Am I covered For Long-Term and Permanent Disability?
Long-term and permanent disability coverage are calculations. Read here to understand the differences involved including how to calculate your benefits.
Long-term disability or permanent disability (also called impairment income) is a feature of the workers’ compensation program. To receive this particular benefit, you don’t have to do anything special except what is required for every workers’ comp claim.
Permanent disability does not mean you will never be able to work again. It just means that you are not able to work in your normal job and perform your job tasks as you did before the accident or illness. Most workers collecting permanent disability will eventually return to work, so this form of disability is really not an especially significant issue.
Workers’ compensation is designed to help with two problems concerning a worker being injured or becoming ill from their job. First, it is meant to cover the medical expenses associated with the incident. Second, workers’ comp will partially replace your lost income if you cannot work because of such an accident or illness. Depending on the state where you work, this benefit takes effect from three to seven days after you’ve had to stop work.
Three types of conditions are associated with permanent disability.
- Statutorial Permanent Disability
This status involves the loss of either both eyes, hands, arms, feet, or legs. It does not mean that you cannot do any work at all, just that you can’t do what you were doing. For instance, if you lost a foot and could no longer work as a courier, you could still draw permanent disability if you could work at a desk.
- Permanent and Totally Disabled
If you suffer from a severe medical issue, such as migraines or severe pain in your back, you may be eligible to collect permanent and total disability. Your treating doctor must say that you are unable to return to work, that this condition negatively affects your daily life, and that it is permanent. An independent medical exam may be required.
- Odd-Lot Permanent Total Disability
This category covers someone who has a permanent restriction on their daily activities, such as being able to stand for only a limited amount of time, being able to lift only a reduced amount of weight, or being able to walk for only a certain distance. Physical therapy could be proposed, and a medical professional would examine the worker’s state of health and abilities during treatment. An appropriate job could then be recommended, but permanent disability could be awarded if nothing was available.
Permanent partial disability means that you could return to work but not in your former job position. You could do something less demanding, such as working at a desk instead of in the field.
Permanent total disability is for someone who is unable to return to work at all because of an injury or illness.
As with any workers’ compensation claim, you must
- be working for an employer that offers or is required to offer workers’ comp protection;
- be an eligible employee according to the workers’ comp rules of the state where you work (for example, if you are a domestic worker or an independent contractor, you may not be entitled to this coverage);
- have suffered the injury or illness because of your work (although it doesn’t have to have occurred at work; for instance, if you are told to report to another job site and are involved in a car accident, this would still be work related).
These are just standard rules for an acceptable workers’ comp claim. Besides these conditions, you must establish additional facts for a permanent disability claim.
- The type and extent of injury you suffered has caused you to become disabled (this will probably require a medical doctor’s assessment).
- You are unable to perform your regular work duties, or your doctor has placed restrictions on your work activity so that it is less than what you were doing. Documentation would also be needed for this case.
It is not necessary to prove that anyone was at fault. Workers’ compensation insurance is a no-fault program.
What Will I Receive If I’m Permanently Disabled?
In the event that you become permanently disabled on the job, a variety of elements will determine the scope of your possible workers’ compensation benefits. These factors will depend on the state you work in. Before any calculations can take place, you must know which class of permanent disability would apply.
There are two classifications under workers’ compensation for permanent disability. The most common classification is for a permanent partial disability. This class is meant for someone who will likely recover and return to work. Not all states provide for payments for persons who are permanently but partially disabled.
The second is a permanent total disability. It is much rarer for workers’ comp cases to be classified in this category because it is usually meant for those who lose limbs, become completely blind, or suffer from permanent paralysis.
Maximal Medical Improvement (MMI)
Maximal Medical Improvement is a term often used in the context of the status of your medical condition. It marks the point in your healing where no further progress is expected. It does not necessarily mean you have completely recovered, only that you have reached a level where your recovery is not anticipated to improve.
You will receive a percentage figure to show how serious your permanent partial disability is compared to someone with full health. Different states may use different terms; in Florida, for example, this figure is referred to as an “impairment rating,” while California refers to it as a “permanent disability rating.”
A common method of calculating benefits involves the “average weekly wage,” or AWW. To compute your AWW, you must first add your total wages, including any overtime, before the injury for a certain number of weeks. The number of weeks depends on your state. The sum of your wages would then be divided by that number of weeks to obtain the AWW. The worker’s earnings considered would not exceed 52 weeks. Many states have a maximum of $1,000 per week on such a benefit, regardless of what the AWW may be.
Calculations for a Partial Disability
Approximately 43 states use a list of disabilities to help calculate workers’ compensation benefits. This list includes body parts and senses, such as the limbs, hearing, or the eyes, with a corresponding percentage of disability benefits associated with it.
Virginia is an example. If a worker lost a thumb in a work-related accident, the worker would be allowed 60 weeks of payments. There is no distinction in these payments concerning the type of occupation the worker is involved in. For instance, a hair stylist and a chauffeur would each receive the same 60 weeks of benefit payments, even though the use of a thumb is crucial to the stylist but less important to the chauffeur.
Partial disability benefits often use a different system for the calculation because the worker will likely be able to continue work in a reduced or alternative role, such as performing duties at a desk. This calculation may still begin with the AWW but would subtract the amount of current earnings. In other words, if a worker’s AWW is $500 per week, that figure would have their current earnings subtracted from it. If the worker is in a light duty position and earns $300 per week, the difference would be $200. If the particular state uses the 60% benefit figure, the worker’s weekly disability payment would be $120 ($200 X 60% = $120).
Another method many states use to assess the value of a disability is called an “unscheduled loss.” This type of computation is commonly used for injuries that are less specific, such as a general head injury, back injury, or injury to an internal organ. Occupational diseases would also be considered an unscheduled loss.
Calculations for a Total Disability
For a total disability, each payment is calculated by multiplying the worker’s AWW by either 60% or by 66 ⅔%, depending on the state.
Some states require a physician to examine the person and reach a conclusion regarding their level of disability. This may involve a physical exam with physical tests to gauge a person’s handicap.
In New York, the system can award disability payments for an indefinite length of time until the person is able to return to work at their previous level. In other states, the duration of payments could range anywhere from three weeks to twenty years. The average range, however, is between three years and seven years. Some states stop the benefits when the person reaches 65 years of age.
The American Medical Association has published a list of disabilities with guidelines in a percentage form that about 40 states use for computations. This list usually involves some sort of restriction of the movement of a body part.
Because of the differences in benefits and the rating method used among states, it is vital that the final MMI be as accurate as possible. Strongly consider obtaining the help of a workers’ compensation attorney who has specific training and experience in the field of disabilities if your disability claim is denied.