Episode Title: Understanding Permanent Impairment Ratings in North Carolina Workers’ Compensation

What is a permanent impairment rating in North Carolina workers’ compensation cases, and when is it assigned?

A permanent partial impairment rating in North Carolina workers’ compensation is assigned by the injured worker’s treating doctor towards the end of their treatment. This rating reflects the extent of the worker’s ongoing medical issues after reaching maximum medical improvement, which means the worker has plateaued in recovery and is not expected to improve further. Even if the worker is not fully recovered, the rating indicates the level of impairment that persists.

Who determines the impairment rating, and what guidelines are used for calculation?

The authorized treating physician, chosen by the insurance company, assigns the impairment rating after the worker reaches maximum medical improvement. This physician is familiar with the worker’s treatment and condition. North Carolina publishes guidelines for these ratings, largely based on the American Medical Association’s standards but with some distinctions. These guidelines can be accessed on the North Carolina Industrial Commission’s website.

How does an impairment rating affect the benefits an injured worker may receive?

When an injured worker approaches maximum medical improvement and is assigned a permanent impairment rating, it is crucial to consult with a workers’ compensation attorney. In many cases, it may be more beneficial for the worker to continue receiving temporary total disability benefits rather than accepting payment for the impairment rating. An experienced attorney can help the worker choose the most advantageous option based on their situation, whether continuing with wage loss benefits, receiving payment for the impairment, or seeking further treatment.

What is the difference between temporary disability benefits and benefits related to a permanent impairment rating?

Temporary disability benefits, commonly referred to as wage replacement compensation, are paid when a worker is out of work due to injury. These benefits are calculated based on two-thirds of the worker’s average weekly wage and are tax-free. In contrast, benefits tied to a permanent impairment rating are calculated based on the impairment percentage assigned to a specific body part, according to a schedule in Section 97-31 of the Workers’ Compensation Act. The compensation for these impairments is determined by multiplying the rating percentage by the number of weeks assigned to that body part.

What options does an injured worker have if they believe their impairment rating is too low?

An injured worker can seek a second opinion on their impairment rating from a doctor of their choice. This option is available if the worker is dissatisfied with the initial rating assigned by the treating physician. Consulting with a workers’ compensation attorney can help the worker find a doctor who might provide a more favorable rating.

How do insurance companies use impairment ratings in workers’ compensation settlements?

Insurance companies calculate the compensation owed based on the impairment rating and may offer payment through a Form 26A agreement, which only covers the impairment, or a clincher agreement, which includes future medical treatment considerations. The decision on how to resolve the claim, whether through a rating payment or a more comprehensive settlement, depends on the worker’s situation at maximum medical improvement.

Is a higher impairment rating always better, or do other factors matter more?

While a higher impairment rating can reflect the seriousness of an injury, other factors like ongoing wage loss benefits and permanent work restrictions may be more beneficial to consider. The best option often depends on whether the worker has permanent restrictions affecting their ability to work, which might make continued temporary total disability benefits a more suitable choice.

How does an injured worker’s ability or inability to work factor into impairment ratings and benefit decisions?

When a worker reaches maximum medical improvement and receives an impairment rating, they may have permanent work restrictions. If these restrictions prevent returning to their previous job, they can continue receiving temporary total disability benefits while looking for suitable employment. Each week they receive these benefits reduces the weeks of compensation they are entitled to for the impairment rating. If their work restrictions persist, they may be eligible for ongoing benefits beyond the impairment period.

What should injured workers understand before accepting an impairment rating or settlement offer?

Before accepting an impairment rating or settlement, workers should consult with an experienced workers’ compensation attorney. Signing a Form 26A to accept a rating starts a statute of limitations on future medical treatment rights. Settling a claim closes it permanently. Understanding the implications of these decisions, including the impact on wage loss benefits, is crucial. An attorney can guide workers through these complex decisions to avoid unintentionally waiving important benefits.