"You Down Wit' PPD?"
By: Joanna Hair
In a worker’s compensation case, permanent partial disability (PPD) benefits are one of three types of income benefits — in addition to temporary total disability (TTD) and temporary partial disability (TPD) benefits — a claimant can receive. However, despite how frequently the subject arises in claims, PPD benefits are also one of the more misunderstood aspects of many claims. Never fear though, our friend “Treach” will be assisting us in learning more about what constitutes a permanent impairment rating, how they are assigned and calculated, when a PPD rating must be paid and how prior injuries may help mitigate exposure. Just follow the below, and “everything’s gonna be all right.”
Treach injured his right knee in a work accident. He has attended appointments with his authorized treating physician (ATP) and has received treatment, including surgery. Despite Treach’s ATP exhausting all possible treatment options, Treach continues to have pain and has limited use of his right knee as a result. Treach’s ATP determines he has a permanent impairment rating. Doctors utilize the AMA Guides to the Evaluation of Permanent Impairment to assess a claimant’s permanent impairment. A permanent disability rating relates to the actual physical impairment of a particular body part, as opposed to economic disability. In Treach’s case, his ATP opines he has sustained a 15% rating to his right leg as a result of his work accident.
So, what does this rating mean in terms of benefits paid? O.C.G.A. § 34-9-263(c) sets out a schedule of body parts, with a maximum number of weeks to which each body part equates. For example, a leg (lower extremity) equates to a maximum of 225 weeks of benefits. In Treach’s case, 15% of 225 equals 33.75 weeks of benefits. Thus, the workers’ compensation carrier must pay Treach 33.75 weeks of income benefits for this permanent impairment rating.
Notably, a claimant cannot receive PPD benefits concurrently with either TTD or TPD benefits. See O.C.G.A. § 34-9-263(b)(2). Typically, a doctor will assess a rating when a claimant has reached maximum medical improvement (MMI). However, Board Rule 263 provides if a claimant who was receiving benefits ceases to receive benefits, the claimant’s PPD benefits must be commenced within 21 days of the insurer’s knowledge of the PPD rating. If a PPD rating has not yet been assigned, the insurer must write to the physician within 30 days to request a rating be issued. Therefore, even if a claimant has not reached MMI, once they are no longer entitled to TTD or TPD benefits, the countdown for commencing PPD ratings commences. Conversely, even if a claimant has reached MMI, so long as they remain entitled to TTD or TPD benefits, PPD benefits are not yet due.
PPD ratings also allow for some apportionment, based on pre-existing conditions. This means if Treach had injured his knee during a concert in 1991 and sustained a permanent impairment to same, the carrier would only be responsible for the increase to his permanent impairment rating. O.C.G.A. § 34-9-241(b). Furthermore, it would be Treach’s burden to show an increase to his pre-existing permanent impairment. Metro Interiors, Inc. v. Cox, 218 Ga. App. 396, 461 S.E.2d 570 (1995).
In conclusion, you have “nothin’ to lose” if you follow these steps:
- If a claimant is no longer entitled to income benefits, determine if a rating has been assigned; if not, ask the claimant’s ATP to issue one, if appropriate.
- Using the schedule in O.C.G.A. § 34-9-263, determine the maximum number of weeks the body part in question is worth, and multiply it by the percentage rating the doctor has assigned.
- As always, once benefits have been commenced, file a WC-2 to memorialize they payment and ask your helpful Swift Currie attorney for assistance if you have any questions.
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