Impairment Ratings and North Carolina Workers’ Compensation Claims

Posted on Tuesday, May 14th, 2019 at 11:11 am    

Even if an injured worker has returned to work, he or she may qualify for additional weeks of workers’ compensation pay if they lose function of a key body part. The benefits will be adjusted according to the injury impairment rating. The rating is given as a percentage rating by the injured worker’s authorized treating doctor.

There are different classifications of work injury disability in North Carolina. The main four are:

  • Temporary total disability. (TTD) Many workers are able to return to work after treatment with the doctors, therapists, and other health providers, but for now, are either held out of work completely by their doctors, or can prove that they are unable to find work within their physical restrictions;  
  • Total and permanent disability. Some workers are never able to return work at all on a permanent basis due to their injuries and are entitled to ongoing compensation for life.
  • Temporary partial disability. (TPD) In the middle, are the workers who can return to work with restrictions at a lower-paying job. They get 2/3rds of the difference between the lower-paying and pre-injury job
  • Extended compensation. A new category passed in 2011, once an injured worker reaches 425 weeks of compensation, if he or she can prove that the employee has sustained a total loss of wage-earning capacity, the employee may receive compensation beyond the 500-week limit; however, this Award can be challenged if the worker if the defendants can prove the worker is no longer disabled.

North Carolina generally pays these workers 2/3rds of their average weekly wage during the time they aren’t working. When workers return to their job with restrictions, they are paid a portion of their average weekly wages which is apportioned based on how much money they are earning at the lower- paying job.

There is one more type of condition that can result in additional wage loss payments (generally 2/3rds of the average weekly wage), even if the injured worker has returned to work. This condition is called a permanent partial impairment. Also called PPI or PPD payments.

The North Carolina Industrial Commission defines this category as follows: “Permanent disability is not a purely medical condition. A patient is ‘permanently disabled’ if ‘under a permanent disability’ when his actual or presumed ability to engage in gainful activity is reduced or absent because of ‘impairment’ and no fundamental or marked change in the future can be expected.”

Essentially, a doctor reviews the various parts of the worker’s body to see if there are any parts (such as the motion of an ankle) that the worker can’t use. The doctor then determines what percentage of that bodily function has been damaged and assigns a percentage (called an impairment rating) to the damage part of the body.

For example, if worker’s foot motion is limited due to the workplace injury, the doctor will assign the following percentages:

Limitation of motion of ankle

  • Motion between 90 degrees and 120 degrees = 10%
  • Motion between 100 degrees and 115 degrees = 25%
  • Motion between 105 degrees and 110 degrees = 50%

The impairment rating evaluation by the doctor is not made until the employee has reached what is called – Maximum Medical Improvement (MMI). Workers do have the right to treat with all physicians and therapists to try to get healthy enough to return to work. There comes a time, though, when additional medical treatment won’t improve the worker’s condition. While the worker may still be entitled to medical benefits if the treatments prevent his/her condition from worsening, the worker’s right to additional wage loss benefits is re-evaluated. The re-evaluation requires a physical examination by a physician who typically refers the injured worker for an extensive workup with a physical therapist facility.

As mentioned, the physician reviews which body part or medically related part is not functioning. The physician than assigns a rating. Generally, today, physicians no longer perform the impairment rating. Rather, specialized physical therapists perform detailed testing on the injured body parts during an extensive test called a Functional Capacity Exam, or FCE.  These physical therapists do the impairment rating use guidelines established by the American Medical Association.  After the testing is performed, the results will be sent to the doctor and the doctor will decide if he or she is willing to sign off on the testing results. Most of the time, they do.

That being said, FCE’s and the AMA guidelines are just that – guidelines. The doctor can assign the impairment rating on his/her own – based on “the examining doctor’s independent opinion based on his own knowledge, experience and clinical examination.”

Usually, the employer’s insurance company will choose the FCE facility that does the initial impairment rating/FCE Testing. The employee, in North Carolina, does have the right to get a second opinion on the rating at an doctor of his or her choosing– paid for by the employer, not the employee.

The amount of pay due a worker with an impairment is based on the following three factors:

  • The number of weeks the state has preset as a maximum for that specific type of injury. These numbers are set forth in Section 97-31 of the North Carolina Workers’ Compensation Act.
  • That number is multiplied by the impairment rating percentage
  • The resulting number is then multiplied by the workers average weekly wage figure (adjusted by 2/3rds)

In the reduced range of motion of the ankle example:

  • Workers who lose the entire use of their ankle/foot are entitled to work loss benefits for up to 144 weeks.
  • If a worker’s impairment rating is 25%, then the number of weeks is cut to 25% of 144 weeks = 36 weeks.
  • The worker then receives 2/3rds of his/her average weekly wage for 36 weeks. So– if the average weekly wage were $1000.00, then 2/3rds of that figure would be $666.67. That is the compensation rate of $666.67 x 36 weeks, which gives us a payment to the injured worker of $24,000.00 for his or her permanent partial impairment to that body part.

Note that these payments ARE NOT in addition to the maximum of 500 weeks of benefits and one cannot receive these payments for. Unless the worker has been determined to be totally disabled per the rules or entitled to extended compensation, 500 weeks is the limit.

The permanent partial impairment benefit therefore really only becomes important where the injured worker has returned to work at the same pay as pre-injury. Then, with the help of an experienced North Carolina workers’ compensation lawyer, the worker may be entitled to a lump sum payment instead of having to wait the 24 weeks to get his/her physical impairment benefit.

Section 97-31 covers the loss of hearing or the loss of vision (one eye or both) in addition to the loss of use or the amputation of any limbs, hands, feet, finger or toes. Additional payments can also be made for disfigurement or scarring. The loss of use of important bodily organs is also covered.

Workers need to be careful. They should review their disability payment rights and overall workers’ compensation rights with an experienced lawyer.   Once the worker accepts a permanent partial disability, they can continue to receive medical benefits – provided the medical benefits are helping the worker. This could further form the basis of a potential settlement with the insurance company—even if the injured worker has returned to work.

Joe Miller Esq., understands when workers should claim the impairment disability benefits. We work to verify the injury and the impairment rating. We recommend settlement when it is in the worker’s best interest. We’ve been fighting for injured workers for over 31 years. For help with all phases of your workers’ compensation claim, call attorney Joe Miller at 1-(888) 667-8295 or complete my contact form to schedule an appointment.

Don’t Get A Side Job While Receiving Comp Checks!

Posted on Wednesday, January 9th, 2019 at 5:01 pm    

In this video, Attorney Joe Miller explains why you should NEVER obtain a side job or other “under the table” job while receiving workers’ compensation benefits:

What if I’m hurt on the job in Virginia and my employer has failed to maintain workers compensation insurance?

Posted on Thursday, August 23rd, 2018 at 9:33 am    

What if you’re hurt on the job in Virginia and your employer has failed to maintain workers compensation insurance? Attorney Joe Miller explains in his latest video:

What if I’m Fired During My Comp Case?

Posted on Tuesday, August 21st, 2018 at 8:30 am    

What do you do if you’re fired during your workers’ compensation case? Attorney Joe Miller answers the question:

Do Not Quit Your Job

Posted on Thursday, August 2nd, 2018 at 12:30 pm    

Lately, we have been coming across cases where we haven’t been able to help an injured worker because they have quit their job after being hurt.

We understand how frustrating it is when an employer or insurance company will not cooperate, or you are sent to a company doctor who will not listen to you. You are hurt and the doctor is sending you back to work when you know you are really in severe pain and you have no business working. So in frustration, you just quit your job and hope for the best.

But injured workers need to understand that just because they are hearing the job numbers in the U.S. are up and there is low unemployment, that does not mean the worker can “have his cake and eat it too,” by simply quitting his job after a serious injury. When the injured worker quits, he does irreparable damage to his chances of obtaining a fair recovery for his workers compensation claim.

You simply cannot quit the job you were hurt on and then expect to have a decent workers compensation claim.

In this video, workers compensation attorney Joe Miller explains why you should NEVER quit your job after an on-the-job injury.

If you or a loved one were hurt on the job in either Virginia or North Carolina, please call us at 888-694-1671 or use our online form.

Workers Comp and Social Media

Posted on Wednesday, October 11th, 2017 at 9:29 am    

Should you be concerned about what you put on social media after your injury? Joe Miller addresses workers comp and social media in a recent interview:

Denied Claims – What Happens?

Posted on Monday, September 11th, 2017 at 3:41 pm    

Attorney Joe Miller explains what happens if your employer denies your claim:

DO NOT QUIT OR RESIGN YOUR JOB!!!

Posted on Friday, December 16th, 2016 at 2:00 pm    

As a firm that focuses on workers compensation, we receive many, many calls each and every day from injured workers, many of whom are injured severely. As explained on our website, in order to best serve our family of clients, we are very selective about the cases we take.

Some folks want to know why we do not take their case. I can tell you that one of the biggest reasons is because the injured worker has quit or resigned his or her job, usually out of frustration.

Unfortunately, especially in Virginia, this action will most likely end or severely damage your case. I can understand why you might do this. You are legitimately injured and cannot seem to get any satisfaction. Sometimes the employer and the insurance carrier will stonewall you and you just cannot seem to get any answers. You are being told you need to come into work, but the injuries are so bad, you can’t work. So you quit.

I don’t know how many ways to say this: DO NOT DO THIS! You can be as frustrated as you want to be, but quitting or resigning will kill your case. Why?

Your entitlement to ongoing workers compensation checks is based on your ability to return to work. If you are able to get under an Award, whether you get payments under that Award is based on your ability to return to your pre-injury job. But if you have already resigned from your pre-injury job, how do we know what is preventing you from working? Maybe the employer will say that they were going to accommodate your doctor’s restrictions? They will argue that the only thing holding you out of work is the fact that…. you quit!

Because you have quit, you have now given the employer the advantage. All they have to do is say that if you had not quit, you would have a job to come back to. Maybe it’s not true, but now that you have quit, there is no way to prove otherwise.

Now for a while, if your doctor holds you completely out of all work, you may be able to prove you are entitled to compensation during that time. But once you are released to light duty, that is over. All the employer has to do is say they would have accommodated your restrictions, and you will not get another penny.

The way to handle things after you are hurt and you come up against a “stone wall” is to do your best to get to any doctor, even a family doctor, after your accident, or an emergency room to give you treatment and some written excuse to be out of work that you can present to your employer. If you cannot do that, and you are truly and demonstrably severely injured or laid up in a hospital, then that is what you tell your employer. But under no circumstances should you ever say that you “quit” or “resign” or make any such statement, because that will end your case.

If the employer wants to fire you because they cannot accommodate you being out due to your injury, then guess what? They have just proven part of your case! As long as you can prove that you were unable to return to work during that time frame due to your work injuries, then you should be able to get benefits.

The main thing is, you have not just handed over your case to the employer and insurance company by quitting or resigning.

If you’ve been severely injured at work and have questions about your case, please do not hesitate to call us at 888-667-8295 or visit us online at www.TheWorkInjuryCenter.com .

What Do I Do If My Workers’ Compensation Check is Late?

Posted on Wednesday, January 20th, 2016 at 10:43 am    

Please watch this video to learn more about what you can do if your Workers’ Compensation check is late in Virginia or North Carolina.