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How do you determine the value of your Workers' Compensation claim? (Part 2)

Keith Williams
Best Nashville Tennessee Injury Attorney Car Truck Motorcycle Aviation Accidents. Best Nashville Lawyer.

Compensation Rate



            Your compensation rate is 66 and 2/3 of your average weekly wage. Average weekly wage (AWW) is a fancy name for your average paycheck over the 52 weeks immediately before the date of your injury at work.

            To calculate your AWW you simply add up your pay during the 52 weeks immediately proceeding the date of your injury and divide that number by 52. Make sure to include all overtime.  Then multiply that number by 2/3.

 


Example:

Medical or Anatomical Impairment

 


Once you have completed your medical treatment, your treating physician will place you at Maximum Medical Improvement (MMI). MMI is defined by the American Medical Association Guides to the Evaluations of Permanent Impairments’ (AMA Guides) as,

“The point at which a condition has stabilized and is unlikely to change (improve or worsen) substantially in the next year, with or without treatment.”

 

            MMI is nothing but a fancy medical term for, medically - you are as “good as you are going to get.”  Once you are at MMI your treating doctor will place a medical or anatomical Impairment on your condition. A medical or anatomical impairment rating is an estimate expressed in a percentage of the loss of activity to a body part or your whole body which reflects the severity of your condition after the injury.

 

           Again in everyday terms, let’s assume you have a work related injury to your lower back. Before the injury your whole body was at 100%.  After your injury (i.e. herniated disc in your lumbar spine) you were at 30%. You have loss 70% use of your body. Over the next few months you have surgery on your herniated lumbar disc and after that you are treated with physical therapy.  Finally after months of treatment and recovery your doctor has an opinion you have reached MMI and have improved to 95%.  The 5% you have lost is a 5% medical or anatomical impairment to your “body as a whole.”  The workers compensation laws require that this 5% must be pursuant to the American Medical Association Guides to Permanent Impairments. (AMA Guides) companies’ best interest to have you as healthy as possible when an impairment rating is assigned.  That means they owe you less money.


            Workers compensation doctors know this. They know that the lower your impairment, the less money the Workers compensation Insurance Company has to pay. They know if they give a high rating you will get more money and that is not in the workers compensation insurance companies’ best interest.  Being the doctor is also a business man or woman, it is probably not in his and his family’s best interest to give a high impairment rating.  He wants the workers compensation insurance company to send the next case his way.  If he or she gives a high imparement rating, that referral may never happen.  Therefore normally, the Workers Compensation doctors keep the impairment rating as low as possible.

 

 

Workers Compensation Doctors

 

            Without writing another book on this subject - workers compensation doctors are usually good respectable practitioners in their given specialty.  It is in the workers compensation insurance companies’ best interest to have you as healthy as possible when an impairment rating is assigned.  That means they owe you less money. Workers compensation doctors know this. They know that the lower your impairment, the less money the Workers compensation Insurance Company has to pay. They know if they give a high rating you will get more money and that is not in the workers compensation insurance companies’ best interest.  Being the doctor is also a business man or woman, it is probably not in his and his family’s best interest to give a high impairment rating.  He wants the workers compensation insurance company to send the next case his way.  If he or she gives a high imparement rating, that referral may never happen.  Therefore normally, the Workers Compensation doctors keep the impairment rating as low as possible.

 

 

Independent Medical Evaluation, IME

            Because it is in the treating workers compensation doctor’s best interest to keep your impairment rating as low as possible, an experienced workers compensation attorney will send you for an independent medical evaluation (IME).  IME doctors are not treating physicians.  They are neither puppets of the workers compensation insurance company.  They are independent of insurance companies and versed in the details of the AMA guides. These IME doctors charge a fee but their opinion is usually a very good investment. Normally an experienced workers compensation attorney will advance this fee for you. (I can’t say what all workers compensation attorneys do but we have an IME performed on every workers compensation case that my office handles)

The increase in the impairment rating from the IME can significantly increase the value of your recovery:

 

             Example:


 

            Worker Joe has a lumbar back injury that requires a lumbar laminectomy.  Joe’s compensation rate is $500.00.  His treating Dr. A gives him a 5% medical impairment rating.  Joe’s attorney sends him to have an IME with Dr. B who assigns Joe a 15% medical impairment rating.  We will us a vocational disability multiplier of four (4) in both examples.

Joe’s recovery would be as follows:

 

Dr. A      400   x   $500   x   5%   x   4   = $ 40,000.00 

 

Dr. B      400   x   $500   x   15%   x   4   = $120,000.00           

 

The fee charged for an IME is usually from $650.00 to $1000.00. It is imperative that your workers compensation attorney has you evaluated by a physician other than one controlled by the workers compensation insurance company. 

 

Continued in How do you determine the value of your Workers' Compensation claim? (Part 3)