MA: Permanency benefits are paid for loss or loss of use or function of body members or for scarring or disfigurement only. Those benefits are called supplemental or specific compensation and are similar to scheduled PPD benefits in other jurisdictions. Massachusetts does not pay benefits for unscheduled permanent disability. Instead, the state pays benefits for wage loss or loss of wage-earning capacity through partial disability benefits. Partial disability benefits are paid at 60 percent of the difference between a worker's preinjury and actual wages or earning capacity, but not more than 75 percent of what the worker would receive for total disability benefits if eligible, or two times the SAWW. LA: Three restrictions are placed on scheduled PPD benefits: (1) any weeks of TTD benefits or supplemental earnings benefits (SEBs) are credited toward the amount entitled for PPD benefits (before August 15, 1999, the credit was for the dollar amount of benefits paid); (2) worker who suffers a hearing loss receive PPD benefits (up to 100 weeks) only if the hearing loss is due solely to a single traumatic incident; and (3) for claims arising before August 15,1999, no PPD benefits were payable unless the anatomical loss, or loss of use, exceeded 25 percent as established in the AMA Guides to the Evaluation of Permanent Impairment. Louisiana does not pay benefits for unscheduled permanent disability. Instead, the state pays SEBs to workers who are unable to earn wage equal to 90 percent of preinjury wage. SEBs are paid at 66 ⅔ percent of the difference between the worker's average monthly wage (AMW) at the time of injury and the worker's current actual AMW or the AMW the worker is able to earn. SEBs are payable up to 520 weeks (including any TTD and PPD benefits already paid). Louisiana pays additional PPD benefits (a one-time payment of $30,000) for specified catastrophic injuries.
Table 8 Permanent Partial Disability Benefits, 2004 (continued)
MI: Permanency benefits are paid for loss or total loss of use or function of body members as listed in the statute. Those benefits are called specific loss benefits and are similar to scheduled PPD benefits in other jurisdictions. Michigan does not have a healing period. Michigan does not pay benefits for unscheduled permanent disability. Instead, the state pays benefits for wage loss or loss of wage-earning capacity.
MD: PPD benefits for unscheduled losses are based on industrial loss of use, expressed as a percentage of loss of use of the whole body (500 weeks). Factors considered in determining industrial loss of use include the nature of the physical disability and the age, experience, occupation, and training of the injured worker.
Sources: State statutes; Ballantyne, 1993, 1997, 1999, 2003, 2005; Ballantyne and Joyce, 1996; Ballantyne and Shiman, 1997; Ballantyne and Telles, 1992; Barth, 1999; Barth and Eccleston, 1995; Barth and Niss, 1999; Telles and Fox, 1997.
PA: Scheduled benefits are called specific-loss benefits in Pennsylvania. There are two different periods of payments under specific loss: for the healing period and for the specific loss itself. By statute, benefits are paid for the healing period before benefits are paid for the specific loss. The healing period ends when the worker returns to work at preinjury wage or the period specified in the statute ends. Pennsylvania does not pay benefits for unscheduled permanent disability. Instead, the state pays benefits for wage loss or loss of wage-earning capacity through partial disability benefits. Those benefits are paid at 66⅔ percent of the difference between the preinjury and current actual or imputed wages, subject to the total disability maximum. If the benefit at the statutory rate is less than 50 percent of the SAWW, the benefit must be calculated using the lower of 50 percent of the SAWW or 90 percent of the worker's AWW. The minimum-benefit row in the table lists the point at which benefits computed using the statutory rate are subject to recalculation.
TX: Under certain circumstances, a worker may receive a supplemental income benefit (SIB) when impairment benefits end. Four conditions must be met: (1) the worker's impairment rating is at least 15 percent, (2) the worker has not taken an advance payment of benefits due (commutation), (3) the worker has not returned to work or is unable to earn at least 80 percent of the preinjury AWW, and (4) the worker has made a good-faith effort to find suitable work. The SIB is calculated at 80 percent of the difference between 80 percent of the worker's average weekly wage and the worker's earnings over the reporting period and cannot exceed 70 percent of the SAWW. Eligibility for SIB terminates at 401 weeks after the date of injury.
WI: Scheduled injuries involve limbs, eyes, and ears. Injuries or conditions listed in the schedule are compensated based on functional impairment ratings only, without regard to loss of earning capacity. The number of weeks listed in the schedule for each body part is paid for total impairment; loss of use is determined as a percentage of the total. Nonscheduled injuries include those to the head, back, or torso that are not specified in the schedule, as well as psychological claims. Compensation for nonscheduled injuries can be based on functional impairment only or on loss of earning capacity. Nonscheduled injuries are rated as a percentage of loss to the body as a whole. Functional impairment benefits for nonscheduled injuries are paid to a worker rehired by the former employer at 85 percent or more of his or her preinjury AWW. Workers who do not return to work, or who are rehired at less than 85 percent of their former wages, can receive earning capacity benefits, which are much larger than functional impairment benefits. Earning capacity benefits are determined by comparing the effect of the impairment on the worker's earning capacity with the worker's permanent and total disability for occupational purposes.
Key: AWW: average weekly wage (preinjury); MMI: maximum medical improvement; na: not applicable; PPD: permanent partial disability; SAWW: statewide average weekly wage; TTD: temporary total disability.
AR CA FL IL IN
Schedule covers loss or loss of use of extremities, vision, and hearing; unscheduled losses rated in proportion to whole body (450 weeks); determined once MMI has been reached.
Schedule provides disability ratings for most impairments; number of weeks for each 1 percent of disability varies according to permanent disability rating. Determined once condition is permanent and stationary (see note).
Rating guide covers most conditions; weeks of benefits equal impairment rating multiplied by a number from 2 through 6, depending on the impairment rating.
Schedule covers loss or loss of use of extremities, vision, and hearing; unscheduled losses rated in proportion to whole body (500 weeks); determined once MMI has been reached.
Schedule provides number of degrees for extremities; unscheduled losses rated in proportion to whole body (100 degrees); determined once MMI has been reached (see note).
LA MA MD MI NC
Schedule covers loss or loss of use of fingers, toes, arms, feet, legs, and eyes; unscheduled losses rated according to wage loss; determined once MMI has been reached (see note).
Schedule not used; statute and department guidelines provide formulas for determining loss of function benefits; unscheduled losses rated according to wage loss; determined once MMI has been reached.
Schedule covers loss or loss of use of extremities, vision, and hearing; unscheduled conditions rated in proportion to whole body (500 weeks) based on industrial loss; determined once MMI has been reached.
Schedule covers loss or total loss of use of fingers, toes, hands, arms, feet, legs, and eyes; unscheduled losses rated according to wage loss.
Schedule covers most impairments.
PA TN TX WI
Schedule covers loss or loss of use of extremities, vision, and hearing; unscheduled losses rated according to wage loss; determined once healing period has ended.
Schedule covers loss or loss of use of extremities, vision, and hearing; unscheduled conditions rated in proportion to whole body (400 weeks); determined once MMI has been reached (see note).
Impairment rated using AMA Guides; weeks of benefits equal whole person impairment rating multiplied by 3.
Schedule covers extremities, vision, and hearing; unscheduled injuries rated in proportion to body as a whole (1,000 weeks; see note).
AR CA FL IL IN
Medical impairment (scheduled injuries; see note).
Medical impairment plus nature of injury and worker's age and occupation (see note).
Medical impairment. Medical limitations plus worker's age, skill, training, occupation, pain, range of motion, stiffness.
Medical impairment (scheduled injuries).
LA MA MD MI NC
Medical impairment (scheduled injuries).
Medical impairment (scheduled injuries; see note).
Medical impairment (scheduled injuries); plus worker's loss of wage-earning capacity and age, experience, occupation, and training for determining industrial loss of use for unscheduled injuries.
Medical impairment (scheduled injuries, see note).
Medical impairment (scheduled injuries).
PA TN TX WI
Medical impairment (scheduled injuries).
Medical impairment plus worker's age, education, training, occupation, loss of present and future wage-earning capacity, and local labor market conditions.
Medical impairment. Medical impairment (scheduled injuries).
AR CA FL IL IN
AMA Guides, 4th edition, required (see note).
AMA Guides, 5th edition, required (see note).
Florida Impairment Rating Guide for listed conditions; AMA Guides for unlisted conditions.
None (see note). AMA Guides, latest edition.
LA MA MD MI NC
AMA Guides, latest edition. AMA Guides, required. AMA Guides,4th edition, required. None (see note). State's own guide.
PA TN TX WI
AMA Guides, latest edition, required.
AMA Guides, latest edition, and Manual for Orthopedic Surgeons.
AMA Guides,4th edition, required. State's own guide.
AR CA FL IL IN
Treating physician. Treating physician rates impairment; disability ratings are made by the Division of Workers' Compensation's Disability Evaluation Unit, the parties, or private raters (see note).
Treating physician; IME (in disputes; see note).
Treating physician; Workers' Compensation Commission.
Treating physician.
LA MA MD MI NC
Treating physician. Treating physician; IME; impartial physician from department's list (in disputes).
Treating physician; insurer- selected doctor.
na Treating physician.
PA TN TX WI
Impairment rating evaluation (IRE) physician from a bureau panel (see note).
Treating physician. Treating doctor; insurer-selected doctor; independent doctor selected from Division of Workers' Compensation's list of designated doctors (effective January 1, 2002).
Treating physician.
Table 9 Determining Permanent Partial Disability Benefits, 2006
Comprehensiveness of permanent disability rating guide or schedule
Rating schedule or guide used
Responsibility for issuing ratings Rating components
AR CA FL IL IN
Yes, by custom and case law. No (see note). Yes, by custom (see note). Yes, by custom and case law. No.
LA MA MD MI NC
Yes, by case law. No. No. na Yes, by custom and case law (see
note).
PA TN TX WI
No. Yes, by custom and case law (see note).
No, by statute (see note). Yes, by custom.
AR CA FL IL IN
Authorized. Authorized. Authorized, by judge's order. Authorized. Authorized.
LA MA MD MI NC
Authorized. Required when medical issues are in dispute; assigned from department list (see note).
Authorized. na Authorized (see note).
PA TN TX WI
Required when medical issues are in dispute.
Authorized. Parties may request that a neutral physician be appointed by the court, with the expense shared equally by both parties (see note).
Independent doctor selected from Workers' Compensation Commission's list of designated doctors. Opinion of designated doctor carries "presumptive weight" in a dispute (see note).
Authorized.
AR CA FL IL IN
None. Rights to future vocational rehabilitation benefits can be settled only under certain conditions (see note).
None (see note). None. None.
LA MA MD MI NC
None. Future liability for medical benefits cannot be terminated if liability for claim has been accepted or determined by a judge.
None. None None.
PA TN TX WI
None. Settlement amount, when the award does not exceed the compensation for 6 months' disability, is final and cannot be readjusted (see note).
Future liability for medical benefits cannot be terminated. Lump-sum settlements are prohibited, but lump-sum payments may be made under specific circumstances (see note).
Most lump-sum settlements are prohibited (see note).
FL: When a worker with a compensable condition sustains a permanent impairment, the worker is rated at the time of maximum medical improvement or within 6 weeks of the date when the worker is scheduled to reach the 104-week threshold for temporary disability benefits, whichever occurs first. Judges of compensation claims can consider only the testimony of the treating physician, an independent medical examiner, and the expert medical advisor. If multiple treating physicians submit impairment ratings, the insurer is required to calculate the impairment rating of the body as a whole. Arrearages for past child support obligations must be deducted from a settlement.
Table 9 Determining Permanent Partial Disability Benefits, 2006 (continued)
Treating physician's rating given special weight in claims with multiple ratings
Use of medical panels/neutral doctors in impairment-rating disputes
CA: Under the 2004 legislation, the treating physician writes a Permanent and Stationary (P&S) Report when the worker's condition is permanent and stationary—that is, when the medical condition is not improving and not getting worse. The P&S Report must include an impairment rating (using the AMA Guides, 5th edition) and the treating physician's estimate of how much of the disability is caused by the job injury compared with other factors, as well as a description of specific medical problems, work restrictions, future medical care, the ability to return to the preinjury job, and other pertinent information. The Disability Evaluation Unit within the Division of Workers' Compensation may review the report and assign a disability rating, or the rating may be determined by the parties or by private raters. Previously, the treating physician was not required to rate the impairment and impairment was based on state's rating guide. The 2004 legislation repealed the presumption of correctness of the treating doctor's opinion for all cases, regardless of the date AR: If the worker has an unscheduled condition and an earnings loss, PPD benefits are based on the degree of impairment and other factors, including the worker's age, education, and work experience. The required use of the AMA Guides, 4th edition, is exclusive of any sections which refer to pain and exclusive of straight leg raising tests or range of motion tests.
Limitations on lump-sum settlements for PPD benefits
Notes:
of injury. A worker who was injured on or after January 1, 2003 and is represented by an attorney can settle prospective vocational rehabilitation benefits with a lump-sum payment not to exceed $10,000, to be used in self-directed vocational rehabilitation; a worker who is not represented can settle future vocational rehabilitation benefits only if certain conditions are met. Settlement of supplemental job displacement benefits (for injuries on or after January 1, 2004) is permitted. Prior to these legislative changes, vocational rehabilitation benefits could not be settled.
continue (at the temporary total disability rate) pending determination of the worker's new earning capacity.
MI: Permanency benefits are paid for loss or total loss of use or function of body members as listed in the statute. Those benefits are called specific loss benefits and are similar to scheduled PPD benefits in other jurisdictions. Michigan does not pay benefits for unscheduled permanent disability. Instead, the state pays benefits for wage loss or loss of wage- earning capacity. Unscheduled benefits are paid solely on the basis of wage loss, at 80 percent of the difference between the worker's preinjury and postinjury net wage to a maximum of 90 percent of the statewide average weekly wage. Michigan does not use medical impairment ratings.
NC: The worker has a statutory right to a second opinion paid for by the employer or insurer.
examination regardless of who requests it. The 2004 legislation also established a cap of 1.5 times the permanent impairment rating for claims in which the worker returns to work with the same employer at the same or greater rate of pay; applicable to all body as a whole impairments and scheduled member impairments worth 200 weeks of benefits or greater and effective for injuries occurring on or after July 1, 2004. When the worker has not returned to work, the legislation retains the 6-times cap on body as a whole injuries and also applies the 6-times cap for scheduled members worth 200 weeks or more. Further, the legislation prohibits a worker from settling the right to future medical benefits until 3 years after the date of settlement approval or trial order on injuries to scheduled body members with a value of 200 weeks or more and to body as a whole injuries for injuries on or after July 1, 2004. Treating physician ratings are given special weight at the discretion of the court.
PA: Scheduled benefits are called specific-loss benefits in Pennsylvania. There are two different periods of payments under specific loss: for the healing period and for the specific loss itself. By statute, benefits are paid for the healing period before benefits are paid for the specific loss. The healing period ends when the worker returns to work at the preinjury wage or the period specified in the statute ends. Pennsylvania does not pay benefits for unscheduled permanent disability. Instead, the state pays benefits for wage loss or loss of wage-earning capacity through partial disability benefits. Those benefits are paid at 66⅔ percent of the difference between the preinjury and current actual or imputed wages, subject to the total disability maximum. If the benefit at the statutory rate is less than 50 percent of the statewide average weekly wage (SAWW), the benefit must be calculated using the lower of 50 percent of the SAWW or 90 percent of the worker's average weekly wage. The minimum benefit section in Table 8 lists the point at which benefits computed using the statutory rate are subject to recalculation. If the exam indicates an impairment rating of less than 50 percent, total disability status ends; partial disability benefits may LA: Permanency benefits are paid for loss or loss of use or function of body members (called scheduled PPD benefits) and for disfigurement and scarring. Louisiana does not pay benefits for unscheduled permanent disability. Instead, the state pays supplemental earnings benefits (SEBs) to workers who are unable to earn wages equal to 90 percent of preinjury wages. These benefits are paid at 66⅔ percent of the difference between the worker's average monthly wage (AMW) at the time of injury and the worker's current actual AMW or the AMW the worker is able to earn. SEBs are payable up to 520 weeks (including any temporary total disability and PPD benefits already paid).
TN: Tennessee uses a two-part approach to calculate benefits for unscheduled losses. If a worker has returned to work at or above the preinjury wage, the benefit can be set as high as 2.5 times the permanent impairment rating (injuries prior to July 1, 2004). Workers who reach MMI and have not returned to work at earnings at or above their preinjury wage can be compensated at up to six times the permanent impairment rating. In both cases, the permanent partial rating is based on vocational disability—the impairment rating is the starting point, and other factors, including age and education, are considered. Lump-sum settlements are based on the best interest of the injured worker and his or her ability to wisely manage and control a commuted award. The 2004 legislation established an Independent Medical Examination Registry to settle disputes concerning an injured