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Disability Rating in Workers’ Compensation Cases

In North Carolina the world of workers’ compensation disability benefits is divided into four different categories, depending on how long the injury lasts and the extent to which it affects the employee’s ability to work. Temporary partial and temporary total disability payments go into effect almost immediately after a work accident to provide the injured worker with wage replacement benefits in addition to the medical bills coverage provided by workers’ comp.

Permanent partial and total disability payments, on the other hand, can go into effect once the person’s doctor deems that they have reached what is called “Maximum Medical Improvement,” or MMI. This is the point at which the doctor determines that the person’s healing has reached a plateau and is unlikely to continue. However, just because a person reaches MMI does not mean that they still may not suffer debilitating and longer-term effects from their injury. Many injured workers will still have significant loss of function in one or more body parts even though their doctors have determined that their healing period is over. However, almost as many of these individuals will not qualify for the extremely limited circumstances that warrant permanent total disability payments for life (such as paralysis of both arms or legs, or traumatic brain injury that disturbs certain cognitive functions). For these individuals, permanent partial disability payments can be the answer.

Like other types of disability payments under workers’ comp in North Carolina, permanent partial disability payments under workers’ comp are calculated at two-thirds of the worker’s average weekly wages at the time of their injury or illness. However, permanent partial benefits are additionally calculated in proportion to the “disability rating” to which their doctor assigns each affected body part.

What is a Disability Rating?

Permanent partial disability ratings are assigned on a scale of zero (0) to 100 percent. A disability rating for 70 percent for an arm, for example, signifies that the person only has 30 percent functionality of that arm even after reaching Maximum Medical Improvement. Permanent partial benefits would then be calculated at 70 percent of two-thirds of the employee’s average weekly wages.

Permanent partial disability continues for the amount of time set by statute (N.C.G.S. 97-31) for each particular body part affected. The amounts of time range from 10 weeks (for loss of a toe other than the big toe) to 300 weeks (loss of back). The disability rating affects this amount as well—weekly permanent partial disability payments will continue for the amount of time listed in the statute for the affected body part, in proportion to the disability rating. From the example above involving an arm with a permanent disability rating of 70 percent, the weekly benefit would continue for 70 percent of 240 weeks, the amount listed in the statute for permanent arm disability). Thus, the payments would continue for 168 weeks.

So how do Doctors Arrive at This Rating?

The North Carolina Industrial Commission, the agency that handles workers’ comp claims in this state, publishes a comprehensive guide for doctors to use in determining disability ratings. It provides guidelines how to reach a numerical ranking for injuries by taking into account a number of factors such as pain, dexterity and weakness. It also outlines procedures for rating injuries that are not specifically included in the statutory schedule. N.C.G.S. 97-31 sets out duration periods for arms, legs, back, hands, feet, organs, and other injuries such as scarring/disfigurement, but there are many workers’ comp injuries with permanent partial effects that do not specifically fit into these categories—for example, a wrist injury would not technically be included in the 97-31 schedule. The ratings guide provides recommended ratings for such injuries, stating that severe wrist damage is worth 50 percent of the value of a hand.

Can I Choose my own Doctor?

The first medical opinion is usually provided at the direction of the employer or their workers’ compensation insurance carrier. However, the NC Industrial Commission can permit the injured employee to change doctors or approve a doctor of the employee’s choosing if they can show good cause for doing so. If the employee disagrees with the disability rating the first assigned physician gives them, the worker has the right to obtain a second opinion from a doctor of his or her choosing at the employer’s expense.

If you have a workers’ comp claim in the Charlotte or Lake Norman area and are considering accepting a permanent partial disability benefit payment, it is important to know that accepting such payment will terminate any other temporary disability payments through workers’ comp. It can also keep you from accepting longer-term disability payments in the future if you do not timely file for a change in circumstances in the event your condition worsens after you were told you reached Maximum Medical Improvement. The procedure for workers’ comp can be a complicated and burdensome process. It is important to speak with an experienced workers’ comp attorney to ensure that you receive the maximum benefits you deserve. Contact Arnold & Smith, PLLC today for a free consultation with one of our dedicated workers’ comp attorneys.