How Do Disability Ratings Work for Workers' Compensation?

In a workers' compensation case, your disability rating determines whether you’ll receive permanent disability benefits and in what amount. Here's how it works.

By , Attorney · University of San Francisco School of Law

A disability rating is one of the most important parts of your workers' compensation case. It determines whether you'll receive permanent disability benefits and in what amount. Permanent disability benefits usually make up the bulk of a workers' comp settlement or award.

When Are Disability Ratings Assigned?

When you suffer a work injury, your first step is to get medical treatment. Depending on your job and the nature of your injury, your doctor might order you off work or impose work restrictions (such as no lifting more than 30 pounds). During this time, you can receive temporary disability benefits to make up for your lost wages.

When your recovery has plateaued and further treatment isn't likely to help, your doctor will declare that you've reached "maximum medical improvement," or MMI. This is a crucial stage in your workers' compensation case: You will now be evaluated for a permanent disability.

What Is a Disability Rating?

A doctor will perform a physical examination and test your ability to function and perform normal daily activities. The exam might involve activities such as testing your range of motion, ability to balance, lifting capacity, and more.

The doctor will then use a set of guidelines to calculate your permanent disability rating (also sometimes called an "impairment rating").

In most states, your workers' comp treating doctor will perform the evaluation and assign a rating.

However, if the insurance company disagrees with the rating, it can request you to undergo an independent medical examination (IME). The IME doctor will perform another evaluation and assign a new rating.

It's not uncommon for these two ratings to conflict, in which case it is up to the workers' comp judge to decide which rating is appropriate (or order a third and final examination). Or, you and the insurance company might agree to take the average of both ratings in coming up with a settlement agreement.

How Does the Doctor Determine the Disability Rating?

The doctor uses a set of guidelines to establish the worker's level of permanent disability. Many states have adopted the American Medical Association's Guides to the Evaluation of Permanent Impairment.

Other states have modified the AMA's guidelines or adopted different guidelines altogether.

Using the guidelines, the doctor will come up with the disability rating, usually stated as a percentage. A disability rating is often assigned for certain body parts—such as the arms, legs, hands, feet, eyes, or ears.

For example, you might receive a 10% disability of the right arm or a 20% disability of the left foot.

The disability rating may also be stated as a whole person impairment (WPI): the percentage of disability to the entire body. WPI ratings are often used for injuries to the back, head, or neck; occupational diseases; or injuries to internal organs.

For example, a back injury might result in a 30% whole person impairment. WPI ratings are also sometimes used when a worker has permanent impairments to multiple body parts.

Why Is the Disability Rating Important?

Your disability rating determines how much you will receive in permanent disability benefits. Each state has different rules regarding what benefits are available and how much they are worth.

In some states, your disability rating will be used to calculate how many weeks of benefits you are entitled to. In other states, the disability rating corresponds to an actual dollar amount. To learn more, see our article on how permanent disability benefits are calculated.

What If My Permanent Disability Rating Is Wrong?

Most states allow you to seek a second opinion if you don't agree with your rating. Each state has its own procedures for how to ask for a reassessment and who will perform it.

You can also request a hearing in front of a workers' comp judge if you don't think your rating reflects the true extent of your injuries.

Get Legal Advice From a Workers' Comp Attorney

If you received a significantly lower disability rating than you expected, you should hire a workers' comp attorney if you don't have one already. An attorney will understand how to present your case in the most favorable light possible to the workers' comp board or judge.

Most workers' comp attorneys don't charge a fee unless you're awarded benefits, so there's nothing to lose.

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