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workers compensation attorney 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

Functional Capacity Exam (FCE)

Related terms include “Physical Capacities Evaluation” (PCE), “Functional Capacity Assessment” (FCA) or “Work Capacity Evaluation.”

A Functional Capacity Evaluation/Exam (FCE) is a series of tests designed to measure physical strength, ”range of motion”, stamina, and tolerance to functional activities, including lifting and carrying and will begin with an in-depth questionnaire.

In a workers’ compensation claim, the results of Functional Capacity Evaluation are typically used to develop return-to-work plans, as the basis of an offer of alternative employment, or as the foundation for a feasibility development plan (work-focused rehabilitation). An evaluator SHOULD ONLY use tests that have to do with the specific individual’s diagnosis and return-to-work goals or job demands.

These tests can be used to evaluate work tolerance and work restrictions, if necessary. The exam is used to determine the extent of the employee’s residual or permanent disability. Do your best, be honest, and remember there’s no right or wrong answer.

P.S. I can safely guess that you WILL NOT be jumping rope.

Hiring an Attorney for Your Worker’s Compensation Dispute

 

Should I hire an attorney?

It is your right to either represent yourself in a worker’s compensation dispute or to hire an attorney. If an Application for Adjustment of Claim (Form 29109) is filed with the Board in your case, then by law, your employer must hire an attorney. Thus, it is often advisable, although not required, that the injured worker be represented as well.

When deciding whether you want to involve an attorney, keep in mind that Indiana’s worker’s compensation laws are written in a way which tend to favor the employer as opposed to the injured employee.

How much does it cost to hire a worker’s compensation attorney?

A free legal consultation with an attorney experienced in the Indiana worker’s compensation system may help you to better determine whether your rights are being protected and whether legal representation is needed at that time.

Attorney fees are limited by the Indiana Worker’s Compensation Act. According to the law, attorneys can charge $200.00 up front, as well as a percentage of any recovery received in a worker’s compensation case. Attorneys may be willing to waive the upfront fee until the case is settled. The current recovery fee percentage is 20% of the first $50,000 and 15% of any remaining amount.

Example:

Deborah and her attorney settled her worker’s compensation case for $60,000. Since the attorney agreed to waive the upfront fee of $200 until the case was resolved, a breakdown of attorney’s fees includes $200, plus 20% of $50,000, plus 15% of the remaining $10,000.

Amount to Attorney: $200 + (.20 x $50,000) + (.15 x $10,000) = $11,700

Amount to Deborah: $60,000 – $11,700 = $48,300

At the end of the case, you may also be asked to pay for any out-of-pocket expenses incurred by the attorney for items such as medical records, postage, long distance phone calls, appointments with specialists, and so forth. These expenses were not included in the above example.

Is my work injury eligible for future medical treatment?

 

Future medical treatment is only considered when an injured worker has sustained permanent injuries from the work accident.

Future Medical Treatment

A doctor who has treated the injured worker will need to state very specifically the type of treatment required, period of time treatment will be needed, and cost of the future treatment. Then, the Board will consider these things in light of their effect on the injured worker’s impairment.

If the injured worker is awarded future treatment, it will be for the sole purpose of limiting of reducing his or her extent of impairment. This does not mean, however, that an injured worker who is left with any degree of impairment from his or her work injury will automatically be awarded future medical treatment by the Board.

Future medical treatment may also be awarded in occupational disease cases and in permanent total disability cases.

What are the Elements of an Approved Indiana Worker’s Compensation Claim?

As stated in the Indiana Worker’s Compensation Act, all of the following elements must be met in order for a worker’s compensation claim to be accepted as compensable, or eligible for compensation. If these elements are met, the employer is responsible for providing the appropriate benefits to the injured employee:

1. Personal injury or death

This means an injury or death occurred. This does not refer to a disease as a job-related injury. Workplace diseases fall under a separate law governing occupational diseases.

2. By accident (unexpected injury or death),

This means the injury or death was unexpected by the employee and employer. This includes injury or death from an unexpected event or an unexpected result.

3. Which arose out of the employment, and

There must be a direct link between the work injury and the job duties of the injured employee; the job put the worker at risk, which resulted in his or her unexpected injury or death.

Please note that the law in this area of “arising out of the employment” is constantly changing. You should consult with the Worker’s Compensation Board or an attorney for further guidance.

4. Arose in the course of the employment.

This considers the time, place, and circumstance of the injury. To meet this requirement, the incident must occur during the employee’s working hours, at a location the employee would be expected to be for his or her job, and under conditions that qualify as work-related.

Locations that an employee would be expected to be can extend to the restroom inside your place of employment, the employee parking lot, or even someplace away from your place of employment if you are required to be at this other location as well.