Alabama Workers’ Compensation Terminology
If you have suffered a serious job injury, during the pendency of your Alabama workers’ compensation claim you will come across terms and abbreviations with which you are probably unfamiliar. With this in mind, following is an excerpt from a handout we used in a meeting with a local union on Alabama workers’ compensation claims. Hopefully you will find this helpful-and remember, if you have questions about your right to Alabama workers’ compensation benefits, don’t hesitate to contact
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What is an impairment rating? After suffering a work injury and receiving medical treatment, you will eventually come to the point where your treating physician states that you are as good as you are going to get; this is known as your date of reaching “maximum medical improvement.” At this juncture, the physician will give an opinion as to whether you have suffered a permanent injury; if you have, then an impairment rating will be calculated.
What exactly is the impairment rating and what does it mean? Impairment ratings are generally calculated in accordance with procedures listed in the A.M.A. Guides to the Evaluation of Permanent Impairment. Specific impairment ratings are provided according to the type of injury you have suffered and what permanent restrictions you now have to the affected body part (arm, hand, leg, feet, eye) and/or to the body as a whole. While the A.M.A. Guides specifically state that their ratings are not purposed to say what an injured worker can do post-accident, in practice these ratings are viewed by most courts as evidence of your permanent physical impairment, but the court is not bound by these ratings.
If you have suffered a permanent injury to a non-scheduled body part (neck, back, shoulder or hip), or if you injury is such that it effects to proper functioning of the body as a whole and you are no longer able to perform your job duties or earn the same type of money, then the impairment rating really is not as important as your physical limitations, as your permanent restrictions are what will be relied upon in determining what compensation you are entitled to receive
What does MMI mean? The way I generally explain this is to explain “maximum medical improvement” is just a fancy was of saying “you’re as good as you’re going to get.”
Legally, an injured worker is found to have reached MMI status once “‘there is no further medical care or treatment that could be reasonably anticipated to lessen the claimant’s disability. G. UB. MK. Constructors v. Traffanstedt, 726 So.2d 704, 709 (Ala.Civ.App.1998). ” When MMI is reached depends on the circumstances of the particular case, and in many cases just because one doctor has opined that an injured worker has reached maximum medical improvement does not mean that another physician (maybe one chosen from a Panel of Four) will agree with this assessment, and ttd benefits can be reinstated if the new treating physician states that you have not yet reached MMI.
Once you have been found to have reached maximum medical improvement, any physical restriction you have is deemed to be permanent, and your right to any temporary total disability (ttd) or temporary partial disability benefits (tpd) ends, and it makes since. You are no longer considered to have any “temporary” problem; now any limitations are considered permanent and any monetary compensation you may be entitled to receive would be either permanent partial disability (ppd) benefits or permanent total disability (ptd) benefits-with a right to lifetime medical treatment.
What is a Panel of Four?
The Alabama workers compensation law understands that there will be instances in which an injured worker is not pleased with the treatment (or lack thereof) that they are receiving from their authorized treating physician and that they may wish to make a change. Given this simple fact, the law allows an injured worker to request a Panel of Four physicians, and from this panel of physicians, the injured worker is allowed to choose a new treating doctor. However, you are only allowed to request a Panel of Four once (twice if surgery is recommended and you wish to have a second opinion). With this in mind, it is important not to burn your Panel choice on a spur of the moment fit of frustration. Additionally, most injured workers do not know much about the doctors provided in their panel. Having the advice of an experienced Alabama workers compensation lawyer can be invaluable at this juncture, as some of the panel doctors have a definite bent in favor of the workers compensation provider.
What are TTD Benefits? Temporary total disability benefits (TTD benefits) is the name given to the workers’ compensation check a worker who was injured at work receives during the period of time they are unable to work due to their job injuries.
TTD benefits have three defining attributes. First, as has already been stated, temporary total disability benefits are payable during the time the injured worker is recovering from their job injury and are unable to work. Unlike benefits for a permanent impairment, there is no maximum number of weeks which an injured worker may received ttd benefits; they are entitled to them until the date they reach maximum medical improvement (an injured worker is said to have reached “maximum medical improvement [mmi] when there is no further medical care or treatment that could reasonably be anticipated to lessen their disability.)
Secondly, ttd benefits provides total monetary relief to an injured worker under the Act in that, unlike in the case of temporary partial disability, no reduction is made to the payable compensation based upon that worker’s residual earning capacity.
Third, TTD benefits are temporary in nature in that they are payable only during a worker’s recovery period; the Act envisions that permanent-disability benefits, if appropriate, be paid to an employee after he or she reaches maximum medical improvement (MMI).
What are TPD Benefits? Temporary Partial Disability benefits (TPD) are similar to temporary total disability benefits (ttd). TPD benefits are payable by the workers’ compensation insurance carrier in instances where the injured employee has not yet reached maximum medical improvement, but they have returned to work and are making less than the average of their 52-week average weekly wage. In this instance, the injured worker receives 2/3rds of the difference between what the injured worker is receiving now vs. their 52-week average weekly wage.
For instance, if your 52-week average weekly wage was $500 per week, but you are only making $400 per week and you have not yet reached mmi status, your TPD benefits would be as follows:
$500 – $400 = $100 x 66.67% = $66.67.
What are PTD Benefits? PTD stands for Permanent Total Disability. It is when the workers’ job injuries are so severe that they can no longer be reasonably expected to engage in their previous fields of employment or other reasonably employment.
Total disability within the Worker’s compensation Act does not mean absolute helplessness or entire physical disability. Millings Company v. Grimes, 267 Ala. 395, 103 So.2d 315 (1958); Stewart v. Busby, 51 Ala. App. 242, 284 So.2d 269 (1973); Wal-Mart Stores, Inc. v. Kennedy, 799 So.2d 188, 198 (Ala.Civ.App.2001). The standard for permanent total disability is whether the employee is (1) able to perform his previous trade or (2) able to obtain reasonably gainful employment. Price’s Bar-B-Que v. Carter, 541 So.2d 38, 39 (Ala.Civ.App.1989). Other “reasonably gainful employment” means employment that is similar in pay to the employee’s previous job and compatible with his pre-injury occupation, his age, his education and his aptitude. Transmart, Inc. v. Brewer, 630 So.2d 469, 471 (Ala.Civ.App.1993). It is also important to note that “other reasonable gainful employment” does not exist unless there is a reasonably stable market for the remaining services that the employee is able to perform, taking into account the quality, dependability, or quantity with which he is able to perform them. Transmart, 630 So.2d at 471
If an injured worker is found to be permanently disabled, basically you are entitled to your TTD check every week for the rest of your life, unless you settle your case for a lump sum or your condition improves and the court later finds that you are no longer disabled. That last part is important, if you do not settle and the court finds that you are totally disabled, that does not mean that your claim is over with; if the defendant is able to later prove to the court that your condition has improved and you are no longer totally disabled, your right to continued PTD benefits can be cut off.
Average Weekly Wage: If you suffered work injury and as a result of said injury, you have to miss time from work, you may become eligible for temporary total disability benefits, or temporary partial disability benefits. These benefits are calculated based on the injured workers’ 52-week average weekly wages for the period of time immediately preceding the job injury. Simply, you add up the total amount of wages you received in the year immediately preceding your job injury (including any bonuses) and divide by 52. If you missed a week from work and did not receive any compensation or vacation pay, then this week is subtracted from the total so as not to falsely lower your actual average weekly wage.
If you have not worked for your employer for a year prior to your job injury, you AWW is calculated in one of two ways. The preferred way is to use the wages you earned while an employee and divide by the number of weeks worked, but sometimes an employee has not worked many weeks before suffering a job injury, and this means of calculating can be unfair to the injured employee. In such a situation, the 52-week average weekly wage of a similarly situated employee.
If your employer continues paying their share of any fringe benefits (eg health insurance) while you are off work, then the value of your fringe benefits is not included in the calculation of your average weekly wage. However, if your employer stops paying their portion of your fringe benefit package, then this value (money) is added into the calculation of your average weekly wages.
What are Vocational Benefits? Once you have reached maximum medical improvement, the treating physician will give an opinion as to whether you have sustained a permanent physical impairment as a result of your job injury. If you have not suffered a permanent injury, your case is essentially over, although your employer and their workers compensation insurance provider will remain responsible for any medical treatment you require in the future related to your job injury. If you have suffered a permanent injury to a non-scheduled body part (head, neck, shoulders, back, hip, or if you have an injury which detrimentally effects the efficient functioning of your body) and you are no longer able to perform you past work or earn the same type of money you were making prior to your injury, then you are entitled to vocational benefits under Alabama’s Workers’ Compensation law.
Your vocational benefits allow you to request that your employer’s workers’ compensation insurance carrier retrain you (if possible), or to obtain additional compensation for your loss of access to jobs now available to you in your post injury condition. It is extremely rare in our experience for the workers’ compensation insurance carrier to inform the injured worker of their right to vocational benefits, and they are under no legal obligation to inform you of your rights as everyone is assumed to know the law.