How Disability Ratings Affect Workers’ Compensation Benefits
In California workers’ compensation cases, the disability rating is one of the most important factors in determining how much permanent disability compensation an injured worker may receive. Once a worker has reached maximum medical improvement, a rating is assigned to reflect how the injury affects their long-term ability to work.
This rating is expressed as a percentage and directly impacts both the amount of benefits and how long they will be paid.
What Is a Disability Rating?
A disability rating is a percentage that reflects the level of permanent impairment resulting from a job-related injury or illness. It is based on:
- Medical reports from a treating physician, Qualified Medical Evaluator (QME), or Agreed Medical Evaluator (AME)
- The worker’s age and occupation
- Apportionment to any non-work-related factors
- The Permanent Disability Rating Schedule (PDRS)
Ratings can range from 0% (no lasting disability) to 100% (total permanent disability). Most cases fall in the partial disability range.
Who Determines the Rating?
The initial rating is often calculated by a disability rater at the Disability Evaluation Unit (DEU), especially when the worker is not represented by an attorney. If the worker has legal representation, the parties may negotiate the rating or rely on an evaluation by a QME or AME.
A judge may also request a formal rating during a dispute or trial.
How the Rating Affects Your Benefits
Once the permanent disability percentage is established, it is used to calculate:
- The number of weeks of permanent disability payments
- The weekly benefit amount
- Whether the worker may be eligible for supplemental benefits or retraining
For example, a rating of 15% may result in a specific number of weeks of compensation at a set weekly rate, while a rating of 70% or more may involve long-term or lifetime payments. A rating of 100% means the worker is permanently and totally disabled and may receive benefits for life.
Can Disability Ratings Be Disputed?
Yes. If either party disagrees with the rating, they can challenge it through:
- A second opinion from a QME or AME
- A consultative or formal rating from the DEU
- A hearing before a workers’ compensation judge
It is not uncommon for insurance companies to assign lower ratings than what may be supported by the medical evidence, which is why review and legal advocacy are important.
What Happens After the Rating Is Finalized?
Once the rating is finalized, permanent disability payments begin. In some cases, the claim may be resolved through a settlement, such as a stipulated award or a compromise and release. The disability rating also determines whether the worker qualifies for a supplemental job displacement benefit if they cannot return to their old job.
Get Help With Disability Ratings and Benefits
If you have questions about your disability rating or believe it does not reflect the severity of your condition, the Law Offices of Norman J. Homen can help. We work with injured workers throughout California to ensure their ratings are accurate and their benefits are properly calculated. Contact us today for a free consultation.
