What are PPD benefits?
PPD benefits fall under workers’ compensation benefits. There are four major types of PPD benefits:
- Wage differential: If the injury forces you to take a lower paying job, you will be entitled to two-thirds of the wage differential for five years after the injury or until you turn 67, whichever is later.
- Scheduled injuries: The Workers’ Compensation Act places a value on the use of certain body parts. The amount of compensation is calculated by multiplying your average weekly wage by 60 percent, multiplying that by the number of weeks of compensation scheduled for that body part (76 weeks for a thumb, for example), and multiplying that product by the degree of impairment (50 percent, for example).
- Non-scheduled injuries: If the injury is not listed on the Workers’ Compensation Act schedules, the benefit is calculated by multiplying the employee’s average weekly wages by 60 percent, multiplying the product by 500 weeks, and multiplying that product by the percentage of impairment to the body as a whole (15 percent, for example).
- Disfigurement: If you suffered a serious and permanent disfigurement to certain parts of your body, your benefit will be calculated by multiplying your average weekly wage by 60 percent, multiplying that by 162 weeks, and multiplying that by the impairment percentage assigned to your disfigurement.
You must notify your employer, either orally or in writing, within 45 days of your injury, or you will lose your claim. Your notification must include a detailed description of your injury. Obviously, it would be best if you put your notification into written form and keep a copy for yourself.
Depending on whether your employer maintains a Preferred Provider Program (PPP), you may use either two doctors you have chosen, or you may choose between one doctor you have chosen or a doctor listed in the employer’s PPP. Although your union may recommend a doctor to you, you don’t have to follow their recommendation.
The initial determination of whether or not you are eligible for PPD benefits rests with your employer and the workers’ compensation insurance company. You might be compelled to undergo an “Independent Medical Evaluation” (IME) with a doctor chosen by the workers’ compensation insurance company, and you may have to undergo a “utilization review” of the proposed medical treatment. They have the right to refuse to authorize your medical treatment, and they often exercise this right because it saves them money to do so.
If your claim is denied or disputed, you have the right to seek arbitration with the Illinois Workers’ Compensation Commission (IWCC). There will be an adversarial hearing at which you will face a lawyer hired by the employer/workers’ compensation insurance company. You may be cross-examined by a lawyer. Both sides may present documentary evidence and call witnesses. You may need an expert witness to help you establish your claim.
The IWCC cannot make a final PPD determination in your favor until a licensed physician certifies that you have reached Maximum Medical Improvement (MMI). Your employer/insurance company may also request that you be assigned an impairment rating, which is designed as a measure of your disability that can range from one to 100 percent. The standards that govern your impairment rating are contained in the Rules of the American Medical Association Evaluation of Permanent Impairment, Sixth Edition.
Given all of the complexities of the claim process and the level of opposition that you are likely to face, this is absolutely no time to “go it alone” – without detailed knowledge of the Illinois workers’ compensation system and experience handling workers’ compensation arbitration claims, you will be nearly helpless against the other side unless you have an experienced workers’ compensation lawyer on your side – not only at the arbitration hearing, but well before the hearing so that you will have time to prepare an effective case.
The IWCC will issue a decision on your case within three or four months of the hearing. If you disagree with it, you can appeal to a three-member IWCC commissioner panel (fewer than one percent of all workers’ compensation claims reach this stage), and after that to the court system. The entire appeals process can take up to two years if you continue to receive adverse decisions. If you are finally awarded PPD benefits, the award will be backdated to the date that you reached MMI, and you will receive back payments. You will also be entitled to reimbursement for 100 percent of your medical bills leading up to MMI.
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