Maximum permanent partial disability rate

Unless you are permanently and totally disabled the most you will be paid for having a permanent injury is based on specific state calculations and the medical rating (degree of impairment by either the authorized doctor, a Division IME doctor or by order). Your wage is often a factor in the calculations as is your age. But what I'd like to point out in this note is that the payment is biweekly until the amount is exhausted. A claimant can get an advance or even a lump sum but otherwise the amount is paid out every two weeks at a set rate. The highest rate for these biweekly checks changes each year but at present it is $413.95 a week. It can be less as it must be computed for each person. What this can mean is that you've been receiving temporary benefits of two-thirds your average wage which can drop down to the rate set for permanent benefits. The theory is that when permanency is determined you can return to work or find new work and receive the biweekly permanency checks anyway unlike temporary money where earnings are deducted. You or your attorney can get an advance if properly done so you might look into it. All this pertains to whole person impairments only. Scheduled extremity amounts are paid out differently. Here is the link for the maximum calculation:
http://www.coworkforce.com/DWC/FormsDeskAids/DESKAIDS/PDFDeskaids/Desk_Aid_4_Max_Rates.pdf

The Social Security Listings

Whether hurt at work or if your health is disabling there may come a point when you apply for Social Security disability. Even if the system is slow it still is an important safety net for those truly unable to sustain work. The listings are severe health problems that have made the list so that if you meet a listing it can mean you are truly disabled enough to deserve disability benefits. However this still requires that you meet other legal requirements but it is a big step to obtaining benefits. For example if you cannot ambulate effectively it may meet one of the listings. The Social Security Administration has very specific details on the listings and I have provided a link to them below.
http://www.ssa.gov/disability/professionals/bluebook/listing-impairments.htm

Can you return to work or are you totally disabled?

Often a person may not be able to return to his usual trade or occupation. This can occur because of restrictions or complications from the work injury as set forth by a doctor. Sometimes a person may have worked for many years and really enjoyed his trade but now is not sure what he can do. If you are only permanently and partially disabled or restricted you may receive compensation but not anything else. What then? Does the insurer have to retrain or put you into voc rehab? Not usually and you may wish to contact the state Vocational Rehabilitation office. There is an earlier blog post on this which I posted. But then if you think it is unfair and seek permanent total benefits (which can be substantial) it is your burden to prove it. Your attorney can apply for a hearing and line up his witnesses and evidence. He may also discuss a settlement. However if it goes to a hearing what will the other side say when you try to show you cannot work at all? Well, the other side can seek to show through its witnesses or evidence that you can work, even if just part time. Believe it or not if they show this and the Judge accepts it then you cannot get further benefits beyond what is allowed by an admission or the Judge. Just thinking it is unfair and no Judge would do this is a mistake. You must be ready to prove your viewpoint if it goes to a hearing. It is a true legal battle with high stakes. Here is a sample of some of the jobs that may be asserted through evidence you can do part time: "The claimant can work as a ticket seller, hotel desk clerk, restaurant host, pizza deliverer, customer service clerk, cashier, automobile salesperson, and sales clerk." This list does not end here...it can go on and on to include working at home! Decent pay comparable to your trade is not a legal consideration. This means it can be difficult to establish you can no longer work. Hard as it may seem it is quite possible to show this but it requires a solid effort. In this area your attorney may do the most good for you. There is caselaw to consider. There is vocational evidence to obtain. There may be further medical evidence to develop. Much can be done here so blindly accepting the insurance viewpoint is not wise.

Medical Transparency

Effective Jan. 1, 2008 a new law now requires more disclosure regarding doctors in the state of Colorado. This law has been signed and will apply after Jan 1st. It impacts workers comp in the sense that soon now you will be able to check further on any doctor to ascertain discipline or other adverse matters. In other words it will be harder to hide behind the traditional cloak of secrecy or nondisclosure that has been the case with the medical community in the past. Here is the link to the new law:

http://www.statebillinfo.com/sbi/index.cfm?fuseaction=Bills.View&session=07&mode=0&sortby=3&filter=b&srch=transparency&page=1&billnum=HB07-1331

Social Security Average Wait 17 Months!

Here is a link to a USA Today article that points out the average wait time for a hearing to appeal a Social Security disability denial is now 17 months. Staffing is down and claims are up so this makes for problems. Please realize this can be solved by Congress and the President providing more funds for the Social Security Administration. The fact is that it is not happening, at least not yet. Political change and a social willingness to deal with this...making it a priority is needed. To know we are a great and free country but cannot take care of our old, disabled or injured is unfortunate. So pay attention to those seeking your vote...what plan do they have to solve this?
http://www.usatoday.com/news/washington/2007-07-29-disabled_N.htm?csp=34

New Court Case on Apportionment

In Colorado apportionment relates to reducing a permanent impairment calculation or reducing benefits because of previous impairment(s). The law has changed by caselaw and statute over the years. The issue remains a complicated one. In this case the claimant had multiple back problems but returned to work until his latest injury. His treating doctor did not apportion but the DIME doctor did. A DIME is a Division Independent Medical Examination and has special value and weight in a workers comp case. Here the DIME doctor reduced the impairment rating because of what he considered some prior impairment that allowed apportionment. The claimant appealed and in this Court of Appeals case tried to assert this was wrong and there should be no apportionment. The case is troubling in that there was no actual previous impairment issued in his prior injuries. Also he was working without further treatment or symptoms from those prior injuries. The claimant argued how can it now count against him? Nonetheless the Court ruled that apportionment was proper and that it is more a matter of there is not enough evidence to overturn the DIME opinion to apportion. I do understand that this is a complex matter but I have to question the speculative nature of a DIME doctor finding prior impairment when there was no documented or objective evidence of prior impairment. In any event here is a link to the court decision just issued on July 26, 2007:

http://www.cobar.org/opinions/opinion.cfm?OpinionID=6246&CourtID=1

Medical Ops....UPDATE!

Yesterday a Denver station Channel 7 noted that Medical Ops Management is now out of business. Here is a link to the full article:
http://www.thedenverchannel.com/news/13747301/detail.html

This pertains to doctor examinations going through the above noted company. It has been alleged that doctor reports were altered or changed without approval by the doctor. Since this can affect the treatment and outcome of cases it was a very serious matter as reported by this station.

Attorneys do make a difference!

One statistic kept by the state of Colorado shows that having an attorney does make a difference in the amount of your benefits. On average a decent attorney can increase your compensation by around 150% when compared to not having an attorney. In some cases this is much much higher. Insurance companies rarely admit someone is totally disabled and here the difference can be huge. One recent case resulted in $180,000.00 additional dollars or 4 times more then first offered. In other cases the workers comp doctor may say the person is released without impairment only to be proven wrong. This can lead to both medical and dollar benefits. The injured worker is led to think the doctor said he is without impairment so the case seems worth little. Turns out more treatment is needed and likely far more dollar benefits then zero! You'd be surprised how many people seek out an attorney when they are denied further care and simply want to get well. So while there are no guarantees attorneys frequently do make a big difference in most cases. In any event here is the stat on attorneys as of the year 2004...click here.

National Health Care?

Health coverage under workers comp is variable. One plus is that for covered and reasonable care the benefit is 100% coverage as long as necessary. The problem is that insurers often deny coverage for one reason or another and this can slow down or eliminate needed medical care. Also you go to one doctor for your injury, another for your overall health and must deal with varying coverages. VA, Medicare, Medicaid, perhaps even coverage under auto policies and a great array of insurance companies all with their own set of rules and payment plans make our current health care system terribly inefficient. To limit benefits is to ration them so the cry that we have the best health care system is questionable. Lately I've come around to accept that drastic change is called for and so have others. Even physicians have a website that promotes a national plan. While I strongly believe in free enterprise I realize the current hodgepodge is not working. One recent proposed law to allow Medicare to negotiate drug prices like the VA does failed and so lower drug prices for medicare beneficiaries was denied. To me that is not free enterprise it is favorable treatment for the drug companies. In any event here is the link to the Physicians website with various articles on healthcare:
http://www.pnhp.org/news/articles_of_interest.php

Less Hearings and Applications for Hearing

According to the Division (Workers Comp) website it appears very clear that over less then ten years there has been a dramatic decrease in hearings and even hearing applications. There may well be many factors to explain this but the stats speak for themselves:

1997 : 12840 hearing applications were filed; actual hearings held were 1987

2006 : 9595 hearing applications were filed; actual hearings held were 1166

By the way the population of Colorado increased ten percent in the last ten years.

Here are the latest Treatment Guidelines

A link is provided so you can see what the latest treatment guidelines are for Colorado physicians to treat in areas like chronic pain, lumbar, cervical, cumulative trauma and the like. These Guidelines are made part of the workers comp rules so they are important. Certainly the treating doctor should be able to treat as needed but the Guidelines are relevant to any treatment.

http://www.coworkforce.com/DWC/Rules/Rules%20pdf/RulesLinksTable.asp#Rule_17

Injured Worker Comments, Suggestions or Questions?

I've set it up so that anyone can comment or leave questions for me. Just click on the comments and leave your question or suggestion...but do so either anonymously or by first name only please. While I cannot guarantee an answer or reply I promise to look at any such comment/suggestion/question. Sometimes we just need to vent or provide our own personal views so if you feel the need then you are free to post your comment on our blog. For example I personally feel the workers comp system in Colorado can be improved upon with better laws. Change can come when we stand up and voice our concerns. Silence only validates the status quo. But if you need professional or individual advice and do not have a lawyer...call my office at 719-596-8900 or email me at workcomp@usa.net.

Workers Comp does not cover all losses

It is important to emphasize that coverage is limited in work injury cases. Workers comp is a creature of statute which sets forth what is covered and what is not. The biggest problem is when someone has a loss of his or her trade or occupation because of a permanent injury and permanent restrictions. Usually some permanent benefits are paid and an effort can be made to maximize these but nothing is paid for the loss of a trade or occupation unless you are permanently and totally disabled. Vocational rehab is seldom offered by the insurer so if this is your situation contact the State Department of Vocational Rehabilitation. This area remains an area of concern and on my wishlist for legislative change. I would strongly urge those who may be in this situation to consult with an experienced workers comp attorney. Never assume the insurers position on your entitlement to benefits is accurate. Moreover if the company designated doctor has released you without impairment or restrictions do not assume that is correct either. You do have recourse here. On numerous occasions such doctors have said no permanent injury and been flat wrong.

Social Security Backlogged

Both nationally and locally the process to obtain Social Security disability benefits is backlogged especially at the hearing level. If denied benefits a claimant can, if he timely acts, appeal for a hearing. It is taking over a year or longer to obtain that hearing in Colorado. Elsewhere the wait can even be longer. It does appear that justice delayed is justice denied. Hopefully over time this backlog can be cleaned up. At my last hearing the hearing Judge was in Tucson and we had the hearing by way of television. Documents are now being scanned in to make a CD so that they are easily handled. All of this provides some hope but it will take some time to speed up the process. Sometimes though it seems like one step forward and two steps back.

May 31, 2007 Court case on prosthetics

If your artificial hip is injured on the job is it covered to receive benefits? Yes said the Court of Appeals in this case. The insurer tried to rely on an old Colorado case that said if your wooden leg was hurt it was not a personal injury just injury to property which was not covered by workers comp. The court said the statutes now do cover injury to prosthetic devices so that old case no longer applies. But can you imagine in that old case being told it's your problem not a workers comp problem since only live legs are covered? At least now its covered though the statute does define what is covered and what is not. In any event here is a link to the case:
http://www.cobar.org/opinions/opinion.cfm?OpinionID=6163&CourtID=1