The most common workplace injuries are lower back strains, hand injuries, lacerations and slip and fall type injuries. These can occur in the actual workplace or at a work related function such as a company picnic. The crucial factor is that there must be an identifiable injury which resulted in a disability (time away from work because of the injury and limited capacity to do your job). If you are injured at work, it is important for you to notify your employer. They will obtain a full evaluation, often by a physician of their choosing, and begin the process of filing a claim. If you are not satisfied with the evaluation and recommendation by the initial treating physician, you can petition the workman’s compensation carrier to be evaluated and treated by a physician of your choosing. Your contact from the insurance company is a case adjustor. This person works for the workman’s compensation carrier and is responsible for handling your claim.
Disability: is commonly used by physicians and workman’s compensation adjustors to describe the level of impairment that is a direct result of an injury. After the initial history and physical examination the physician will make a determination about the level of disability and how that disability is related to the pre injury functional capacity as well as to the job description. This will be one of three designations.
Total temporary disability: An example is a telephone line worker who has suffers two broken legs, requiring surgery, and severe burn on the right arm. A patient in this condition should not be working or attempting to work and would likely be unable to perform his/her usual and customary job even with reasonable accommodations.
Partial temporary disability: An example is a security guard with a fractured wrist or an administrative assistant with an ankle fracture. In these cases, the patients are able to return to work. However, they will require restrictions and workplace modifications.
Able to return to work without restrictions: This describes a patient who is still able to perform his/her usual and customary duties at work and therefore does not qualify for disability. An example is a laborer with a 2nd degree burn on the back of the calf or a administrative assistant with a chronic meniscus tear with mild intermittent pain less than 5% of the time. These individuals have a clearly defined injury and may have some permanent disability from their injury but can continue to perform their job without restriction.
After each visit your adjuster will receive a PR-2 form that outlines your current physical exam, level of impairment, whether or not you are able to return to work and in what capacity. Once your injury has been treated and you have improved you have reached “maximum medical improvement” meaning that further improvement of your condition from a medical standpoint is unlikely. At this point you will be evaluated for your permanent disability and a numerical score will be assigned to your case based on several factors, including the amount of motion lost, amount of strength lost, and loss of pre-injury work ability. This is reported in a number termed “Whole person impairment” or WPI. Even though your injury may be isolated, the report will indicate a whole person impairment.
Part of the final report, which is termed a “permanent and stationary report or PR-4” will include carve outs for future medical care of problems that are related to the original injury. For example, if a patient has a severe fracture involving the knee joint surface, the likelihood of developing knee arthritis is high even with the best surgical treatment. If arthritis of the knee develops at some point in the future, it should be covered under the original claim for the injury.
The final concept is apportionment. Apportionment refers to the amount of long term disability to which your injury contributed versus a pre-existing condition as a percentage. For example, if you have moderate knee arthritis and fall at work aggravating your knee pain then the amount of disability from the fall and the amount due to pre-existing arthritis needs to be determined. Medical care is not apportioned so whatever treatment you need is covered by your workers comp claim, but the final disability in terms of whole person impairment will be largely due to pre-existing knee arthritis and not the fall. In this case perhaps 10-20% of the disability is apportioned to the fall and 80-90% is due to the pre-existing arthritis. Unfortunately, because a work comp claim is a legal issue, this estimate is open to interpretation.