What’s the difference between an impairment rating and a disability rating, and what does maximum medical improvement mean in a SC workers’ compensation case?
SC workers’ compensation law is filled with terms that may be confusing to most people. If you’ve been injured on the job and you are collecting workers’ compensation benefits, however, you must understand what some of these terms mean and how they can affect 1) your employment and 2) your potential settlement in your workers’ comp case.
Below, we will discuss impairment ratings and maximum medical improvement in the context of SC workers’ comp cases, including:
- What an impairment rating means and how it affects your case,
- The difference between an impairment rating and a disability rating, and
- Maximum medical improvement (MMI) and how it affects your case.
Maximum Medical Improvement in SC Workers’ Comp Cases
Maximum medical improvement (MMI) is when your doctor decides that you don’t need further treatment or medical care – or further treatment will not improve your condition or lessen your impairment.
What if the Insurance Company or the Doctor is Wrong?
The insurance company may decide you have reached maximum medical improvement before the doctors, multiple doctors might disagree as to whether you have reached MMI, or you might believe you could benefit from additional treatment despite a doctor or the insurance company’s opinion.
You have the right to seek a second, independent medical opinion if you disagree with the insurance company’s chosen doctor’s conclusion.
When this happens, you can request a hearing, present your medical evidence, and the Workers’ Compensation Commission will decide whether you have reached maximum medical improvement.
Why Does Maximum Medical Improvement Matter?
Maximum medical improvement is a critical milestone in your SC workers’ comp case, because, depending on your circumstances, it may:
- End your temporary total disability payments – if you’ve reached MMI, your disability is no longer temporary; now it is permanent,
- Allow you to return to work – if you are not permanently and totally disabled, your doctor may release you to work without restrictions, or release you to work with permanent restrictions,
- End payment of your medical care by the workers’ comp insurance company, although you may still be entitled to “Dodge medicals” if post-maximum medical improvement care would reduce your disability, or
- Entitle you to receive permanent disability compensation – once your doctors have declared that you have reached maximum medical improvement, you will be assigned 1) a permanent impairment rating that reflects your permanent loss of ability and 2) a permanent disability rating that will help to determine the amount of your cash settlement.
Once you have reached maximum medical improvement, the next step that brings you closer to a final settlement is the determination of your impairment rating and your disability rating.
Impairment Ratings in SC Workers’ Comp Cases
Once you have reached MMI, you will be assigned 1) a permanent impairment rating, which will help to determine your disability rating, and 2) a disability rating, which will help to determine the amount of your final settlement.
What is an Impairment Rating?
Your doctor will determine your permanent impairment rating, which might be done in the doctor’s office, or it might be done in a “functional capacity evaluation” at a physical therapy office.
The impairment rating estimates the percentage of your ability to use the affected body part that has been lost, and it is determined based on guidelines issued by the American Medical Association (AMA).
What is a Disability Rating?
The impairment rating is not the same as your disability rating. For example, you may have a low impairment rating, but the impairment still makes you disabled for purposes of doing your job. In this situation, you would have a low impairment rating but a high disability rating.
This matters because it is the disability rating that drives the amount of compensation you receive in your final settlement – regardless of the impairment rating, a high disability rating means that you cannot work or your ability to work has been reduced, which entitles you to more compensation.
On the other hand, you could also have a high impairment rating and a low disability rating – which would reduce the amount of compensation that you are entitled to receive.
To maximize your disability rating, you will need to show how the impairment affects your ability to perform job tasks as well as its effect on your daily life. For example, if your job requires you to lift heavy objects, a 20% impairment rating could prevent you from performing that job, resulting in a higher disability rating (and higher potential settlement).
Your Myrtle Beach worker’s compensation lawyer on the Axelrod team will help you to file your claim, determine how long your workers’ compensation benefits may last, and represent you before the workers’ compensation commission for any hearings and appeals.