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.
Social Security Disability & Workers’ Compensation
Sometimes, workers sustain a work injury that leaves them unable to return to their former job or a similar job. Since permanent total disability (PTD) benefits are not a guarantee for an injured worker who cannot return to his or her prior job or place of employment, these individuals might be forced to seek benefits elsewhere.
Consequently, social security disability (SSD) benefits may be pursued by the injured individual. This often leads to the question of whether SSD benefits will be reduced if the worker is also receiving TTD benefits from workers’ compensation. To determine if there will be a reduction in SSD benefits, a specific formula needs to be followed. Here is how you can determine whether your workers’ compensation benefits will affect drawing social security pay early due to a work-related disability:
- If the total of your combined monthly workers’ compensation and social security benefits (including what others in your household draw) exceeds 80% of your gross average earnings per month (average current earnings) prior to the disability, then your SSD benefits will be reduced so that you do not exceed this 80% level
- Example: Donna draws $1,000 from SSD per month. Her husband draws $1,500 per month. Donna is also drawing $548 from workers’ compensation each month. Thus, benefits in this household total $3,048. Donna’s gross average earnings per month before she became disabled from a work accident was $3,500. Since 80% of $3,500 equals $2,800, the amount that Donna and her family draws from SSD will have to be reduced by $248 (the difference between $3,048 and $2,800) in order to meet the 80% requirement.
OR
2. If your monthly social security disability pay alone is more than 80% of your gross average earnings per month prior to the disability, then your SSD benefits will be reduced so that the combination of drawing these events along with workers’ compensation benefits does not exceed the amount over 80% that you drew just through SSD income.
- Example: Dennis draws $1,300 from SSD per month, while his son draws $300. In total, Dennis’ household receives $1,600 from SSD each month. This does not account for what Dennis earns from workers’ compensation. Dennis’ gross average earnings per month prior to the disability was $1,800. 80% of $1,800 equals $1,440. In this case, since the SSD benefits are more than the 80% requirement, the $1,600 will serve as the maximum standard of benefits level. Thus, the SSD benefits will be reduced so that the combination of this plus Dennis’ workers’ compensation benefits does not exceed $1,600.
On the other hand, workers’ compensation disability pay will not be part of the earnings that determine what you can get from social security disability when you do become eligible to draw it. In other words, if you had a work accident in 1992 and you received 11 weeks of temporary total disability pay that totaled $2,500, then the Social Security Administration will not recognize the $2,500 as part of your total earnings for 1992. This is because social security taxes are not taken out of workers’ compensation disability income.
How to Find Out Your Employer’s Worker’s Compensation Insurance Information
Employers are required by law to post the name, address, and telephone number of their worker’s compensation insurance carrier in an obvious area within the workplace (for example, in the breakroom). You may also ask your employer for this information.
If your employer says they do not carry worker’s compensation insurance and you have been injured on the job, you can contact the Worker’s Compensation Board of Indiana to verify whether your employer has worker’s compensation insurance. If your employer does not carry insurance, the Board will take action against your employer. The law allows penalties to be assessed against any employer who fails to carry worker’s compensation insurance in the state of Indiana.