What is Permanent Disability and How is it Determined?

Some work injuries are minor, but some leave you with a long-lasting disability that affects you for life. Permanent disability benefits generally compensate those who are not expected to fully recover from their work injury. However, there are certain requirements in order to obtain a permanent disability status before you can get compensated.

Permanent Disability is when a Qualified Medical Evaluator (QME) doctor, Agreed Medical Evaluator (AME) doctor, or a Primary Treating Physician (PTP) finds your injury or illness has left you with permanent limitations that impact your ability to work. The doctor will evaluate all your medical records pertaining to your workers’ compensation claim before their own evaluation of you. Then after their evaluation, they will make a report on their findings. The doctor will also need to determine if your injury was a 100% result of your work injury or if there was a previous non-work-related injury to that same injured body part causing part of the disability. “The injured employee has the burden of proving, by a preponderance of evidence both the overall level of permanent disability and that at least some of the permanent disability was industrially related.” (Escobedo v. Marshalls (2005) 70 CCC 604, 612 (appeals board en banc). In order to find permanent disability, the doctor must declare that you are permanent and stationary and your injury has reached maximum medical improvement. “A disability is considered permanent when the employee has reached maximal medical improvement, meaning his or her condition is well stabilized, and unlikely to change substantially in the next year with or without medical treatment.” (Cal. Code Regs., tit. 8 § 10152, No. 17, (2023)). The QME report will also include a whole person impairment (WPI) rating for each body part affected by the workplace injury.

Permanent Disability is determined by a complex rating schedule created by the state of California. The rating schedule can be found at https://www.dir.ca.gov/dwc/pdr.pdf . The Doctor addresses whether there is any residual impairment from the injury which is used to determine the permanent disability rating. Some of the factors considered by the Doctor are the injured body part and the date of the work injury. This formula is then calculated to get your permanent disability rating in a percentage. Your percentage of permanent disability is then given a specific dollar amount determined by state law. “An award of permanent disability, unlike that of temporary disability, specifies the amount to be paid, subject only to modification by the Workers’ Compensation Appeals Board upon a proper showing.” (County of Los Angeles v. WCAB (King) (1980) 45 CCC 248, 251). For injuries occurring on or after January 1, 2013, the law mandates that permanent impairment be assessed in accordance with the America Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides). Permanent Disability benefits are limited because it may not cover all the income lost due to your work injury. They are not designed to make you whole, but to help you adjust to a lesser ability to compete in the open labor market.

Trying to understand the whole Workers’ Compensation process is daunting and not an easy task. That is why having an attorney to explain the Workers’ Compensation process and ensure you are getting fairly compensated for your injury is very important. At Mastagni Holstedt, A.P.C. our attorneys are dedicated to helping clients navigate California’s complex Workers’ Compensation system.