An injured employee may seek compensation for work injury from parties which caused the injurious event (e.g., a defective device manufacturer or a vehicle driver who triggered a collision) and the employer if the injury arose out of and in the course of employment and the worker was not an independent contractor. A personal injury claim involves proof of at-fault party’s negligent acts or omissions and damages (such as incurred medical expenses, loss of earnings, loss of normal life, pain, and suffering) proximately caused by said acts. If an employee promptly gives notice of work injury to the employer, then the employer’s insurance carrier must pay regardless of the employee’s immigration status or fault all injury treatment bills, two-thirds of the average weekly wage during the recovery time and compensate for loss of body parts’ use, but will not pay for pain and suffering, and other personal injury claim damages. A personal injury claim cannot be settled without paying back to the worker compensation insurance company 75% of their payments made so to prevent the worker’s double recovery for the sustained injury.

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USE OF IMPAIRMENT RATING TO RESOLVE BENEFITS PAYMENT DISPUTES

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An impairment rating evaluation may resolve a dispute as to the injured workers’ ability to return to their full duty or light duty work tasks because of their medical condition and correlated payment of worker compensation, social security administration disability, or other benefits.

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To determine the worker’s injury extent, nature and level of recovery, the third-party tests and evaluations are used by the disputing claimants and insurance companies. Such evaluations include independent medical examinations (IME) by hired medical professionals, Functional Capacity Evaluation (FCE) to determine physical limitations on work activities and impairment evaluation to ascertain a person’s ability to perform job tasks the same way as it was done before the injurious event.

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Impairment ratings quantify the level of pain, injury effect on the persons’ neurological or physical condition. This helps in finding a genuine level or exaggeration of injuries. Injury-caused physical or mental impairments can be permanent, temporary, severe, or mild.

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Unlike impairment, disability is based on determination of limits and restrictions on a worker’s ability to complete pre-injury job tasks. For example, the permanent spinal injury condition is impairment, but the disability determination would depend on the person’s ability to carry heavy objects as part of job duties, i.e. a desk job or construction work involving the heavy items’ lifting and carrying.  

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Impairment Rating Evaluation (IRE) performed by a doctor establishes the level of impairment and its effect on work to be done. The medical impairment rating helps to determine when the worker may return to work and in what capacity, i.e., if the rating shows a worker is unable to perform full duty, then the worker is deemed to be totally disabled or partially disabled if able to perform a desk job or a light duty job.

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An IRE is usually done after doctor’s determination of the maximum medical improvement (MMI) status, i.e., the reached stable condition can only be managed and unlikely to change for at least a year. Illustration: The traumatic brain injury treatment reached the MMI at some date, but the injured worker cannot return to work due to loss of cognitive skills and neurological disorders. The condition improvement is not expected at least for a year and, therefore, the impairment is permanent.

The worker’s benefits cannot exceed 500 weeks if an IRE rating is less than 50 percent (partial disability, may work in some capacity), but the benefits may continue for as long as medically needed (no time limitations) if the IRE rating is more than 50 percent, i.e., the worker is totally disabled.

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The IRE is useful tool to achieve a fast settlement of worker compensation claims in cases involving severe work injuries.

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