Georgia’s workers’ compensation system is designed to assist workers with both minor injuries as well as more significant and long lasting medical problems. If your injury is minor, and you miss no work or only a day or two, you will be eligible for medical care but nothing else.
If you are put on “no work” status for 7 or more day, you will get TTD (temporary total disability) benefits and medical care.
Finally, if your workplace injury leaves you with a permanent impairment, your treating doctor will assign a permanent partial disability (PPD) rating to your case which represents the percentage of loss you have to a particular body part and to your body as a whole based on the American Medical Association Guide to the Evaluation of Permanent Impairment.
What are the AMA Guidelines to Evaluation of Permanent Impairment?
For example, if your injury is to your lower back, and you undergo surgery that relieves pain but leaves you with a reduced capacity to lift, bend and twist, your doctor may conclude that you have reached maximum medical improvement and that you have a 20% PPD rating to the body as a whole.
This does not mean that you have lost 20% of your lifting capacity – it means that based on the AMA Guidelines you have lost 20% of your function and that you are unlikely to improve within the next year. The AMA Guidelines are an attempt to standardize disability evaluation – your particular medical situation may leave you with a much higher degree of limitation than what the Guidelines say.
Don’t Assume Your PPD Rating is Correct
Your doctor will issue a rating based on various objective criteria such as the nature of your injury and your response to treatment as well as the doctor’s subjective opinion about your fitness for work given your medical problem. And, of course, not every doctor applies the AMA Guidelines correctly, which can negatively impact you.
In your workers’ compensation case, the question of whether you have reached MMI (maximum medical improvement) or if your PPD rating is fair and accurate will depend a lot on the doctor performing the evaluation.
If your work injury doctor came from your employer’s posted panel, there is a good chance that this doctor will be biased to some degree in favor of the insurance company. If we have had more say in choosing your treating doctor, you may get a fairer rating.
The point here is that like everything else in the Georgia workers’ compensation world, you cannot and should not assume that the insurance company will act fairly or reasonably. I have seen the work of and have opinions about the skills and biases of just about every doctor in the state of Georgia who accepts workers’ compensation patients and I will advise my clients if I think that your PPD rating is too low. Georgia law gives us options and we can take full advantage of these legal remedies.
What Happens if my PPD Rating is Too Low?
If your PPD rating is unreasonably low, the settlement value of your case will be reduced. Georgia law assigns a set number of weeks to various injuries. In the back injury example I used above, my client has a 20% disability to his body as a whole. Under Georgia law, disability to the body as a whole counts as 300 weeks. If my client’s benefit rate is $550 per week, the PPD value would be: 300 x $550 = $165,000 x 20% impairment = $33,000.
If my client’s PPD rating was 10% instead of 20%, his PPD value would be only $16,500.
I use the PPD value plus some or all of the remaining TTD that could be applicable, plus an estimate of future medical care to come up with a settlement value for your case.
Even if the math is a little confusing, I hope you can see that the settlement value of your case would be unreasonably low if we use the insurance company’s numbers and estimates for future costs, but much more reasonable if we use my estimates.
In a mediation, I use my many years of experience to demonstrate to the mediator that my valuation of your case is more accurate than what the insurance company wants to do.