How Do Physicians Calculate Worker Impairment Ratings?

Physicians calculate worker impairment ratings by considering the following factors:

• What type of disability the worker has suffered (partial versus total)
• What kind of job the disabled worker had before they were injured
• How old the worker was at the time of injury
• How much pain the injury will continue to cause the disabled worker
• How much money the disabled worker made before they were injured

What Is a Worker Impairment Rating?

Worker impairment ratings are used to determine how much a disabled injured worker can receive in workers’ compensation benefits. These benefits include money for:

• Temporary and permanent disability
• Loss of wages
• Medical care
• Retraining expenses

It can also include death benefits if the injured worker does not survive.

According to LAB § 3700, employers must provide employees with these benefits if the employee sustains an injury or contracts an illness as a direct result of doing their job. Workers who recover fully from their injuries receive temporary payments. Alternatively, workers with permanent disabilities may receive long-term or lifelong benefits.

The exact amount the employee can receive depends on the factors described earlier. Specifically:

• Whatever medical care the physician deems necessary will be covered by workers’ compensation benefits.
• The longer a worker cannot do their job, the longer they can receive compensation for a percentage of their normal weekly wage.
• Workers may receive other benefits, such as a voucher to pay for retraining, as applicable (e.g., if they can never return to their old job).

As a general rule, the more serious the injury, the more money you could receive. This money is often invaluable for disabled worker, who would not otherwise be able to pay bills or ensure their family gets the things they need.

Who Determines Worker Impairment Ratings?

Your employer’s insurer, an administrative law judge (ALJ), or someone else may appoint a physician to examine you. Physicians calculate worker impairment ratings and then report their findings to whoever requested the evaluation. You or your worker compensation lawyer could also request a copy of the report.

The California Department of Industrial Relations (DIR) states that physicians must use the appropriate permanent disability ratings schedule when determining what “score” to give the worker. These schedules provide guidance for rating disabilities that affect the:

• Hands, fingers, feet, and toes
• Back
• Hips
• Heart
• Lungs
• Vision
• Hearing
• Mind and mental health
• Other body parts

The schedule also takes disfigurement into account. For example, if your injury leaves you with large scars on your neck or face, your impairment rating may increase.

Considering the Effect Your Impairment Has on Your Professional Life

Finally, the physician must determine what sort of an effect the injury will have on your ability to earn an income throughout the remainder of your career. Consider the following examples:

• Worker A lost a finger in a workplace accident, but they are eventually able to return to their old position. Their disability has not had a substantial, long-term effect on their career, so their impairment rating is relatively low.
• Worker B suffered partial vision loss. As a result, they now only qualify for lower-paying positions, which means their impairment rating may be higher than Worker A’s.
• Worker C suffered a spinal cord injury and is permanently paralyzed from the neck down. They can never work at any job again, so their impairment rating is much higher than both Worker A’s and Worker B’s.

These examples, while helpful for illustrating part of how the rating system works, are much simpler than real cases would be. For instance, if Worker A experiences a lot of chronic pain due to their injury while Worker B does not, their impairment ratings should reflect this.

Your physician may take a while to arrive at your impairment rating, depending on their workload and on how complicated your case is.

What If I Disagree With My Worker Impairment Rating?

There could be any number of reasons why a physician fails to provide an accurate rating, including:

• A misinterpretation of the evidence you or your employer gave them
• Missing evidence, such as if you sent in medical records that never arrived at the examining physician’s office
• Pressure from your employer’s insurance company to provide a lower rating so that the insurer does not have to pay you as much in benefits

Regardless of how it happened, you may find yourself with an impairment rating that does not reflect your injury’s severity. In this situation, you will want to tell your workers’ compensation lawyer about the issue. If you have not yet hired a lawyer, now would be a good time to do so.

How a Workers’ Compensation Lawyer Can Help You

A workers’ compensation attorney can inform you of your full rights as an injured worker and make sure you receive all of the benefits you qualify for. They may do this process by:

• Arranging for you to get a second opinion from another physician
• Collecting and sending out evidence to prove that your injury and its effects on your career are just as serious as you say
• Meeting with the insurance company and/or your employer to negotiate a fair agreement, if possible
• Filing an objection with the state Division of Workers’ Compensation (DWC), if the insurer refuses to treat your claim in good faith, and representing you in any hearings that result from the objection
• Telling you your case’s approximate worth—this way, you will know if your physician or the insurer tries to undervalue your injuries
• Answering every single question you have about your case and how the workers’ comp system works

Unfortunately, some physicians do calculate worker impairment ratings based on the insurer’s wants rather than the employee’s needs. You can hire your own legal representation to make sure that no one takes advantage of you.

What Is Your Worker Impairment Rating?

Before going to a medical exam, it is a good idea to learn more about how physicians calculate worker impairment ratings and how much your case could be worth. This way, your employer’s insurer cannot shortchange you or offer insufficient benefits without your knowledge. Call KJT Law Group today at (818) 507-8525 for a free consultation