Permanent Partial Disability Indemnity Benefits in Louisiana Workers Compensation

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What Are 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. 

Typically, permanent partial disability (PPD) benefits are paid after the employee returns to work.

In fact, an injured worker can receive permanent partial disability (PPD) benefits, even if the worker does not miss any work.

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

Thus, the lump sum payment for permanent partial disability is due once the employer or insurance company has notice of the anatomic loss.

No "settlement" or "settlement papers" are needed to receive a lump sum payment under permanent partial disability (PPD) benefits.

Calculation of Specific Losses Under Permanent Partial Disability in Louisiana Workers Compensation

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.

The impairment rating is assigned by the treating physician based on the American Medical Association's “Guides to the Evaluation Permanent Partial Disability.”

However, the employer or 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.

Scarring and Disfigurement Benefits in Louisiana Workers Compensation

Aside from the Permanent Partial Disability benefits listed above, other permanent partial disabilities not falling within those injuries are covered as follows under the Louisiana Workers Compensation Act:

    • 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.

Therefore, in order to be a compensable permanent partial disability, a scar must render the employee “seriously and permanently disfigured.”

Typically, most scars are permanent. But often the workers compensation insurance companies argue that scars are not sufficiently serious so as to be compensable.

Louisiana courts have defined disfigurement as “that which impairs or injures the beauty, symmetry, or appearance of a person or thing; that which renders unsightly, misshapen, or imperfect, or deforms in some manner.” 

Also, a serious disfigurement is a disfigurement “of such a character that it substantially detracts from the appearance of the person disfigured.”

Again, as per Louisiana law on scarring and disfigurement:

    1. Compensation is not to exceed 66.67% of wages for a period not to exceed 100 weeks may be awarded;
    2. When the disability is susceptible to percentage determination, compensation shall be established in the proportions detailed above; and 
    3. When the disability is not susceptible to percentage determination, compensation as is reasonable shall be established in proportion to the compensation provided in the cases of specific disability.

And basically, workers compensation judges are allowed great discretion in determining the reasonableness of an award for serious and permanent scarring or disfigurement.

Nonetheless, in most cases, injured workers can receive workers compensation benefits for 100 weeks when scarring or disfigurement occurs, and these benefits expire after that time runs out.

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

The Louisiana lost wage statute is La. R.S. 23:1221. Concerning 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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