least a portion of the injured employee’s wages while he or she is unable to work.  The type and length of the temporary disability benefits received will be determined by the types of work restrictions set by the employee’s medical provider.  An employee will no longer receive temporary disability benefits once he or she returns to work or is told by the medical provider he or she is sufficiently recovered to return to work.  California law provides that temporary disability can only be paid for a maximum of 104 weeks within the five years following the injury.  There are, however, some conditions that will allow for payment of temporary disability benefits for longer, such as chronic lung disease, chemical burns to the eyes, or amputations.

Permanent disability benefits are benefits that are paid in recognition of your future loss of earning capacity as a result of the injury.  Like temporary disability benefits, the benefit will be paid based on a medical evaluation.  The medical provider must determine when an injury has reached maximum improvement (i.e., has “stabilized”) and at that time will determine an employee’s permanent disability rating. The medical provider will determine the percentage of your disability and the amount paid will be directly determined by that percentage; the higher the percentage, the total money will be paid to the employee.  For any amount under one hundred percent, an employee is partially disabled.  An employee who is permanently totally disabled will be entitled to receive weekly payments in the amount equal to the temporary disability rate for the rest of the employee’s life.

If you have questions about whether what the different types of disability payments mean for your business, call us today.  We can talk to you about your rights and responsibilities.

How Long Can My Worker Stay Out on Temporary Disability?

There are many precautions that careful employers will take to make sure that workers are not injured during the course and scope of their employment.  Keeping equipment in good repair, having updated training for all workers, and creating a safety committee are just a few ways that may help reduce work-related injuries.  Despite the best safety measures, however, it is highly likely that a worker will eventually be injured on the job.  If this occurs and the injury is severe enough to prevent him or her from doing his or her job during recovery, then that person is said to be temporarily totally disabled.  This is a determination that can only be made by a medical professional.  While the worker is healing, he or she can apply to receive two thirds of the wages he or she received while performing the regular duties associated with his or her employment, up to a maximum amount set by statute.  Especially when a worker is out for a substantial amount of time, as an employer, you may wonder how long that worker can stay on temporary disability.

If a worker sustains an injury that prevents the employee from coming to work for at least three days or requires the worker to be hospitalized (or both), then the worker may apply for temporary total disability.  California statute provides that the first payment must be paid within just fourteen days of when a doctor makes the determination that the work-related injury renders the worker unable to work.  Once the payments begin, there are several ways that the worker’s entitlement to continued temporary disability payments may end.  One way is that the injured worker returns to work in some capacity, even if it is not to the original position.  Another way is that a medical professional determines that the injured worker has recovered to the extent that he or she can return to work in some capacity.  Third, if the injured worker has received total temporary disability payments for the statutory maximum of 104 weeks, the worker will no longer continue to receive payments.  Finally, if the physician determines that the worker’s condition is stable and he or she will no longer improve, then the payments may then change to permanent disability payments.

We have extensive experience in helping our clients understand their rights and responsibilities with regard to their employees.  Contact us today to discuss your business and what we can do to help make sure you comply with the law.

What is Temporary Disability?

No employer wants to see his or her employees get injured, and employers take many admirable steps to prevent this from happening.  Unfortunately, work-related injuries will happen despite the best precautions and most careful of training schedules.  In the event that a worker does sustain a work-related injury, the injury will be classified as either permanent or temporary.  The classification of injury will have long-reaching effects for both the employee and the employer.

Temporary disability benefits will be available to an employee who has sustained a work-related injury while he or she is temporarily medically disabled and is prevented from returning to work due to the work-related injury.  These benefits are payable to the employee at the rate of two thirds of the regular wages of the injured employee.  There is a maximum benefit set out by California law.

There are two types of temporary disability benefits available.  One is Temporary Partial Disability (TPD) and the other is Temporary Total Disability (TTD).  TPD benefits are appropriate and available for those workers who have sustained a work-related injury, cannot return to his or her normal employment, but can work in some sort of modified position or capacity.  These benefits are paid at the rate of two thirds of the balance between what a worker normally earns and what he or she is earning in the modified position.  For example, if a worker typically makes $300 per week, but makes only $200 per week in the modified position, the difference between the two is $100.00.  Two thirds of $100 is $66.67.  The injured worker would receive the pay check of $200 per week plus $66.67 in TPD benefits. Note that there is a maximum for benefits set by California law.  If the modified salary is already higher than these maximum amounts, the worker will not be entitled to receive TPD benefits.

TTD benefits will be available to an injured employee where a doctor has determined that the worker is unable to return to any work for at least three days.  The TTD benefits are payable until the worker is able to return to regular work.  The benefits would also end if the employee is able to return to modified work in the event the employer offers such work.  Once the injury becomes “permanent and stationary,” as determined by a doctor, the TTD benefits will end, even if the worker has not returned to work at that time.

Employers should make sure they have a firm understanding of the different types of disability benefits.  Call us today at (714) 516-8188 for an appointment to discuss your business and workers’ compensation benefits.

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