How Impairment Ratings work in a Texas workers' compensation case.
Once a worker reaches Maximum Medical Improvement (MMI - Read about MMI here) in their workers' comp case, they are issued an Impairment Rating. The Impairment Rating is a rating of deficiency given to an injured worker, stating to what degree their injuries will affect future job performance. Or to put it more simply, imagine you are selling a car online and you describe the exterior as an 8 out of 10 and the interior as a 7 out of 10. An impairment rating is just like that but for injured workers.
In a Texas workers' compensation claim, the Impairment Rating is issued to an employee after they've "recovered," and it dictates future benefits they may receive. As such, the Impairment Rating an employee is issued is a hotly contested part of a workers' comp case. In this article, Texas workers' compensation attorney Michael Grossman explains how Impairment Ratings work and what injured workers need to know to protect their legal interests.
Questions answered on this page:
- What is an Impairment Rating?
- Who assigns a workers' Impairment Rating?
- How does the Impairment Rating affect future benefits?
- How can an experienced work accident injury attorney help you get maximum compensation for your injuries?
- What Texas law dictates how doctors issue Impairment Ratings?
Your Impairment Rating is Determined After...
A workers' impairment rating is issued after they have reached Maximum Medical Improvement, which is the point at which their workers' comp doctor basically says, "This is as good as you're going to get." Once the comp doctor determines that the worker has achieved MMI, the doctor will then issue an Impairment Rating to illustrate how well the recovery went.
This is dictated by Section 408.123 of the Texas Labor Code. It reads as follows:
After an employee has been certified by a doctor as having reached Maximum Medical Improvement, the certifying doctor shall evaluate the condition of the employee and assign an impairment rating using the impairment rating guidelines described by Section 408.124. If the certification and evaluation are performed by a doctor other than the employee's treating doctor, the certification and evaluation shall be submitted to the treating doctor, and the treating doctor shall indicate agreement or disagreement with the certification and evaluation.
After reaching MMI and receiving this rating, an injured worker is no longer eligible for the Temporary Income Benefits they should have been receiving. However, once a worker is assigned an Impairment Rating they stand to gain a different kind of workers' compensation income benefits. These are, not surprisingly, called Impairment Income Benefits
Guide to Rating Your Impairment
Section 408.124 of the Texas Labor Code requires that an employee's Impairment Rating is to be determined by (in our opinion, a very outdated) medical textbook:
(b) For determining the existence and degree of an employee's impairment, the division shall use Guides to the Evaluation of Permanent Impairment, third edition, second printing, dated February 1989, published by the American Medical Association (AMA).
If that seems a little outdated, for reference the most up-to-date Guides to the Evaluation of Permanent Impairment is the 6th Edition, which was released in 2008. Recently, it appears that the Workers' Compensation Commissioner has instructed workers' comp doctors to use the 4th Edition. While that may seem like a leap forward, don't get too optimistic; the 4th Edition is still 15 years behind the most recent edition.
Your Impairment Rating is Determined After...
The Guides to the Evaluation of Permanent Impairment rates impairment, as interpreted by a physician, by giving each worker a percentage of deficiency. The lower the rating, the higher level of work the employee ought to be able to perform. Let's use an example to clarify:
- Imagine a worker (Bob) suffered a knee injury in a work accident. This will continue to be a problem for the rest of his life, he walks with a limp and doesn't move as fast as he used to. Let's say he's issued an Impairment Rating of 10, which means he's 10% deficient. This makes a big impact on his Impairment Income Benefits. The lower his Impairment Rating, the healthier he is. An Impairment Rating of 1 would mean that he's 1% deficient. Whereas an Impairment Rating of 15 would mean he's 15% deficient. Long story short: the bigger the number, the worse the condition of the worker.
It's also worth noting that the higher the rating, the more compensation an injured worker is able to get in the form of Impairment Income Benefits. Obviously, it behooves an injured worker who wants to get maximum compensation to be issued an Impairment Rating that is a big numerically as possible. But since this is open to interpretation, naturally, a workers' comp attorney can argue this point in order to get the worker additional money.
What no one likes to talk about is that the doctor an injured worker sees is paid by the workers' compensation insurance carrier, and although they're supposed to be impartial on matters of a worker's recovery, it is ultimately the insurance company who is paying them.
While the list of doctors who injured workers can see is determined by the Workers' Compensation Board, they work very closely with workers' compensation insurance providers to keep workers' compensation costs down. This means that their is tremendous pressure on the Workers' Compensation Board to replace doctors who return consistently high impairment scores, with those who score workers' injuries in a way that is more favorable to the insurance companies and thereby lowers the cost of the entire workers' compensation system. It is tragic that these cost control measures come at the expense of the most seriously injured workers in our state.
Ultimately, pressures from insurance companies can cause injured workers' cases to receive lower impairment scores than they would otherwise receive.
Why The Guide May Not Be A Valid Way To Assess Your Injury
The Guides to the Evaluation of Permanent Impairment have been criticized in recent years because it is viewed as archaic and biased against injured employees. It was created more than two decades ago and does not include different complications for certain injuries. It also lumps people with the same injuries together when, in reality, each person can be limited by the same injuries in different ways. Everyone has different skill sets and we feel that it is unfair to claim that everyone without, say, the use of their left arm will function at the exact same efficiency.
While short of lobbying the legislature to update the statute, there is really nothing that can be done about this, it is still important for an injured worker to be aware of this shortcoming in the workers' comp system, so that they can safeguard their own interests throughout the process.
Why You Need A Lawyer to Help You Fight Your Unfair Impairment Rating
The best way to help offset the bias created by this guide is to hire an experienced work injury lawyer who can fight for your rights. An experienced work accident attorney will be able to help you determine the true impact of your injuries and get you the necessary compensation you deserve.
Our attorneys at Grossman Law Offices have helped thousands of clients get the compensation that they deserve. Call today for a free consultation at (855) 326-0000.
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