Welcome to Did You Know from Ask Approach. Throughout 2021 we’ll take a look at lesser-known aspects of services offered by Approach. For a quick look at all of the services available to Approach clients, download our Approach Services infographic or check out our Service Spotlight blog posts.
Nurse case manager
Every client at Approach has access to our full-time, on-staff Nurse Case Manager. Our nurse helps with many claim-related questions and specializes in translating medical-speak to layman’s terms. She’s also a member of our crisis response team, helping employers and family members in the immediate aftermath of serious accidents.
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We sometimes ask our nurse to review claims that are closing with a Permanent Partial Disability, or PPD. A finding of PPD means that the injured employee no longer has use full use of specific parts of their body – yes, they have a disability, but they’re still able to work.
PPD vs Disability
We often think of “Disability” in workers’ comp as permanent and total disability — a finding that the employee is injured to such a degree that he or she is unlikely to return to gainful employment. A worker in this situation receives a lifetime monthly pension.
A permanent partial disability means the worker can return to work (hopefully they are already back on the job by the time PPD is determined). In this instance, they receive a one-time payment for their disability.
PPD payments aren’t affected by work status, so your employee shouldn’t have any fear of returning to work in a job that’s within their medical restrictions.
Assigning PPD to a claim
PPD normally comes up in one of two situations:
The claim manager at L&I can refer the injured employee for an impairment rating to determine if they have a permanent partial disability (PPD). If the worker is found to have PPD, then the amount of the payment will be charged to the claim. This can impact your future rates, so your Retro Coordinator will always review the rating to ensure it’s consistent with rating schedule, based on objective medical findings.
PPD payments aren’t affected by work status, so your employee shouldn’t have any fear of returning to work in a job that’s within their medical restrictions. If PPD is found, they will be compensated. And, your company can still participate in money saving programs such as Stay-at-Work and Preferred Worker regardless of PPD.
How much are PPD payments on a workers’ comp claim?
The amount of the PPD payment is determined by the Impairment Rating. And, the impairment rating is determined by an L&I-approved provider. L&I also keeps the list of amounts to be paid for each rating.
Some ratings are based on a percentage of total disability and this is usually the case for the spine and many central body parts. Others, such as extremities, have flat fees assigned to them. There are also a few ratings based on medical procedures, such as joint replacements, rather than parts of the body. You can see the L&I Impairment Rating amounts in Chapter 12 of the Medical Examiner’s Handbook.
L&I also references the Physicians Guide to Permanent Impairments. Some physicians may use the sixth edition of this publication, but L&I only recognizes ratings that are based on the fifth edition. here are also a few impairments related to procedures, such as meniscectomies (knee surgeries) and joint replacements.
Once the rating is determined, the corresponding dollar amount is paid to the injured employee and that amount is charged to the claim.
Nurse and IME review of Impairment Ratings
PPD payments are an important part of workers’ comp – they recognise that the employee has a permanent limitation resulting from a workplace injury or occupational disease, while offering recovery and hope for continued gainful employment. Improper PPD payments can unfairly impact your company, which is why your Approach Retro Coordinator checks the rating for accuracy.
Our nurse will review the claim and impairment rating if there’s any question from the Retro Coordinator. As a fully-licensed nurse, she’s able to spot inconsistencies, unclear information in the report, or even errors, such as having a pre-existing impairment assigned to the claim.
Your Approach Retro Coordinator will let you know if your claim is subject to impairment rating. Or contact us if you have questions about a current or past claim.