What Should You Know About Permanent Disability Benefits

If you have a serious medical problem, you might be able to receive permanent disability benefits through workers’ comp. First, you’ll have to demonstrate that your medical condition isn’t likely to change and that it prevents you from working. You should see a Certified Workers Compensation Attorney to help you with this, as it is complicated.

Eligibility for Permanent Disability Benefits

The first step toward getting any kind of workers’ comp benefits is to show that you meet the eligibility requirements:

Your employer must have workers’ comp insurance.

You must be an eligible employee.

You must have a covered work-related injury or illness.

You must file a work comp claim.

You must follow the rules for getting medical treatment from a workers comp doctor. In California, that doctor is a QME or Qualified Medical Examiner.

How Long Does It Take to Stop Improving?

You won’t be considered for permanent disability benefits until your treating doctor says you aren't expected to improve. In workers’ comp lingo, this is usually called “maximal medical improvement” (MMI), or sometimes “permanent and stationary.”

The amount of time it takes to reach MMI can vary widely—anywhere from a month to a few years after you were first hurt or became ill. The nature of your injury or illness will have the biggest impact on how long it takes.

Some states assume that employees have reached MMI when they’ve been getting temporary total disability benefits for a period of time (usually 104 weeks).

Determining Permanent Disability

Once your doctor says you’ve reached MMI, the process will begin to determine whether you have any permanent disability and, if so, how much. This is also generally the point when you’ll stop receiving temporary disability payments if you’ve been off work and those benefits haven’t already run out. (Several states have a time limit on temporary total disability benefits.)

The rules for determining permanent disability vary from state to state. Your doctor will say whether you have a lasting medical condition or impairment that was caused by your work-related injury. An impairment could be anything from a bad back to a severed finger to painkiller addiction that you got after a serious orthopedic injury.

The insurance company will request an qualified medical examination (QME) to assess your permanent impairments. You might also be able to ask for an QME if you disagree with another doctor’s opinion.

States use different criteria to decide whether injured employees have permanent disabilities. The result of the process is what’s called a permanent disability rating, expressed in a percentage.

If your disability rating is less than 100%, you may be able to receive partial permanent disability benefits.

Getting the Permanent Disability Checks

Once the insurance company hears from a doctor that you have a permanent disability, the company should begin sending you checks. But if there’s a dispute, your workers' compensation lawyer will prove invaluable. The rules and the process are complicated, and insurance companies (and their lawyers) do everything they can to keep their costs down by denying permanent disability benefits. You need an experienced attorney on your side to protect your rights and your future.

You should also know that permanent disability benefits don’t necessarily last the rest of your life. If you’re totally and permanently disabled, you’ll usually be entitled to a lifetime pension (though a few states cut off payments at a certain point for all but the most serious disabilities). When it comes to partial permanent disability, however, most states limit how long the benefits last.

Whether the benefits are for partial or total permanent disability, some states allow you to opt for a lump-sum payment in a workers comp settlement. Here again, it would be wise to speak with a workers’ comp attorney before you agree to a settlement to make sure you don’t sign away important rights.