Permanent Disability: Question “Authority!”

If you are reading this, chances are your workers’ compensation doctor is about to release you with your “rating,” or you have received a letter from the claims adjuster which provides an estimate of what your permanent disability rating is – at least according to them.

Generally, you will be told that the permanent disability rating is “based on what the doctor determined,” and will be led to believe that there is nothing you can do about it. The claims adjuster will assign a dollar value based on a chart, and invite you to sign paperwork committing you to a settlement.

It reminds me of buying a new car at an auto dealership – the salesperson tells you what the sticker price is, and you either take it or leave it. What the claims adjuster either doesn’t understand or does but won’t tell you is that human beings are not cars. Each person is unique regarding the extent of recovery and limitations after experiencing a work injury.

Here is the quick background on how an initial permanent disability rating is initially determined:

1) A doctor will utilize the AMA Guides 5th edition to assign a “rating” for your injury.

2) The doctor’s rating will then be plugged into a formula in the California Permanent Disability Rating Schedule (PDRS) which, modifies the doctor’s rating based on your occupation at the time of the injury and your age, as well as other factors.

3) Once the PDRS rating percentage is determined, the Permanent Disability Indemnity Chart will assign a dollar value for each percentage of disability – basically, like the “Kelly Blue Book,” an auto dealership uses.

For many injuries, the process described above works well for many injured workers. However, because the charts used in the process are generic, there are unique cases where the charts do not tell the whole story – in other words, the generic rating is inaccurate.

The Physician May Assign a More Accurate Rating

What the claims administrator and their hand-picked doctor won’t likely tell you is that the physician has the discretion to assign a rating that is different than what the generic chart says in the AMA Guides 5th edition. For example, if the chart assigns a particular percentage to an injury, the law states a physician is entitled to assign a higher rating if it is justified. Milpitas Unified School District vs. WCAB (Guzman),187 Cal. App. 4th 812 (2010). It often requires a deposition to assure the doctor takes into consideration all unique factors in your case. There are other methods to assure an accurate rating as well.

The Physician May Assign a More Accurate Rating

Even if the doctor’s initial rating is accurate, the generic PDRS result may be inaccurate, and the law permits an injured worker to establish a different percentage than the PDRS assigns.

For example, I recently represented a lab worker who developed a work-related sensitivity to a particular metal. The treating physician and PDRS assigned a rating of 13% – which means 13% of the jobs in the California labor market were no longer available to him. However, my client explained that if he was exposed to this metal he would break out in extremely painful rashes, and unfortunately, this metal is EVERYWHERE – doorknobs, paperclips, staples, and even food.

After consulting with a job search specialist (vocational experts,) it was determined that my client was 100% disabled, and we were able to recover a far more accurate permanent disability award for him.

The bottom line is this: If you believe that your doctor is not paying attention to the seriousness of your injuries DON’T WAIT! Ideally, you should get advice BEFORE the doctor gives you a rating. If you already have a rating, consider getting advice before signing anything.

We are here to help. If you or someone you care about has a work injury, feel free to contact us today – (714) 547-5025.