What is a fair settlement amount? Does anyone ever get back what they have lost? How do you keep from getting the short end of the stick?
L&I settlements are inherently unfair – they are a compromise. Nobody ever gets back what they have lost – you lose the use and function of a body part – but L&I can only give you money.
As for not getting a bad deal, that depends on your facts, the claim management, and what you do to help yourself.
Understand the PPD rules, make sure your physical and mental losses are fairly and accurately assessed (don’t trust IME doctors), and help the claims manager make the right decision.
The PPD rules are part of the law governing L&I claims. You can find them in the Revised Code of Washington (RCW ) Title 51, and the Washington Administrative Code (WAC) Title 296, in our Things You Need to Know section. They are complex, having been written by politicians and insurance people and intended to be understood by doctors, lawyers, and judges.
The PPD rules are divided into two sections; by body system, called the category rating system, found in RCW 51.32; or by body part, called specified disabilities, found at RCW 51.32.080.
The category rating system includes: spine, neurologic system, mental health, respiratory, taste and smell, speech, skin, and internal organs.
The specified disabilities include: legs, feet, arms, heads, eyes, and hearing.
Each specific WAC subject is also roughly divided into two, with rules for evaluation of that category followed by the specified body system and their objective clinical findings. There are also general rules for impairment rating RCW 51.32.080 and WAC 296-20-2010, special rules for evaluation WAC 296-20-220, AMA guides, and yearly PPD schedule update found on the L&I website. These yearly schedules convert percentages or categories into dollars, and allow for modest yearly increases to reflect the percentage change in the consumer price index.
The WAC’s provide complex medical/legal determinations meant to attach a percentage to an impairment of loss of function. That percentage is taken to the PPD schedule for the year of your injury, to determine the dollars you should receive after your claim closes. The money is often paid out over the course of several months.
Alvin loses part of his little finger at work in August of 2009. Alvin finishes his medical care, returns to work, and is sent by his claims manager to an IME for a rating. The IME doctor concludes Alvin has lost 50% of his little finger. The claims manager goes to the WAC PPD schedule in effect for August 09 and sees that a little finger in 2009 has a PPD impairment value of $4,897.35. 50% of that is $2,448.67. She closes Alvin’s claim by order, and sends Alvin a check for $2,448.67.
Was it fair that Alvin lost half a finger and got $2,448.67? You decide; but think about this. What about two different Alvins? What if Alvin the Brut is a pro football lineman and doesn’t need his finger. – Fair? What if Alvin the Virtuoso is a concert pianist who needs this finger but now because he lost his finger he can no longer work at the job he’d practiced all his life for. Is that fair? Understand this: the L&I PPD system doesn’t care who you are, a 50% little finger PPD is the same for everyone; it doesn’t matter how much the injury affects you.
Does it make any difference if football Alvin was at fault for stupidly injuring his finger in a careless drunken post game celebration when he broke a bottle of champagne over his head and cut his finger? What if pianist Alvin lost his finger through no fault of his own, when his employer dropped the grand piano cover on his finger? They both get the same amount. Fault doesn’t matter, because L&I is a no fault system.
If these rules are too complex, not to worry. You don’t have to know how to apply the rules to get paid. If you can tell us:
So how do you and Alvin the piano player get a fair PPD settlement? Alvin hires a sharp L&I lawyer who gets a better PPD rating by sending Alvin to a real doctor for thoughtful and accurate finger rating of 90%. Sharpe lawyer also recognizes Alvin’s depression over losing his finger and his job. Alvin gets mental health treatment for depression and a category III rating, worth $45,346.55. Alvin also is advised to take advantage of vocational rehabilitation and is trained in a new career as a band leader. Happy ending, or at least fair, considering the constraints of the system.
We can tell you how much money you should get. Contact us.