How Is a Workers’ Comp Disability Rating Calculated in California?
After a serious work injury in California, your doctor may declare that you’ve reached maximum medical improvement (MMI)—meaning your condition isn’t expected to improve further. At that point, your condition will be evaluated and assigned a permanent disability rating.
This rating is a key factor in determining how much compensation you receive through workers’ comp.
What Is a Disability Rating?
A disability rating is a percentage that reflects how much your injury affects your ability to work. For example, a 10% disability rating means your injury has reduced your overall ability to work by 10%.
The higher the rating, the more benefits you may be eligible for.
Who Assigns the Rating?
Your primary treating physician will evaluate your condition and submit a report. If there’s a dispute, you may be evaluated by a Qualified Medical Evaluator (QME) or an Agreed Medical Evaluator (AME). These specialists are trained to assess work-related injuries and assign fair ratings.
What Factors Are Considered?
– Your age
– Your occupation
– Your level of impairment
– Future work restrictions
– The AMA Guides (5th Edition) for evaluating medical conditions
California applies a formula to calculate your permanent disability percentage, which is then used to determine how long and how much you’ll receive in benefits.
How Ratings Affect Your Benefits
Disability ratings directly impact:
– Weekly payment amounts
– Duration of payments
– Eligibility for job retraining (if necessary)
For example, someone with a 25% rating will receive significantly more in compensation than someone with a 5% rating.
Can You Challenge a Rating?
Yes. If you believe your rating is too low—or if the insurer disputes the rating—you have the right to challenge it. This usually involves requesting a second opinion from a QME or presenting evidence at a hearing.
Get Help With the Numbers
Understanding how disability ratings work is essential to getting fair compensation. If you’ve reached MMI or are confused about your rating, it’s a good time to speak with an attorney.
Thomas F. Martin, PLC offers a free 30-minute case evaluation to review your case and explain your options. Call (714) 547-5025 today.
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