disability benefits indiana

Permanent Partial Impairment (PPI)

Oftentimes as physicians we are asked to calculate permanent partial impairment ratings. Impairment is defined as a significant deviation, loss or loss of use of any body structure or function in individual with a health condition, disorder or disease. Impairments are determined as a percentage of the body part involved and then converted to a percentage of the whole person. An injury may result in an impairment from 0 to 100% of the whole person depending on the severity of the condition. Impairment ratings are defined by anatomic, structural, functional and diagnostic criteria. An accurate exam is also important in determining impairment as is the specific diagnosis. Ultimately the system for determining impairment should be reliable so that different raters arrived at consistent impairment ratings when assessing the same individual.

To achieve consistency the American Medical Association has been publishing The Guides to  Evaluation of Permanent Impairment since the 1950s. Every seven years a new edition is printed. The most recent edition is the Sixth Edition published in 2008. This addition continues to emphasize diagnosis as a key contributor to determining the impairment rating. There are also adjustments for the significance of the patient symptoms and functional abilities. The physical findings and diagnostic studies can also influence the impairment. In my opinion The 6th Edition provides a better template for determining impairment. However it is a more complicated process and physicians have been slow to accept and utilize this edition. Many physicians still rely on the Fifth Edition. Some jurisdictions require the use of specific references for determining impairment.

Generally impairment should not be determined until the patient has reached a point of maximum medical improvement (MMI). Until the patient reaches a point of maximum improvement their impairment may change. For instance if a patient needs surgery for an unstable joint their impairment prior to the surgery would be much higher as they would likely lack motion and stability of the joint. After the surgery they would potentially improve functionally and symptomatically. Furthermore their joint would become more stable and have greater range of motion. Their impairment would be much less after the surgery if the outcome was as described above. Similarly when determining impairment for brain or nerve injuries we need to wait until the patient has made maximum medical improvement. After they have fully benefited from therapy and time we can then accurately measure their neurologic findings which will help to determine the significance of their loss and resultant impairment.

When determining impairment the physician should cite the reference and include the page or tables that were used in calculating the percentage. Furthermore if a body part is converted to a larger part or whole person the methodology needs to be described. A properly calculated impairment rating should be easily understood by those reading the report.  It should also be easily supported by the reference utilized to determine the PPI.

Partial Impairment

What happens to my benefits when I am on workers’ compensation?

 

Indiana law does not specifically address whether the employer must continue to pay for the employee’s benefits (for example, health insurance) when the employee is on workers’ compensation. So, since the law is not specific, should the employer decide to stop paying for these fringe benefits, the employer may be required to add the amounts paid for these benefits to the employee’s average weekly wage calculations when determining his or her disability pay.

On the other hand, if you have a collective bargaining agreement, that agreement may require your employer to continue to offer these benefits when you are on workers’ compensation. Similarly, if you are out on FMLA leave, your employee benefits may be protected as well.

If you have any questions of concerns regarding your benefits during your workers’ compensation claim, you should consult a qualified Indiana workers’ compensation attorney.

Am I eligible for Permanent Total Disability (PTD) after my work injury?

 

Permanent total disability is a situation where an injured worker is unable to perform reasonable forms of work activity following his or her work accident. In other words, the individual is incapable of sustaining even the most limited work activities, like doing a sit down job, as a result of his or her work injuries.

Indiana Worker's Compensation

This type of disability takes into account the following about the injured worker:

  • Age
  • Mental Well-Being
  • Physical Impairment
  • Work Experience & Acquired Skills
  • Level of Education or Specialized Training (including Military Training)
  • Capacity to Function After Released from Medical Care

So basically, after taking into consideration the  items listed above, if an injured worker no longer has the job on which he or she was injured, and if it is likely that without this job, the injured worker would have a hard time getting another available job that is regular and continuous, then he or she will likely be awarded permanent total disability benefits.

A vocational expert will most likely be called on to help make the permanent and total disability determination for the injured worker. A psychologist may also be needed to evaluate the worker’s state of mind.

The Indiana Worker’s Compensation Act indicated that when a worker’s injuries leave him or her with a permanent and total disability, then the injured worker is to receive either the amount payable for his or her impairment OR 500 weeks of lost wage compensation, whichever of the two totals up to be the greater amount. If you receive some TTD benefits and are later found to be permanently and totally disabled, the TTD benefits received up to that point will be subtracted from the 500 week total.

If I receive a high impairment (PPI) rating from the doctor, will I qualify for Permanent Total Disability?

 

It depends.

Impairment and disability are different terms. Impairment refers to loss of physical function. Disability refers to inability to work. Your impairment rating is just one factor to consider in determining if you are permanently and totally disabled.

Again, permanent total disability (PTD) is based on your ability to perform reasonable kinds of work within today’s workforce.

Injured Worker Resource: The Second Injury Fund

The Second Injury Fund was originally meant to help workers who had a second injury, which when combined with the injuries from a prior accident, left the worker permanently impaired. It was later expanded to also include those individuals who were permanently and totally disabled and had reached their 500 week maximum for disability benefits, as well as, those who needed prosthetic replacements or repairs.

Benefits from the Fund are paid at the same weekly rate as that calculated for the employee’s 500 weeks of disability pay. They are distributed to the injured worker for no more than 150 weeks. An injured worker can seek renewal of benefits for another 150 weeks at the end of each 150 week period.

In order to renew your request for benefits from the Fund, it is very important that you do the following:

  • File prior to the end of each benefit period
  • Include with your petition for renewal all medical documentation that proves you are still permanently and totally disabled

A separate application for prosthetic repairs or replacements should be used to apply for funding to cover such costs.

For more information about applying for Second Injury Fund benefits, visit the Worker’s Compensation Board here.

Permanent Total Disability (PTD): What Injured Workers Need to Know

 

The law in Indiana provides injured workers with three forms of disability pay: Temporary Total Disability (TTD), Temporary Partial Disability (TPD), and Permanent Total Disability (PTD).

Permanent Total Disability (PTD)

Permanent total disability is a situation where an injured worker is unable to perform reasonable forms of work activity following his or her work accident. In other words, the individual is not capable of sustaining even the most limited work activities, like doing a sit down job, as a result of his or her work injuries. This type of disability takes into account the following about the injured worker:

  • Age
  • Mental well-being
  • Physical impairment
  • Work experience & acquired skills
  • Level of education or specialized training (including military training)
  • Capacity to function after released from medical care

According to the Indiana Worker’s Compensation Board’s Guide to Indiana Worker’s Compensation, when a vocational doctor says that the injured worker will NEVER be able to work again in ANY REASONABLE employment within society, then he or she is entitled to a total of 500 weeks of pay at the rate of 66 2/3%  of the pre-injury average weekly wage OR the amount payable for his or her impairment, whichever of the two totals up to be the greater amount. This means that if you have received lost wages up to the point that you are found to be permanently and totally disabled, the number of weeks that you were already paid will be subtracted from the 500 week maximum.

Example:

A fifty-six year old  male migrant worker, whose first language is Spanish, is involved in an industrial accident and loses his right leg. He now has a 100% permanent impairment rating to his lower extremity. Given the factors previously noted, this man would likely be limited in his ability to find other employment and may in fact, be unable to find any other reasonable employment after his accident.

If, however, the same incident happened to a fifty-six year old male attorney, who also received a 100% permanent impairment rating to his right lower extremity, is is less likely that he would qualify for PTD benefits because he would probably be able to do another form of work despite his impairment.

Determining PTD Eligibility

A vocational expert will most likely be called on to help make the permanent and total disability determination for the injured worker. A psychologist may also be needed to evaluate the worker’s state of mind.

More Options

The Second Injury Fund is available to employees injured on the job with resulting permanent and total disabilities. Those who apply and are accepted will receive additional income after the 500 week maximum. For more information regarding this fund, you can learn more here.