Total Permanent Disability vs. Partial Permanent Disability – What’s the Difference?
Maximal Medical Improvement is when an injured worker plateaus in improvement after an injury and is no longer expected to improve either with or without further treatment. Any residual disability at this point is considered to be permanent. The distinction between temporary and permanent disability is the level at which the injured worker is expected to remain, and may be compensable. The following applies to the Workers’ Compensation system in California.
Permanent Disability
Permanent Disability refers to a lasting impairment or injury that significantly affects an individual’s ability to perform their job or daily activities. The injury or condition has plateaued and is unlikely to substantially improve with or without further medical treatment. Permanent disability can manifest in two primary forms:
- Total Permanent Disability (TPD): severe impairment rendering the individual incapable of performing any gainful work in the open labor market. Examples of injuries that are classified as total permanent disability are total blindness in both eyes or loss of use of both hands.
- Partial Permanent Disability (PPD): the injury or impairment substantially reduces their ability to perform specific tasks or occupations, though they may or may not be able to resume some work. Most Orthopaedic injured workers have less than total permanent disability.
When an individual reaches a point where their medical condition is not improving and unlikely to change considerably in the next year with or without medical treatment, their condition is considered at Maximal Medical Improvement (MMI), an updated term from the more archaic Permanent and Stationary distinction.
Partial Disability
Partial Disability characterizes a scenario where an individual has sustained an injury or impairment that, while affecting their ability to perform certain ADL tasks or work types, does not wholly incapacitate them from all work and non-work ADLs. This type of disability is more common in Workers’ Compensation claims. Partial disability benefits are often awarded to compensate for the reduced earning capacity due to the injury, accounting for the limitations it imposes on the individual’s ability to perform certain work and non-work ADLs. Most Orthopaedic injuries fall under this distinction. Actual rating of multiple disabilities is performed by raters at the DWC.
Role of QMEs in Evaluations
A QME can determine an injured worker to be permanently disabled but does not actually calculate the permanent disability; this is performed by a rater at the DWC. The rater uses the QME’s permanent impairment rating in order to determine the disability. This process follows specific guidelines set forth by the AMA Guides 5th Edition. A QME will conduct a thorough medical evaluation followed by an assessment of the whole person impairment using the AMA Guides based on established criteria for the particular injury or condition. Determining the whole person impairment rating takes into account the extent of functional limitations, loss of range of motion, sensory and/or motor strength deficits, as well as DBE (diagnoses-based estimates), among other factors. Based on the evaluation findings, the QME assigns a percentage rating of whole person impairment for each injured body part. By analyzing a QME’s report, the rater determines the overall permanent disability rating.
A rating of 100 percent indicates that the injured worker has a permanent total disability. A rating between 1 to 99 percent indicates a permanent partial disability, which has vastly different implications for settlement.
A QME’s role in Workers’ Compensation is to evaluate the extent of a disability or impairment, considering various factors like medical records, physical examinations, functional limitations, and the impact of the injury on an individual’s work and non-work ADLs. Their assessments bear substantial weight in determining the level of permanent disability benefits accorded under Workers’ Compensation laws, significantly influencing the support and aid available to the injured worker.