Appealing a Denial of Permanent Partial Disability Benefits (Workers' Comp)

If you are denied permanent disability benefits, you have the right to appeal.

A permanent partial disability award is a sum of money intended to compensate you for the permanent bodily impairment you sustained as a result of your workplace injury or occupational disease. If you are denied a permanent partial disability award, but you believe you suffered permanent impairment due to a work-related injury or illness (called an occupational disease in some states), you have the right to appeal that decision.

How Are Permanent Partial Disability Awards Determined?

Permanent partial disability awards are determined based on your permanent impairment for each affected body part (see more below). Therefore, you could receive multiple permanent awards under a single claim if you were permanently disabled by more than one body part. Similarly, you can receive a permanent impairment award for each workers' compensation claim. For example, a prior workers' compensation claim in which you received a permanent impairment award will not preclude you automatically from receiving a permanent impairment award under your current workers' compensation claim (again, see the information below for more details).

How Is the Amount of Permanent Disability Decided?

To determine whether you should receive a permanent partial disability award, and the amount of the award, it is important to understand how permanent partial disability awards are determined.

First, your treating physician and likely one or more independent medical examiners will determine whether you sustained any permanent bodily impairment as a result of your work-related injury or occupational disease. One or more of these doctors will provide an opinion as to the degree of impairment, such as 10% or 50% disabled. This degree or percentage should correlate with a statutory schedule for benefits in your state.

At the time your workers' compensation claim is closed, you will receive notice of whether you will receive a permanent disability award. The notice will also state the amount of the award being offered.

One important thing to note: the amount of permanent impairment awards are determined by statute or workers' comp regulation, and they vary only based upon the date of injury and degree of impairment. Thus, a piano player and a soccer player will receive the same permanent impairment award for a hand injury; there is no distinction in the law for personal circumstances to increase or decrease a permanent partial disability award.

Impact of Prior Permanent Partial Disability Awards

If you previously received a permanent partial disability award, whether for your current work-related injury or a previous workers' compensation claim, your permanent partial disability award may be reduced by the amount of your prior award. Depending on the laws in your state, this typically occurs when your previous award was for the same body part involved in your current workers' compensation claim. For example, if you previously received a $5,000 award for a low back injury, and your award for the current workers' claim having to do with your back is $8,000, you may receive only $3,000.

Alternatively, if you received a permanent partial disability award for an injury to a different body part than the part(s) involved in your current workers' compensation claim, your permanent impairment award under the current claim will not likely be affected.

Appeal Rights

You will receive an order or notice at the time your workers' compensation claim is closed. This order or notice will state the amount of a permanent partial disability award, if any, you have been awarded. The order/notice should describe the procedure for disputing or appealing the determination or amount of your permanent partial disability award.

The procedure may include a preliminary appeal within the state agency responsible for administering your state's workers' compensation system. The next level of appeal is typically to your state's workers' compensation board. An appeal to the board level involves sophisticated legal procedures, and is best handled by an attorney experienced in workers' compensation.

Talk to a Workers' Comp Attorney

If you believe you should have received a permanent partial disability award, or your award should be higher, talk to an attorney immediately. The appeal periods can be very short, and you want to ensure that you protect your appeal rights. An experienced workers' comp attorney can navigate the appeal system to advocate on your behalf so that you have the best chances of success.

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