What you will learn from this article:
- Having surgery for a workplace injury can affect the payout received through workers’ compensation.
- Impairment ratings are used to determine the level of disability and the amount of compensation a worker is entitled to.
- Workers may need to see multiple doctors, including one chosen by the insurance company, which can lead to disagreements in impairment ratings.
When you suffer from an injury due to a workplace accident, the workers’ compensation system is designed to provide you with financial support while you recover from your injury. This financial compensation includes coverage for your medical expenses as well as a portion of the wages you miss out on while recovering. It also provides future compensation, if your injury has caused permanent disability to you.
If you need surgery, this could affect the payout you receive, which is calculated in part based on your impairment rating.
In this article, we will go into more detail to help you understand how workers’ compensation and impairment ratings work, and how they could affect your settlement. If you have questions and need help navigating a claim, our Kentucky workers’ compensation lawyers at McCoy & Sparks can assist you. Don’t hesitate to reach out and set up an appointment for an initial consultation.
Understanding Workers’ Compensation and Impairment Ratings
When you are injured in a workplace accident, the workers’ comp benefits you receive will depend on your level of disability. For example, someone whose injury leaves them permanently disabled and unable to return to work in any capacity will receive more money than someone who is only partially disabled and is able to return to their job duties.
Impairment ratings come into play when a worker is determined to have a Permanent Partial Disability (PPD). Under Kentucky Workers’ Compensation Law, PPD is a benefit that may be owed to an employee who has reached maximum medical improvement but still qualifies for a permanent impairment rating, which could result in a loss of wages or earning capacity. However, even someone who has returned back to the same job earning the same or greater wages may still qualify for PPD benefits if they have an impairment rating.
Maximum medical improvement (MMI) simply refers to the point at which the employee has reached recovery or at which their condition has improved as much as it is ever going to. If at this point, the worker is still suffering from a permanent impairment that leaves them partially disabled, then they will receive PPD benefits.
However, before it can be determined how much the worker is entitled to, they must first be assigned an impairment rating.
In Kentucky, only a doctor can assign an impairment rating and that rating must be calculated based on the American Medical Association Guide to the Evaluation of Permanent Impairment, 5th Edition. This rating essentially measures the loss of bodily function and is based on a percentage system. That percentage is then used to calculate how much the workers’ comp settlement should be.
Workers’ Comp Disability Rating Impairment Rating Chart
KRS 342.730(1)(b) establishes factors that are applied to the impairment rating assigned. WHen an impairment rating is multiplied by the statutory factor, that gives us the permanent disability rating.
The statutory factor chart works by associating an impairment percentage with a statutory multiplier, and those numbers are then used in the formula when calculating the benefits. The chart is as follows:
| Impairment % | Statutory Factor |
| 0-5% | 0.65 |
| 6-10% | 0.85 |
| 11-20% | 1.00 |
| 21-25% | 1.15 |
| 26-30% | 1.35 |
| 31-35% | 1.5 |
| 36% or more | 1.7 |
The formula used to calculate the benefits is:
(.667 x your average weekly wage, which is the same as the TTD rate) x impairment % x statutory multiplier
If your average weekly wage is $500, for example, and your impairment percentage is 12%, then the calculation would be (.667 x $500) x 12% x 1 which comes out to around $40 per week, payable over a 425 week period.This would have a value of $17,000 paid out over the 425 week period.
This amount is multiplied by a factor of 2 or 3, depending on whether you are able to return to work at the same wage and same job duties as before. For example, if you had permanent restrictions that prevented you from returning to work and you had to take a job that paid you less, in the example, your weekly award would be $120 per week. These multipliers can be increased depending on your age at the time of your injury and your education level, if you have less than a 12th grade education or GED.
If the permanent disability rating is greater than 50%, then PPD benefits are payable over a 520 week period instead.
Other factors such as the age of the claimant can limit what is owed to them and how many weeks of benefits are owed. Generally, all workers’ compensation benefits end when the injured work turns 70.
To make it easier, the Kentucky Workers’ Compensation website also offers this handy tool to help you calculate your PPD benefits: PPD Benefit Calculator
What if the Workers’ Comp Doctor Disagrees With My Doctor?
It’s important to note that when you become injured, you might have to see two different doctors to satisfy your employer’s workers’ compensation insurance company.
For example, you will likely see your doctor who will assign you an impairment rating once you have reached maximum medical improvement, but your employer’s insurance company might also require you to see a doctor of their choosing for a second opinion. In these cases, it is not uncommon for the insurance company’s doctor to disagree with the injured worker’s doctor. There are many different ways to calculate impairment ratings and doctors may employ different methodologies.
This is because the insurance company will defend your claim however they can to try and reduce what they have to pay to you. So the doctor they choose, for example, might try to claim that your impairment percentage is not as high as the one your doctor assigned to you, or they may agree with your doctor’s impairment rating, but say that half of the rating is from pre-existing factors.
To ensure the ALJ rules in your favor and agrees with the higher impairment rating assigned by your doctor, it is often necessary to work with an attorney who can help you build a strong case with persuasive and compelling evidence that proves the extent to which you are impaired.
If I Need Surgery, Will This Affect My Impairment Rating?
In a way, yes, surgery can affect your impairment rating. Remember, your impairment rating is based on your level of impairment once you have reached maximum medical improvement. So if you have surgery, it likely reflects that you suffered a more severe injury than someone with a similar injury who did not need surgery.
The AMA Guides give specific criteria for when an impairment rating is assigned based on a specific type of injury or work-related condition, and when an impairment rating may be based on other factors such as range of motion, grip strength, and pain. It can be complicated to understand whether the impairment rating assigned to you is fair and accurately reflects your condition.
Even if there isn’t a dispute over an impairment rating or approval for surgery, it is highly recommended that you work with an attorney when filing a workers’ compensation claim, especially if you end up permanently or partially impaired. A lawyer will protect your rights, help you gather evidence to build a strong case, and handle negotiations with the insurance company to ensure they pay you the full amount of benefits you deserve.
Trust McCoy & Sparks—Premier Workers’ Compensation Attorneys in Central Kentucky
At McCoy & Sparks, we have years of experience handling complex workers’ compensation cases and can help you navigate the process with ease. We know what it takes to help you win your case and ensure you are awarded the full and fair workers’ compensation benefits you deserve.
You owe us nothing unless we recover compensation for you. Make the right call to (844) 4KY-WINS for a risk-free consultation with one of our workers’ compensation attorneys today.