Impairment Ratings in Texas Workers' Compensation: The Basics
Impairment ratings are one of the most difficult to understand concepts for injured workers in Texas. Any time a doctor, lawyer, or administrative worker starts to talk about it, workers are immediately confused by the seemingly endless stream of medical, legal, and other technical jargon that is associated with the impairment rating. Fortunately, however, the basics of the impairment rating process are fairly easy to grasp, and it becomes much less difficult to understand once those basics are understood.
Here are a few basic principles that will help you to better understand impairment ratings and the impairment rating process. As always, because I practice law in Abilene, Texas, these concepts are specific to the State of Texas.
The Impairment Rating Isn't Relevant to the Early Part of a Claim. For most injured workers in Texas, the length of time that an injured worker receives income benefits is based on two things: disability and the impairment rating. During the early stages of the claim, whether the work has disability (the inability to earn wages in the same way he/she did before the injury) is the primary determining factor. So workers' in the early part of their claim won't have an impairment rating.
An Impairment Rating is Issued When a Worker Reaches Maximum Medical Improvement (or MMI). At some point in the course of treatment, one of the many doctors involved in a workers' compensation claim will determine that the injured worker has reached "maximum medical improvement." At this point, the "switch" is flipped. No longer is the worker entitled to benefits based on disability. Instead, the worker becomes entitled to benefits based on an impairment rating, which must be issued once a worker reaches maximum medical improvement.
An Impairment Rating Can Only Come From One of Four Sources. Once it is time for a worker to receive an impairment rating, it must come from one of four sources: (1) the workers' treating doctor (the doctor who has managed the care of the worker thorugh the injury), (2) a doctor that the treating doctor asks to perform an impairment rating (this is often called a "referral" doctor), (3) a designated doctor (a neutral third-party doctor, or (4) a Required Medical Examination (RME) doctor (this is a doctor hired by the insurance company to conduct an exam). No other sources of impairment ratings will be considered in the claim.
The Impairment Rating Must Be Done in a Very Specific Way. Impairment ratings are issued using an extensive set of instructions that are provided in a book called the Guide to Evaluation of Permanent Impairments. This book, which is effectively the "Bible" of impairment ratings, dictates the exact percentages of impairment that must be assigned to various types of injuries. In some cases, the Guide allows a little room for judgment calls, but for the most part it is supposed to be applied in a uniform, predictable manner.
The Impairment Rating Can Only Apply to Accepted Injuries. As I have indicated before, if a worker has injuries that have not been "accepted" by the insurance company, they won't be part of the rating. Excluded conditions can sometimes have a huge impact on a claim.
An Impairment Rating Can Be Zero. A person performing an impairment evaluation doesn't have to give a rating. Sometimes ratings will be zero percent, or there may be a certification that there is no permanent impairment.
The Designated Doctor Carries the Most Weight. In the event that more than one doctor undertakes an impairment rating, then the designated doctor's decision will carry the most weight. If either the insurance company or the injured employee do not like the designated doctor's decision, they must file for a dispute resolution to change the outcome of the case.
Once an injured worker has received an impairment rating, a 90 day countdown begins. Unless the worker takes action to challenge it within that period of time, it will become a fixed part of the claim. As such, once a rating is received, it is important to take action to make sure that it was correctly done, and that it takes all of the relevant injuries into account. An experienced workers' compensation attorney can help with that evaluation.