By: Patrick A. Johnson
Earlier this week, I received a phone call from an adjuster asking me how to calculate a disability rating for payment of a Permanent Partial Disability (PPD). The adjuster understood the calculation method, but she did not know where to go for the value of the particular body part. It then occurred to me that while we attorneys know that this information is contained in Louisiana Revised Statute 23:1221(4), how does the adjuster get that information? So, I copied that section from the statute and sent it on to her along with a quick review on how to perform the calculations. Since we recognize that if one adjuster has this question, there may be more of you who face the same situation, here is how you figure out a PPD rating.
When an employee suffers a loss that gives rise to a permanent partial anatomical loss of use of a body part, they are owed a payment of indemnity based upon the level of disability and as compared to the value of a 100% loss for that body part. For example, if the doctor assigns a 20% loss for a body part, and a 100% loss of that particular body part is worth 50 weeks, then the PPD value for that anatomical loss is 10 weeks (20% of 50 weeks). Further, the percentage of loss of function or anatomical impairment must be identified by the doctor under the most recent addition of the American Medical Association’s “Guides to the Evaluation of Permanent Impairment.” Assuming that the doctor has given you the level of impairment correctly – and if it is not done correctly, then it is usually safer to ask for it to be done correctly rather than waiting around for the doctor to fix the issue themselves, which usually occurs after the opposing counsel has already filed a 1008 for nonpayment of the disability rating – then you have to know what the value of a 100% loss is for the particular body part. These listings can be found in paragraph (4) of LSA-R.S. 23:1221, and are as follow:
(a) For the loss of a thumb, sixty-six and two-thirds percent of wages during fifty weeks.
(b) For the loss of a first finger, commonly called the index finger, sixty-six and two-thirds percent of wages during thirty weeks.
(c) For the loss of any other finger, or a big toe, sixty-six and two-thirds percent of wages during twenty weeks.
(d) For the loss of any toe, other than a big toe, sixty-six and two-thirds percent of wages during ten weeks.
(e) For the loss of a hand, sixty-six and two-thirds percent of wages during one hundred fifty weeks.
(f) For the loss of an arm, sixty-six and two-thirds percent of wages during two hundred weeks.
(g) For the loss of a foot, sixty-six and two-thirds percent of wages during one hundred twenty-five weeks.
(h) For the loss of a leg, sixty-six and two-thirds percent of wages during one hundred seventy-five weeks.
(i) For the loss of an eye, sixty-six and two-thirds percent of wages during one hundred weeks.
(j) Loss of both hands, or both arms, or both feet, or both legs, or both eyes, or one hand and one foot, or any of two thereof, or paraplegia, or quadriplegia shall, in the absence of conclusive proof of a substantial earning capacity, constitute permanent total disability.
(k) The loss of the first phalanx of the thumb or big toe, or two phalanges of any finger or toe, shall be considered to be equal to the loss of one-half of such member, and the compensation shall be one-half of the amount above specified.
(l) The loss of more than one phalanx of a thumb, or more than two phalanges of any finger or toe shall be considered as the loss of the entire member; provided, however, that in no case shall the amount received for more than one finger exceed the amount provided in this schedule for the loss of a hand, or the amount received for the loss of more than one toe exceed the amount provided in this schedule for the loss of a foot.
(m) Amputation between the elbow and the wrist shall be considered as equivalent to the loss of a hand and amputation between the knee and the ankle shall be equivalent to the loss of a foot.
(n) A permanent total anatomical loss of the use of a member is equivalent to the amputation of the member.
These do not cover all of the potential PPD ratings, but these are, by far, the most common. There are separate calculations for individuals who suffer paraplegia, quadriplegia, a complete anatomical loss of one or more body parts, or severe burns covering a major portion of the body, but most adjusters work their entire career without having to run these particular calculations. Should you be unfortunate enough to encounter one of the situations, you are always free to call for assistance.
Since the doctors rarely have access to these listings, the disability rating may be for a body part not specifically listed. In that situation, you would use the body part that most closely conforms to the one identified by the doctor. For example, you will note that there is no specific listing for the shoulder. We commonly apply the rating for the arm. On occasion, a doctor may provide multiple ratings. You may see a percentage for the hand and a separate rating for the arm from a permanent hand injury. The claimant is not entitled to two separate awards. You simply run the calculations for both, and you pay which ever rating provides the greater award to the claimant. For example, if the doctor gives the claimant to a 20% rating for the hand and a 3% rating for the arm, the disability for the hand would be 10 weeks of indemnity (20% of 50weeks), and as it is greater than the 6 weeks of indemnity for the disability rating for the arm (3% of 200 weeks), you pay the claimant the 10 weeks of indemnity.
When obligated to pay a PPD rating, you can take a credit for any indemnity already paid. In the example above, if you owe 10 weeks of indemnity, but you have already paid 6 weeks, then you owe the claimant an additional 4 weeks of indemnity as a separate payment. However, always remember that the payment of the PPD award does not have any effect on the future payment of indemnity. If the claimant in this example remains unable to work in any capacity, you would issue the claimant a check for 4 weeks of indemnity as a PPD payment, but you would still owe them Temporary Total Disability the following week and for each week in the future in which they are unable to work in any capacity. You can take a credit in the future, but it is only taken off of the maximum 520 week limitation for Supplemental Earnings Benefits. You simply reduce the maximum520 weeks by the amount of the PPD payment, plus the credit for any other indemnity previously paid.
As this email blast is already long enough, we will save for another blast how to calculate the PPD payment for a scar or a burn, as those are much more complicated and essentially require a separate email.