In most Texas workers’ compensation cases it becomes necessary to dispute an impairment rating. The system is set up against injured workers right now. This leads to premature impairment ratings that cut off your benefits before you have healed and returned to work. In order to protect yourself and your benefits, you will have to know what to do when an impairment rating gets assigned.
What Is An Impairment Rating?
An impairment rating is a measurement of the permanent damage to your body resulting from your work injury. It is based on the damage resulting from the “compensable” injury. This means that it only includes the damage from the diagnoses that the insurance company agreed to cover. The impairment rating must follow a book entitled, “The AMA Guides To The Evaluation Of Permanent Impairment.”
An impairment rating is usually based on your diagnosis and symptoms or your lost range of motion. If you have a back injury, your diagnosis and symptoms are the basis of the impairment rating. If you injured a joint, then lost range of motion is usually how your impairment rating is determined. When there are multiple injuries, each of them get a rating and they get added together.
Why Do You Need To Dispute Your Impairment Rating?
An impairment rating is supposed to be assigned only after you reach maximum medical improvement (MMI). Maximum medical improvement is when you have recovered from your injuries to the point that there is no longer any reason to expect further recovery. If you think that your impairment rating was given too soon because you expect to continue to get better, then you will want to dispute an impairment rating.
Another issue that affects the decision to dispute is the impairment rating itself. Doctors make mistakes all the time and assign incorrect impairment ratings. Sometimes they certify a rating that is too low and need to be questioned about it. As you can imagine, this is usually how the insurance company doctor does it.
A third reason to dispute an impairment rating is if there is an extent of injury issue. This happens, for example, when you have a herniated disc with nerve damage in your lumbar spine but the insurance company only accepts liability for a back contusion. In these situations, you must dispute the impairment rating in order to preserve your ability to continue to get benefits while you get medical treatment for the more serious injuries.
What Happens To Your Benefits When You Get An Impairment Rating?
Before you reach MMI, you are eligible to get temporary income benefits to replace your lost wages. When you get placed at MMI, your eligibility for TIBs ends. From that point forward you will not get benefits for lost wages unless you overturn the impairment rating. That only happens if you dispute an impairment rating.
After you reach MMI and get an impairment rating, the type of benefits you get change to impairment income benefits. These benefits only pay 3 weeks for every percentage of impairment you have. This means that if you get a 5% impairment rating, you will only get 15 weeks of benefits and then the money on your case is gone. You have to dispute an impairment rating to keep your eligibility for lost wages so you can still get paid if you have surgery down the road.
How Can I Dispute An Impairment Rating?
There are two ways to dispute an impairment rating. It’s very confusing to figure out which way is the correct way to file the dispute in any given situation. That’s why it’s a good idea to let a Texas workers’ compensation attorney take a look at it. That way you can get advice on the correct way to file your dispute.
The rule is that you can dispute an impairment rating by either requesting a Benefit Review Conference or requesting a designated doctor (DD). In both instances you should note on the form that you are disputing the impairment rating that you already received. The catch is that requesting a DD only works as a dispute if there has never been a DD on the case before for any reason.
If you request a DD when there has been one earlier in your case, then that doesn’t count as a dispute. That counts as a missed deadline. A request for a Benefit Review Conference always works to dispute an impairment rating. That is the best way to guarantee that you are filing a valid dispute and protecting yourself.
Remember that the deadline to file a dispute is 90 days from the day that you receive a copy of your first impairment rating or notice from the insurance company. If you miss that deadline then the rating becomes final and there is nothing you can do about it.
For more information about Texas workers’ compensation law, check out our FREE book, “The Ultimate Survival Guide For Texas Injured Workers: Everything You Need To Know To Beat Insurance Companies At Their Games.” And to go even more in depth, subscribe to our YouTube channel.
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