Permanent Partial Impairment ratings are given by the doctor at maximum medical improvement. These are intended to document the loss of use you have to your injured body part.

The legislature has assigned a value, expressed in weeks, to your body:

Back 300 weeks

Arm 240 weeks

Hand 200 weeks

Thumb 75 weeks

First finger 45 weeks

Second finger40 weeks

Third finger 25 weeks

Pinkie finger 20 weeks

Big toe 35 weeks

Other toes 10 weeks

Foot 144 weeks

Leg 200 weeks

Eye 120 weeks

A “week” is one week of your compensation rate – the amount you were paid each week while out of work.

There are a few things to keep in mind about ratings. First, ratings are the primary means of compensating or settling with an injured worker who can return to his or her old job or make just as much money as before. If you aren’t able to return to your old wage-earning levels don’t worry about your rating.

Second, if the adjuster doesn’t like the rating that her hand-picked doctor gave you then she can send you for a second opinion on the rating. On the other hand if we don’t like the rating we can get a second opinion with a doctor of our choosing and the adjuster has to pay for it.

Third, the rating is usually paid out week by week, not in a lump sum. The adjuster may do it in a single payment but it’s likely she won’t and she’s not require to do so.

Fourth, as with the rest of the money you receive from workers’ compensation this is tax-free money.

There is no hard and fast rule as to how the doctor gives you restrictions. Some doctors will order a Functional Capacities Evaluation. They will review the recommendations from the FCE and either adopt those as your permanent restrictions or modify them.

Other doctors will use their personal judgment regarding what you can do. Many of these doctors scoff at the increased use of FCEs and are confident they can accurately assess safe levels of physical activity.

A third group of doctors are inclined to give you no set restrictions at all but encourage you to watch yourself or “find another line of work.” These doctors are undoubtedly well intentioned but often create real problems in workers’ compensation claims. As we’ve heard, this set of doctors explain they are concerned that giving you written restrictions will handcuff you indefinitely, especially if you are looking for work with a new company. On the other hand, we think it is a little naïve to expect an employer to accommodate a worker’s request for job modifications when the doctor hasn’t specifically said the injured worker needs it.

An example of where this third group can inadvertently create problems occurred for us when a doctor released our client without any restriction in writing. Our client insisted that the doctor had told him to find a different line of work. Based on this, the client did not return to work the next day. Not showing up for work he was summarily terminated. The insurance adjuster then moved the Industrial Commission to cut off his weekly checks on the basis that he had no documented disability.

We took the doctor’s deposition and he seemed astonished. “But, I told the rehabilitation nurse that he could not return to his old job. I just didn’t want to limit him in terms of his future options.” When asked why this didn’t appear anywhere in her report the nurse simply replied that she’d asked advice from the adjuster. The adjuster told the nurse to leave it out of the report, as she wanted to terminate the injured worker’s checks. The rehabilitation nurse went along with the adjuster’s request.

It would be difficult to overstate the number of clients who have come to us over the years frustrated when a doctor or therapist suggested they were depressed. In our society depression is often seen as a character flaw, a weakness, or an excuse. Without doubt, these injured workers are genuinely offended that someone is suggesting that “it’s all in their head.”

On the other hand a prominent psychiatrist who deals with a lot of injured workers testified in a deposition that 80% of people who suffer from chronic pain, (defined as pain lasting for at least six months), will develop clinical depression. Our bodies are just not made to deal with high pain levels for that long of a time. And the fact that former co-workers, adjusters, and rehabilitation nurses are often less than sensitive to an injury that seems to go on indefinitely doesn’t help.

When speaking with doctors about this most of them have readily agreed that it’s very rarely JUST in someone’s head. But they do cite numerous studies, which confirm what the psychiatrist detailed and note that those studies often suggest that if the mental outlook improved then the patient’s capacity to cope with the pain would improve. That doesn’t mean the pain goes away… it doesn’t. It’s just that it’s easier to deal with it and function in spite of it.

We’ve long recommended that our clients develop at least an informal network of people who can provide emotional support as you work through this. That’s all the more true when you don’t get better on schedule, when you cannot return to your old job, or when financial pressures get increasingly difficult. This may be family (although it’s already tough on family), a couple of close friends from church, or a counselor. The important thing is to not try to tough it out. We’re all human and when you have difficult workers compensation case it’s not time to try to be superman.