It will be a number that represents a percentage of your whole body that is permanently impaired.  Your impairment rating will not be assessed until you have reached the point of Maximum Medical Improvement (MMI).  This is the date that your condition plateaus or isn’t likely to improve substantially, or the expiration of 104 weeks from the date disability accrues (see Income Benefits and Wage Replacement), whichever is sooner.  Once you have reached MMI, you are no longer entitled to Temporary Income Benefits (TIBs), wage replacement benefits.  Instead you will receive Impairment Income Benefits (IIBs) at a rate of 3 weeks of benefits for every percentage point of your impairment rating.

If your injuries are very severe and your impairment rating is 15% or higher, you may be entitled for an additional benefit called Supplemental Income Benefits (SIBs).  If you, or the insurance carrier disagrees with your impairment rating, it must be disputed within 90 days.  There are different ways to dispute an impairment rating and various reasons to do so.  Texas workers’ compensation rules regarding benefits for injured workers are very complex so it’s crucial to have skilled legal representation.  

Do You Qualify for Impairment Benefits? 

Every injured worker is entitled to an impairment rating evaluation, but whether that results in impairment income benefits is another matter.  The amount of Impairment Income Benefits (IIBs) a worker receives is ultimately determined by a doctor once the individual has reached “maximum medical improvement” or “MMI”.  A qualified doctor will examine you to determine both the date off MMI and your impairment rating.  The insurance carrier will pay three weeks of impairment income benefits for each percentage point of impairment, and each week equals 70% of the average of your weekly wages prior to the injury.  For example, if the doctor says that your impairment rating is 5% from a back injury, then you would be entitled to IIIBs for 15 weeks, but if your impairment rating is 0% (0x3=0), you would not be paid any IIBs. 

Impairment Rating Disputes

Impairment ratings are a hot topic of dispute in workers’ compensation because there are so many ways it could go wrong.  This is just a short list of the possible types of disputes about impairment ratings:

  • Maximum Medical Improvement date is wrong
  • Doctor didn’t rate all of the compensable injuries
  • There are more injuries that should be compensable and rated
  • The doctor didn’t calculate the rating correctly
  • Not all records were available for the rating doctor
  • The doctor wasn’t qualified to do the rating
  • Doctors differ in opinion on MMI date or impairment rating
  • There is still treatment that will affect the MMI date so the rating is premature
  • There is good cause for failing to timely dispute an impairment rating
  • And many, many more…
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Who Determines Your Impairment Rating?

You may have several evaluating doctors give competing opinions on your impairment rating. You could be assessed by a state-appointed doctor (Designated Doctor, or DD), an insurance-selected doctor (Required Medical Examiner, or RME), or your treating doctor or a doctor selected by him or her. The DD is the controlling opinion unless another opinion is adopted by agreement of the parties or by an administrative law judge at a Contested Case Hearing. You may see these doctors several times if they determine you have not yet reached MMI or if there are other questions for them to address, such as the extent of the injury to be rated.

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Contact a Workers’ Comp Attorney Before It's Too Late

Missing a deadline to dispute an impairment rating is one of the hardest challenges to overcome in a workers’ compensation case.  Don’t wait until your benefits stop to get help, because it might be too late by then. Navigating compensation for permanent impairments is complex and difficult and rife with traps for the unwary.  Call our worker's comp attorneys and we can help you ensure you get an impairment rating at the right time, for the right injuries, so you get the right compensation for your injuries.

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