PPI Ratings (Permanent Partial Impairment Ratings)

When the employer is determined to be "medically stable", then he or she is entitled to a Permanent Partial Impairment (PPI) rating.

"Medically stable" means that there is no objective measurable improvement.  Medical stability is presumed in the absence of objectively measurable improvement for a period of 45 days however that presumption can be rebutted.

The PPI rating is determined by a physician who is specifically trained to conduct PPI ratings.  He examines the Employee and reviews medical records and then makes his determination based upon the American Medical Association Guidelines to the Evaluation of Permanent Impairment.

When the physician assesses a certain PPI rating, he will state that the Employee has a per centage of whole body disability.  The whole body figure used in Alaska in $177,000.  Thus if the physician says that the Employee has a 10% PPI rating, then the Employee should be paid 10% of $177,000 or $17,700.

There is a lot of room for disagreement in this process.   Frequently the insurance company will hire an doctor to perform an Employer Medical Evaluation (EME) and that doctor concludes that the Employee is medically stable but the treating physician say that he isn’t, that he needs more treatment to improve.

Another area of disagreement is when the Employee became medically table.  Sometimes the EME will conclude that the Employee was medically stable months before the evaluation but the treating physician assesses a different date.  The reason that is a problem is that if the Employee was drawing Temporary Total Disability during the period time after which the EME said that he is medically stable, the insurance company is going to want that money back.

The obvious area of disagreement is the PPI rating itself.  The EME will often conclude that the rating is very low, claiming that there is pre-existing degenerative changes and/or that the Employee was malingaring (faking) the extent of his disability.

When these disagreements come up, the Employee is entitled to a Second Independent Medical Evaluation (SIME).  A SIME is an evaluation by physician chosen by the Board.  The insurance company pays for the SIME and if the Employee needs to travel to the doctor, the insurance company is required to pay for the travel as well as time missed from work.

For more information, see http://www.keenanpowell.com/faq-wc.html

Contact Keenan Powell through the contact form or call: 258-7663.  Toll free: 888-368-5678.