Permanent Disability Benefits
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The FAQ information on this page is from the Department of Industrial Relations website.
Permanent Disability Benefits
Most workers fully recover from job injuries but some continue to have medical problems. Permanent disability (PD) is any lasting disability that results in a reduced earning capacity after maximum medical improvement is reached. If your injury or illness results in PD you are entitled to PD benefits, even if you are able to go back to work.
PD benefits are limited. If you lose income, PD benefits may not cover all the income lost. If you experience losses unrelated to your ability to work, PD benefits may not cover those losses. See the DWC fact sheet on PD for more information.
How is PD identified?
Once you are P&S or have reached MMI, your doctor will send a report to the claims administrator telling them you have PD. The doctor also determines if any of your disability was caused by something other than your work injury. For example, a previous injury or other condition. Assigning a percentage of your disability to factors other than your work injury is called apportionment.
What happens to the doctor's report?
You or the claims administrator also has the right to have the report of your primary treating physician (PTP) rated, but this does not happen automatically. You must request a rating of the PTP’s report by completing a Request for Summary Rating Determination of Primary Treating Physician’s Report and sending it to the DEU with a copy of the PTP’s report.
The process used to calculate your rating can vary, depending on your date of injury or other factors. The PD rating is used in a formula that determines the benefits you’ll receive.
You have a right to receive a copy of the QME’s report as well as the reports from your PTP. Read the QME’s and PTP’s reports carefully. Make sure they are complete and do not leave out important information. If you believe there are factual errors in the QME’s comprehensive report, you can request a factual correction of the report, but you must do so within 30 day of receipt of the report.
The QME will review the request and will issue a supplemental report indicating whether factual correction is necessary to ensure accuracy of the report and how any changes affect the QME’s opinions.
What if I don't agree with the doctor?
There are other specific and strict timelines you must meet in filing your QME forms or you will lose important rights. Read DWC Information and Assistance Unit guide 2 for more information.
When you receive the list of QMEs from the DWC Medical Unit you have to select a doctor, set up an exam and tell the claims administrator about your appointment. If you do not make the appointment within 10 days, the claims administrator may pick the doctor and make the appointment for you.
If you have an attorney, he or she can help you pick a QME or you can be evaluated by AME. An AME is the doctor your attorney and the claims administrator agree on to do your medical examination. In this case you should discuss your options with your attorney.
Can I get more detail about the PD rating and how it is calculated?
If you were injured between Jan. 1, 2005 and Dec. 31, 2012 your PD award may be increased or decreased by 15 percent, depending on whether you work for an employer with 50 or more employees and your employer offers regular, alternative or modified work.
I don't agree with the rating by the state disability rater. What can I do?
How much will I be paid for my permanent disability?
PD benefits are set by law. The claims administrator will determine how much to pay you based on three factors:
- Your disability rating (expressed as a percentage)
- Date of injury
- Your wages before you were injured
How and when are PD benefits paid?
If you have not missed any work, PD payments are due when the claims administrator learns the injury has caused a permanent disability.
Why am I receiving so many notice letters?
Is the claims administrator required to pay a penalty for delays in PD payments?
You can resolve your whole claim through one lump sum settlement called a C&R . A C&R may be best when you want to control your own medical care and/or you want a lump sum payment for your permanent disability. A C&R usually means that after you get the lump sum payment approved by the workers’ compensation judge, the claims administrator will not be liable for any further payments or medical care.
You can also agree to a settlement called a stip or stipulation. A stip usually includes a sum of money and future medical treatment. Payments take place over time. A judge will review the agreement.
If you cannot agree to a settlement with the claims administrator, you can go before a workers’ compensation administrative law judge, who will decide your permanent disability award. A judge’s finding is called a F&A. The F&A generally consists of a sum of money and a provision for the claims administrator to pay for approved future medical treatment.
If you agree to a stip or receive an F&A, the amount of your PD benefit will be spread over a fixed number of weeks. If you C&R your case you get a lump sum payment. If you have PTD, you are eligible to receive payments for the rest of your life.
In all of these situations your PD payments will likely begin before the final decision about the amount of your PD is reached. That’s because, once your doctor says you have permanent disability, the claims administrator will estimate how much you should receive and begin making payments to you before the final percentage of disability has been calculated.
When the actual amount of PD due has been determined, the amount due over the original estimate will be paid.
Find more information about permanent disability in the factsheet.
Contact Sacramento Work Injury Lawyer
Have you suffered a serious work injury? Contact workers’ compensation attorney at the Law Office of Roy Yang for FREE consultation about your California workers compensation claim benefits. Give us a call at (916) 269-9100 to speak with a Sacramento work injury lawyer today.
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