Top 5 Questions: Work Comp Impairment Benefits

After sustaining an injury on the job, you are entitled to medical treatment, lost wages, and what are called permanent impairment benefits.  The rate at which you are entitled to be paid, for how long, and what the penalties are to the workers compensation carrier for late payment can be confusing.  The Dolman Law Group is available for a free consultation.

  1. What are permanent impairment benefits?

Expressed with the acronym PIR, permanent impairment benefits are a monetary benefit you receive when you’ve reached maximum medical improvement and have been assigned a permanent impairment rating.  They’re also paid when you’ve reached a total of 104 weeks of lost wage payments and an impairment rating is assigned.  Reaching 104 weeks’ worth of lost wage payments means you’ve reached what is referred to as “statutory MMI.”

  1. What is a permanent impairment rating?

A permanent impairment rating is assigned pursuant to the 1996 Florida Uniform Impairment Guidelines.  The rating is expressed in the form of a numerical percentage; example 3%, 6%, 8%, etc.  The percentage reflects the extent to which your job injury caused a permanent physical impairment to your body as a whole.  The significance of the impairment rating being based on your body as a whole is that the impairment to the specific part of your body injured on the job may be significant. For example, a work related injury to one of your knees, shoulders, back, or neck that requires surgical intervention.  The work injury to that specific part of your body could result in a significant loss of function with respect to that body part.  However, when compared to your body as a whole, the degree of impairment decreases. For example, if you sustain a work related shoulder injury that results in loss of range of motion, ability to lift certain amounts of weight, or otherwise use your arm as before, the degree of impairment to your shoulder could hypothetically have a percentage rating between 10% or 15%.  When your permanent impairment rating is considered against the degree of impairment the loss of function causes to your body as a whole, the hypothetical impairment rating cold drop to 2%, 3%, or 4%.  These figures are for examples purposes only and are in no way intended to reflect the actual percentages of impairment suffered from a job injury.   It is not uncommon for a doctor to assign an impairment rating that is lower than it should be and not consistent with the applicable guidelines.  In addition, it’s common to find that a work comp carrier did not pay the correct amount of permanent impairment benefits.  When we have reason to question the accuracy of an impairment rating, we work to correct it.  We ask every client how much they are being paid in the form of wage loss benefits or permanent impairment benefits.  Based on the information available, we take the time to run the formulas necessary to determine whether they are being paid correctly or if they received the proper amounts.

  1. How much are permanent impairment benefits worth?

The specific explanation is found under Fla. Stat. 440.15(3)(a)(c). [1] For accidents occurring on or after October 1, 2003, an employee’s entitlement to impairment income benefits begins the day after the employee reaches maximum medical improvement, or the expiration of temporary benefits (the 104 weeks expressed above); whichever occurs earlier.  Impairment income benefits are paid biweekly at the rate of 75 percent of the rate you received from the carrier when you were on a no work status.  This rate is referred to as your temporary total disability (TTD) rate.  You generally received checks every two weeks.  If you were on a no-work status, you would take the amount you received every two weeks, divide it in half, and then multiply it by .75 (75%).  The resulting figure is your Permanent Impairment Rate.  Please review our articles for additional information explaining wages loss benefits payable under Florida’s worker’s compensation system.  The articles will help provide additional information to help understand the work comp system.   If you are working at the time you are assigned a permanent impairment rating, your benefits will be reduced by 50 percent for each week in which you earn income equal to, or in excess of, your average weekly wage.  An employee’s entitlement to impairment income benefits begins the day after the employee reaches maximum medical improvement or the expiration of temporary benefits, whichever occurs earlier.

  1. How long am I eligible for permanent impairment benefits? 

Permanent Impairment Benefits are payable for a period of time that depends on the Permanent Impairment Rating percentage you are assigned.  For Permanent Impairment Benefits ranging between 1% and 10%, you are entitled to two weeks’ worth of benefits for each percentage point. For example, if you’re impairment rating is 4%, you are entitled to 8 weeks worth of impairment benefits.  For each percentage point of impairment from 11% up to and including 15%, 3 weeks of benefits are to be paid.  For each percentage point of impairment from 16% up to and including 20%, 4 weeks of benefits are to be paid.  For each percentage point of impairment from 21% and above, 6 weeks of benefits are to be paid.  There is another issue that arises when your impairment rating

  1. When am I entitled to receive my impairment benefits?

You become eligible for permanent impairment benefits the day after you reach MMI. Once the employee has reached the date of maximum medical improvement, impairment benefits are due and payable within 14 days after the carrier has knowledge of the impairment.   There’s a process that occurs before you receive your impairment rating and the 14 day time frame begins.  After your authorized treating physician has determined that you have actually reached OVERALL MMI, or 6 weeks before your 104 weeks of wage loss benefits are scheduled to end, your authorized physician shall evaluate you and assign an impairment rating. The doctor shall issue a written report to the employee and the carrier certifying that maximum medical improvement has been reached.  The report shall state the impairment rating to the body as a whole, and provide any other information required by the department by rule. The carrier shall establish an overall maximum medical improvement date and permanent impairment rating, based upon all such reports.  Issues can arise if you receive multiple MMI dates.  How is it possible to receive multiple MMI dates?  As you undergo treatment, you may see a number of physicians that specialize in different areas.  You may reach MMI from a pain management standpoint, but not a neurosurgical or orthopedic standpoint; or vice versa.  If issues surrounding wage loss benefits were easy to understand, no one would need the benefit of experienced counsel.  More often than not, individuals are victimized and taken advantage of as a result of not being familiar with the complex body of laws governing work comp claims.  We’re here to answer any questions you have and as always, consultations are free.  Please call us at (727) 853-6275 or visit www.dolmanlaw.com.

Dolman Law Group
5435 Main Street
New Port Richey, FL 34652
(727) 853-6275

https://www.dolmanlaw.com/new-port-richey-workers-compensation-lawyer/

References:

[1] http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0400-0499/0440/Sections/0440.15.html

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