Impairment Ratings in Louisiana Workers Compensation

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In Louisiana workers compensation, it is often helpful to determine how much - or to what degree - an injured employee has been injured.

For example, key questions in many Louisiana workers compensation claims often include the following:

    • Is the injured employee unable to return to work because of the employee's work-related injury or illness?
    • Is the injured employee able to return to some type of different work - such as light duty work - even though the employee continues to suffer from a work-related injury or illness?

Many times it is the workers compensation insurance company which seeks to determine how much - or to what degree - an employee has been injured.

And frequently, the workers compensation insurance company seeks this information because it is considering settlement with the injured employee.

In order to determine how much - or to what degree - an employee has been injured, the workers compensation insurance company often will seek an evaluation to determine an impairment rating. 

What Is an Impairment in Louisiana Workers Compensation?

In Louisiana workers compensation, an impairment is defined as a medical problem that affects the employee's functioning of his or her body and prevents the employee from using his or her body the same way that the employee did prior to the employee's accident, injury or illness.

An impairment in Louisiana workers compensation can be:

    • Physical or mental in nature;
    • Caused by an injury or by an illness;
    • Permanent or temporary; and
    • Severe or mild.

Impairments in Louisiana workers compensation usually affect an injured employee's ability to perform his or her job, and therefore often have a major impact on an employee's workers compensation claim.  

Thus, the way in which impairments are evaluated is extremely important to the employee's workers compensation claim.

Impairments Versus Disabilities

In Louisiana workers compensation, an "impairment" is not necessarily the same as "disability."

Specifically, "impairment" is a medical condition meaning an anatomical or functional abnormality or loss following maximum rehabilitation, while "disability" is a legal term describing when an individual is unable to have gainful activity because of an impairment.

In other words, impairment refers to the issue affecting the physical or mental condition of an employee, while disability refers to the limits and restrictions on an employee's ability to perform his or her job.

For example, let's say a desk job worker and a warehouse worker at the same company somehow suffer the exact same back injury at work.  Since the injury is the same, both employees have the same exact impairment.

But if the desk job worker can go back to work, then he is not disabled; while if the warehouse worker cannot can go back to work, then he is considered disabled. And the warehouse worker will be entitled to different workers compensation benefits than the desk job worker, even though they suffered the exact same back injury at work.

What Is an Impairment Rating in Louisiana Workers Compensation?

In Louisiana workers compensation claims, it can be important to quantify or measure how much an injured worker has been affected by a work-related injury or illness.

This is where impairment ratings come into play.

Essentially, an impairment rating is simply an assessment of the severity of an injured worker's impairment.

Impairment ratings in Louisiana are based on the 6th American Medical Association Guides to the Evaluation of Permanent Impairment.

Again, in Louisiana workers compensation, an "impairment" is a medical condition meaning an anatomical or functional abnormality or loss following maximum rehabilitation.

So an impairment rating can typically only be properly determined if the employee is at Maximum Medical Improvement (MMI), which means the completion of all contemplated treatment, or that all the treatment that has been offered has been declined.

At Maximum Medical Improvement (MMI), a doctor will often tell the injured employre that his or her medical condition won't improve any more, and that the focus should then turn to managing the medical condition.

Whole Person Impairment Ratings

Typically, an impairment rating in Louisiana workers compensation provides a percentage number – between 0 and 100 – to the level of impairment, so that the injured employee and the workers compensation insurance company can understand how much the worker has been injured.

However, usually impairment ratings are different for each body part, and then converted to a "whole person" impairment ratings. 

In other words, when different body parts of an injured employee are affected by the work-related accident, then the impairment ratings for each body part are combined into a "whole person" impairment rating. 

For example, when impairment ratings are different for each body part combining whole person impairments, an injured worker might have a 40% whole person impairment of one body part and a 16% whole person impairment of second body part. These impairments, using a combined values chart, may translate into a 50% whole person impairment.

In another example, an employee with an injured finger may need to determine the relationship of a finger impairment to whole person impairment. In such a case, an injured worker might have a 40% impairment of the hand, which equates to a 36% impairment of the upper extremity, which equates to a 22% impairment of the whole person.

How Do Impairment Ratings Work in Louisiana Workers Compensation?

As noted above, an impairment rating provides an estimate of an individual's physical or mental impairment in the form of a percentage, either of the whole employee and/or of just the employee's affected extremities (such as the employee's arms or legs).

This impairment rating percentage can be used by a physician to determine if an insured employee is able to return to his or her job position, or another different job position.

Typically, in such a case, the employee's treating physician may refer the employee to a Functional Capacity Evaluation (FCE) in order to obtain an impairment rating for any permanent impairment that the employee may have and/or to define any permanent work restrictions.

Additionally, this impairment rating percentage is sometimes converted by the workers compensation insurance company to determine a monetary award.

However, an impairment rating is NOT used in order to determine Supplemental Earnings Benefits (SEBs) or Temporary Total Disability (TTD) benefits or Permanent Total Disability (PTD) benefits.

Instead, in Louisiana workers compensation, this impairment rating percentage is used to determine a monetary award under LA R.S. 23:1221 for Permanent Partial Disability (PPD) benefits, which concerns cases of amputation or loss of use of parts of an injured employee's body.

In fact, because Louisiana workers compensation provides credits for payment of Temporary Total Disability (TTD) benefits or Supplemental Earnings Benefits (SEBs) against any Permanent Partial Disability (PPD) benefit obligations, it is rare that any impairment rating will be required for a Louisiana workers compensation claim.

Finally, it is important to recognize that Louisiana workers compensation insurance companies frequently use impairment ratings during settlement negotiations when determining the settlement amounts it will offer. 

Impairment Ratings and Permanent Partial Disability Indemnity Benefits in Louisiana Workers Compensation

Permanent partial disability (PPD) benefits are monetary benefits for the injured employee who is able to perform some work, but has suffered permanent or disfiguring injuries such as amputation (the loss of a limb or finger or other), significant scarring, hearing loss, blindness, internal injuries or other catastrophic injuries.

If an injured employee is unable to perform his or her usual or customary occupation, but can engage in some other gainful employment for which he or she is suited by education, training or experience, then this employee is deemed to be partially disabled. 

Permanent partial disability (PPD) benefits are paid as a lump sum payment, according to an amount set under Louisiana law.

Unlike other disability benefits - such as  temporary total disability (TTD) benefits and supplemental earnings benefits (SEBs) - which compensate an injured worker for wage loss, permanent partial disability (PPD) benefits compensate an injured employee for loss of use of a body part or for disfigurement. 

This is because permanent partial disability (PPD) benefits are based on impairment or disfigurement - not on wage loss, like temporary total disability (TTD) benefits and supplemental earnings benefits (SEBs).

Calculation of Permanent Partial Disability Indemnity Benefits Using Impairment Ratings

Louisiana law provides a specific schedule of benefits that are due for total loss of specific body parts.

In the following cases, workers compensation benefits shall be solely for anatomical loss of use or amputation and shall be paid to the injured worker as follows:

    1. For the loss of a thumb, 66.67% of wages during 50 weeks.
    2. For the loss of a first finger, commonly called the index finger, 66.67% of wages during 30 weeks.
    3. For the loss of any other finger, or a big toe, 66.67%of wages during 20 weeks.
    4. For the loss of any toe, other than a big toe, 66.67% of wages during 10 weeks.
    5. For the loss of a hand, 66.67% of wages during 150 weeks.
    6. For the loss of an arm, 66.67% of wages during 200 weeks.
    7. For the loss of a foot, 66.67% of wages during 125 weeks.
    8. For the loss of a leg, 66.67% of wages during 175 weeks.
    9. For the loss of an eye, 66.67% of wages during 100 weeks.
    10. Loss of both hands, or both arms, or both feet, or both legs, or both eyes, or one hand and one foot, or any of two thereof, or paraplegia, or quadriplegia shall, in the absence of conclusive proof of a substantial earning capacity, constitute permanent total disability.
    11. The loss of the first phalanx of the thumb or big toe, or two phalanges of any finger or toe, shall be considered to be equal to the loss of one-half of such member, and the compensation shall be one-half of the amount above specified.
    12. The loss of more than one phalanx of a thumb, or more than two phalanges of any finger or toe shall be considered as the loss of the entire member; provided, however, that in no case shall the amount received for more than one finger exceed the amount provided in this schedule for the loss of a hand, or the amount received for the loss of more than one toe exceed the amount provided in this schedule for the loss of a foot.
    13. Amputation between the elbow and the wrist shall be considered as equivalent to the loss of a hand and amputation between the knee and the ankle shall be equivalent to the loss of a foot.
    14. A permanent total anatomical loss of the use of a member is equivalent to the amputation of the member.

In all these situations listed above (which involve a permanent partial anatomical loss of use or amputation), the injured worker will receive compensation based on the percentage of impairment to the body part.

So if the injured worker has a 50% impairment rating, then the worker will receive 50% of the allowed weekly benefits listed above.

However, the workers compensation insurance company may be entitled to a credit for other disability benefits paid against any amount of permanent partial disability.

Also, the injured worker will not receive any benefits for permanent partial disability unless anatomical loss of use, or amputation, or loss of physical function is greater than twenty-five percent as established in the American Medical Association "Guides to the Evaluation of Permanent Impairment." 

So, for example, if an injured worker's accident results in the total loss of that worker's arm, the employee would be entitled to 200 weeks of permanent partial disability benefits.

And if this accident resulted in a 50% loss of use of that employee's arm, then the employee would be entitled to 50% of that 200 weeks assigned to the hand, or 100 weeks.

But remember, the workers compensation insurance company will receive a credit against these PPD benefits for any other indemnity payments which it previously paid.

So in this sense, permanent partial disability benefits merely provide a minimum level of benefits for certain types of injuries, and not necessarily the total amount of benefits the employee will receive.

Impairment Ratings and Settlements in Louisiana Workers Compensation 

Even though impairment ratings are not technically required for most Louisiana workers compensation claims, the workers compensation insurance companies frequently use impairments ratings during the settlement of Louisiana workers compensation claims.

So essentially, an injured employee's impairment rating does often affect the settlement value of the employee's workers compensation claim, even though it is not required for claims other than Permanent Partial Disability (PPD) benefits.

First of all, it is important to realize that an impairment rating is often not provided until the employee is at Maximum Medical Improvement (MMI), which means the completion of all contemplated treatment, or that all the treatment that has been offered has been declined. And the workers compensation insurance is most likely to attempt settlement once the injured employee is at Maximum Medical Improvement (MMI).

So right around when the workers compensation insurance company is most likely to engage in settlement talks (when the employee is at Maximum Medical Improvement) is when the workers compensation insurance company will receive an impairment rating.

Often the impairment rating is provided within a Functional Capacity Evaluation (FCE), so this impairment rating is provided to the workers compensation insurance company whether it needs it or not, and again right around when the workers compensation insurance company is most likely settle the employee's claim.

Also, impairment ratings are required to a much greater degree in states outside Louisiana, so often the workers compensation insurance company will handle claims across numerous states, and thus be predisposed to using impairment rating for settlement purposes, whether or not they are required in Louisiana.

The Louisiana Statute for Impairment Ratings and Permanent Partial Disability (“PPD”) Indemnity Benefits

The Louisiana lost wage statute is La. R.S. 23:1221. Concerning impairment ratings and permanent partial disability ("PPD") benefits, the statute reads as follows:

§1221. Temporary total disability; permanent total disability; supplemental earnings benefits; permanent partial disability; schedule of payments

Compensation shall be paid under this Chapter in accordance with the following schedule of payments:

(4) Permanent partial disability. In the following cases, compensation shall be solely for anatomical loss of use or amputation and shall be as follows:

(a) For the loss of a thumb, sixty-six and two-thirds percent of wages during fifty weeks.

(b) For the loss of a first finger, commonly called the index finger, sixty-six and two-thirds percent of wages during thirty weeks.

(c) For the loss of any other finger, or a big toe, sixty-six and two-thirds percent of wages during twenty weeks.

(d) For the loss of any toe, other than a big toe, sixty-six and two-thirds percent of wages during ten weeks.

(e) For the loss of a hand, sixty-six and two-thirds percent of wages during one hundred fifty weeks.

(f) For the loss of an arm, sixty-six and two-thirds percent of wages during two hundred weeks.

(g) For the loss of a foot, sixty-six and two-thirds percent of wages during one hundred twenty-five weeks.

(h) For the loss of a leg, sixty-six and two-thirds percent of wages during one hundred seventy-five weeks.

(i) For the loss of an eye, sixty-six and two-thirds percent of wages during one hundred weeks.

(j) Loss of both hands, or both arms, or both feet, or both legs, or both eyes, or one hand and one foot, or any of two thereof, or paraplegia, or quadriplegia shall, in the absence of conclusive proof of a substantial earning capacity, constitute permanent total disability.

(k) The loss of the first phalanx of the thumb or big toe, or two phalanges of any finger or toe, shall be considered to be equal to the loss of one-half of such member, and the compensation shall be one-half of the amount above specified.

(l) The loss of more than one phalanx of a thumb, or more than two phalanges of any finger or toe shall be considered as the loss of the entire member; provided, however, that in no case shall the amount received for more than one finger exceed the amount provided in this schedule for the loss of a hand, or the amount received for the loss of more than one toe exceed the amount provided in this schedule for the loss of a foot.

(m) Amputation between the elbow and the wrist shall be considered as equivalent to the loss of a hand and amputation between the knee and the ankle shall be equivalent to the loss of a foot.

(n) A permanent total anatomical loss of the use of a member is equivalent to the amputation of the member.

(o) In all cases involving a permanent partial anatomical loss of use or amputation of the members mentioned hereinabove, compensation shall bear such proportion to the number of weeks provided for herein for the total loss of such members as the percentage loss or impairment to such members bears to the total loss of the member, provided that in no case shall compensation for an injury to a member exceed the compensation payable for the loss of such member.

(p) In cases not falling within any of the provisions already made, where the employee is seriously and permanently disfigured or suffers a permanent hearing loss solely due to a single traumatic accident, or where the usefulness of the physical function of the respiratory system, gastrointestinal system, or genito-urinary system, as contained within the thoracic or abdominal cavities, is seriously and permanently impaired, compensation not to exceed sixty-six and two-thirds percent of wages for a period not to exceed one hundred weeks may be awarded. In cases where compensation is so awarded, when the disability is susceptible to percentage determination, compensation shall be established in the proportions set forth in Subparagraph (o) of this Paragraph. In cases where compensation is so awarded, when the disability is not susceptible to percentage determination, compensation as is reasonable shall be established in proportion to the compensation hereinabove specifically provided in the cases of specific disability.

(q) No benefits shall be awarded or payable in this Paragraph unless the percentage of the anatomical loss of use or amputation, as provided in Subparagraphs (a) through (o) of this Paragraph or the percentage of the loss of physical function as provided in Subparagraph (p) or (s) of this Paragraph is as established in the most recent edition of the American Medical Association's "Guides to the Evaluation of Permanent Impairment".

(r)(i) In all claims for inguinal hernia, it must be established by a preponderance of the evidence that the hernia resulted from injury by accident arising out of and in the course and scope of employment; that the accident was reported promptly to the employer, and that the employee was attended by a licensed physician within thirty days thereafter.

(ii) If the employee submits to treatment, including surgery, recommended by a competent physician or surgeon, the employer or insurer shall pay compensation benefits as elsewhere fixed by this Chapter.

(iii) If the employee refuses to submit to such recommended treatment, including surgery, and establishes by a preponderance of the evidence that his refusal is based upon his conscientious religious objection thereto or that such recommended treatment, including surgery, involves an unusual and serious danger to him, the employer or insurer shall pay compensation benefits as elsewhere fixed by this Chapter. In all other cases of the employee's refusal to submit to such recommended treatment, including surgery, the employer shall provide all necessary first aid and medical treatment and supply the necessary truss, support, or other mechanical appliance at a total cost not in excess of six hundred dollars. In addition, the employer shall pay compensation for a period not to exceed twenty-six weeks.

(iv) Recurrence of the hernia following surgery shall be considered as a separate hernia, and the provisions and limitations of this Subparagraph shall apply.

(s)(i) In addition to any other benefits to which an injured employee may be entitled under this Chapter, any employee suffering an injury as a result of an accident arising out of and in the course and scope of his employment shall be entitled to a sum of fifty thousand dollars, payable within one year after the date of the injury. Interest on such payment shall not commence to accrue until after it becomes payable. Such payment shall not be subject to any offset for payment of any other benefit under this Chapter. Such payment shall not be subject to a claim for attorney fees; however, attorney fees may be awarded in a claim to collect such payment pursuant to R.S. 23:1201.2.

(ii) In any claim for an injury, it must be established by clear and convincing evidence that the employee suffers an injury and that such resulted from an accident arising out of and in the course and scope of his employment. Nothing herein shall limit the right of any party to obtain a second medical opinion or, in appropriate cases, the opinion of an additional medical opinion medical examiner pursuant to R.S. 23:1123.

(iii) Only the following injuries shall be considered injuries for which benefits pursuant to this Subparagraph may be claimed:

(aa) Paraplegia or quadriplegia or the total anatomical loss of both hands, or both arms, or both feet, or both legs, or both eyes, or one hand and one foot, or any of two thereof; however, functional loss or loss of use shall not constitute anatomical loss.

(bb) Third degree burns of forty percent or more of the total body surface.

(iv) Notwithstanding the provisions of R.S. 23:1291.1 and 1377, any benefit paid pursuant to this Subparagraph shall be reported to the office separately from any other benefit paid pursuant to this Chapter and shall not be subject to assessment by the office or by the Louisiana Workers' Compensation Second Injury Board.

(v) Repealed by Acts 2006, No. 494, §1.

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