Where Permanent Partial Disability Fits
Oregon Workers' Compensation is an insurance benefit system for injured workers. The statute requires employers to provide a schedule of benefits to injured workers regardless of fault. The statute also tells employers how to process claims, and provides a framework to resolve disputes for denied claims or deny benefits.
Every workers' compensation claim involves medical services. If the injured worker is disabled, the second benefit provided is wage replacement, also known as temporary total disability or "time loss." Permanent Partial Disability, also known as "PPD" is supposed to compensate the injured worker for permanent lost earning capacity. However, the actual compensation is determined through a complicated set of rules.
When and If You Are Entitled to PPD
When the injured worker has completed treatment, and there is no expectation of improvement with more time or medicine, the injured worker is considered "medically stationary." At that point, if a closing examination shows measurable permanent impairment, the injured worker is entitled to permanent partial disability. The permanent partial disability benefit, also called "PPD" is supposed to represent compensation for lost earning capacity. However, it is based on the impairment rating rules, which provide a specific formula to calculate the dollar benefit.
Whether you qualify for PPD depends on what kind of injury you suffered, whether it causes permanent limitations, and if so, how much. Sometimes, an injury may cause some form of permanent impairment. However, to qualify for PPD, the permanent impact of an on-the-job injury must "show up" on the impairment rating standards, which are designed to determine how much a permanent impairment interferes with someone's ability to do work activity.
PPD does not include compensation for "pain-and-suffering," or a permanent loss of enjoyment of life. It is strictly related to how a permanent impairment impact someone's ability to perform work.
The Types of PPD
There are two types of PPD benefits. The first is known as "whole person impairment." To determine whole person impairment, the insurance company will send the injured worker to an independent medical examiner, or schedule a closing examination with the attending physician. The examining physician will then take measurements, depending on the kind of injury involved. For example, for a neck or back injury, the physician will measure things like range of motion, strength, and make a judgment call on whether or not the injured worker has suffered significant loss of repetitive use of the injured body part. The findings are then applied to rules that calculate the permanent partial disability rating. That number is then multiplied by a dollar figure set out in the statute to determine the dollar amount of the permanent partial disability award.
The second kind of permanent partial disability is known as "work disability." This benefit is paid when the attending physician determines that the injured worker cannot return to his or her job as a result of the on-the-job injury. The job title may be the same, but even if it is performed differently, or if there are some modifications on the job site, then the injured worker should be entitled to work disability.
Work disability can be a significant permanent partial disability benefit. To determine the dollar amounts of the work disability benefit, the insurance company will consider the age, education, and skill level of the injured worker. these are known as "social and vocational factors." The rules provide a point system, depending upon these factors. The calculation is then multiplied by either the injured worker's average weekly wage, or an index number known as the "state average weekly wage." Only the attending physician's opinion counts in determining whether an injured worker is able to return to the job at injury.
Where Do You See Your PPD Calculations?
The insurance company's decision on permanent partial disability appears in the Notice of Closure. If you do not agree with the calculation of the permanent partial disability award, you can file a Request for Reconsideration. This is an appeal of the Notice of Closure to the Oregon Workers' Compensation Division. Depending upon the issues you appeal, the Oregon Workers Compensation Division will assign a medical arbiter, which is a medical doctor, to perform and examination. In most cases, the Workers' Compensation Division will adopt the findings of the medical arbiter in deciding the appeal. It is important to know the risk before appealing your claim closure, because you could end up with less benefits than you did at closure.
Also, when you appeal the Notice of Closure, the Workers' Comp. Division will look at other issues on your claim, like whether it should have been closed in the first place, and whether you were paid for all the time you were off work becuase of your injury.
Questions? We handle these cases every day, and can help you know where you stand. Contact us, or check out our website for other articles about who claim closures work.