A PPI or Permanent Partial Impairment rating is integral to the Indiana workers’ compensation system. If you’ve been injured in a work-related accident, knowing how the PPI rating works is an important part of ensuring you win the compensation you deserve. It’s especially critical to understand what your PPI rating means so you can contest it if necessary. Attorney Randall Sevenish can assist you with all aspects of your Indianapolis workers’ compensation case.
The Basics of a PPI Rating in Indiana
The PPI rating is the percentage by which a person’s body has been injured. More specifically, it refers to the loss of function of either a part of the body or the entire body. When a workers’ compensation case is filed, and the insurance company processes it, the final step is to have a doctor assign the injured worker a PPI rating. This rating will affect the amount of compensation the worker receives.
A PPI is not assigned until a worker reaches what is known as the Maximum Medical Improvement, or MMI. The worker’s MMI indicates that the injury has healed as much as it’s going to heal. The treating physician, or sometimes another doctor if the worker is referred out, will determine the PPI rating once the worker achieves MMI. A Functional Capacity Evaluation, which gauges the worker’s range of capabilities, may be conducted as part of this.
How Is the PPI Rating Set?
In assessing an injured worker’s PPI rating in Indiana, doctors use the American Medical Association’s Guides to the Evaluation of Permanent Impairment. The purpose of this publication is to give physicians a reliable way to measure the degree of lost functionality, either in a specific body part or the whole body, depending on the nature of the accident.
State guidelines advise that PPI ratings should be assigned to the most specific body part possible. For example, if the injury affected only the finger, the rating should include only that part and not the entire arm or the rest of the body. An exception to this is an accident in which multiple body parts were injured. Also, some injuries, such as amputations or partial amputations, are more complex and don’t fit neatly into black-and-white guidelines.
How Does the PPI Rating Affect Workers’ Compensation?
PPI ratings are based on how impaired the affected body part is. Indiana uses a statutory workers’ compensation schedule by which everyone is given the same amount of money for the same percentage of impairment. A doctor determines the PPI based on the state schedule; the schedule, in turn, assigns a degree of impairment to the worker. The degree corresponds to the dollar amount that will be awarded. The following are the schedules for each degree of impairment:
- Degrees 1 to 10: $1,750
- Degrees 11 to 35: $1,952
- Degrees 36 to 50: $3,186
- Degrees 51 to 99: $4,060
If, for example, a workplace injury results in loss of the employee’s big toe (great toe), the schedule assigns 12 degrees. Assuming the doctor assesses a 100% PPI rating, the worker will receive $1,750 for each of the first 10 degrees of impairment and $1,952 for the last two degrees. The worker’s total amount of compensation would be (10 x $1,750) + (2 x $1,952), which equals $21,404.
There are cases in which the state schedule does not list the body part that was lost in the accident. In a situation like this, the worker will receive what are called unscheduled benefits based on the total amount of bodily function that was lost. The percentage of impairment would be the same as the degree listed in the schedule.
For instance, a doctor may decide that the worker has a 20% impairment of a body part that is not listed. The worker would receive the same amount of benefits as if he or she had lost a body part that is listed as 20 degrees on the schedule. The amount of compensation would therefore be 20 x $1,952, or $39,040.
What If the Worker Disagrees With the PPI Rating?
Unfortunately, doctors have a major incentive to assign an unfairly low rating to an injured worker. They are selected and paid by the workers’ compensation insurance company which naturally wants as conservative a PPI rating (and therefore as small a payout) as possible. Some doctors are even known for assigning low PPI ratings, which in many cases equate to lower workers’ compensation payments than workers deserve.
If this happens to you, an experienced workers’ compensation attorney can negotiate with the insurance company for a more beneficial rating. Our firm may also refer you to another doctor who will conduct an independent evaluation that will fairly assess your impairment. We will then present this opinion to the insurance company to attempt to obtain a better impairment rating and payout for you. If the insurer refuses to negotiate in good faith, we can take your case to court.
Working to Maximize Your Indianapolis Workers’ Compensation Award
Your Permanent Partial Impairment rating will affect your workers’ compensation benefits, but you do have legal options in the event it is unreasonably low. The first step you should take is to reach out to Sevenish Law Firm. Give us a call today or contact us online to have us review your case.
