The last thing that any worker wants to face is suffering a devastating injury while on the job. Fortunately, the workers’ compensation system provides a method for compensating workers for their injuries while they heal and recover. Each state is required to have a workers’ compensation benefit program, but the rules and requirements of each system vary. One universal similarity between each state’s systems is the exclusive remedy rule. In exchange for benefits to compensate the worker for their injury, the workers’ compensation system requires the injured employee to forgo his or her right to sue the employer for the injuries he or she sustained.
The workers’ compensation system operates independently from the judiciary, with its own judges, hearings, procedures, and trials. There are some instances, however, in which a worker or employer may appeal a workers’ compensation case to a judicial court. To do so, however, the party seeking review must exhaust all appellate remedies made available through the worker’s compensation system.
One of the most heavily litigated aspects of a workers’ compensation case is the determination of whether the worker’s injuries are either partial or total. A partial disability occurs when the worker has suffered an injury but is not totally prevented from working. Partial disabilities occur as the result of a wide variety of medical conditions, including carpal tunnel syndrome, amputation of a body part, hearing loss, knee injuries, nerve damage, PTSD, and loss of vision in a single eye. A partial disability can be either temporary or permanent in nature. Permanent disabilities often include severe back injuries like herniated discs, nerve damage, and amputations.
After filing a workers’ compensation claim, the employee will typically be required to complete a medical examination to determine the extent of his or her injuries. A partial disability typically occurs when the employee’s injury is determined to affect 25 percent to 50 percent of the employee’s physical or mental capabilities. Many workers’ compensation insurance companies will fight the medical professional’s opinion regarding the extent of the injury. In this case, the insurance company can request a Qualified Medical Examination, or QME. During a QME, a neutral third-party physician will examine the injured worker and render an opinion regarding the nature and scope of the injuries. If the worker has retained legal representation, an Agreed Medical Examiner, or AME, will perform the exam. For this proceeding, the attorney and the insurance company must agree upon the physician to perform the examination.
After establishing the nature and scope of the worker’s injury, the medical provider will continue to examine the worker’s progress. If the worker is on a temporary partial disability basis, benefits will continue until either the worker retains to work, or a physician declares the worker physically fit. A doctor may conclude that a worker has reached a level of maximum medical improvement, or MMI, which means that the worker’s medical condition has healed as much as possible with the assistance of medical attention. At this time, the worker may be put on a permanent partial disability status, thereby qualifying the worker for permanent disability benefits. To determine the amount of compensation that a partial disability sufferer will receive, most states use a financial schedule. In some states, the amount of compensation is determined by the extent of the partial disability.