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Permanent partial disability benefits can be limited by the caps, which don't take effect until your treating physician declares you have reached MMI.
Let's say you're being treated for an injury for an extended period of time before the physician declares you have reached MMI. Over the course of your treatment, you have received $50,000 in wage loss/temporary disability benefits. However, your impairment rating is 15%, which may be worth an additional $40,000. But because of the $75,000 cap for impairment ratings under 25%, you will only receive $25,000 in permanent partial disability benefits.
It's theoretically possible for you to be eligible for no permanent partial disability benefits because the amount you have already received in temporary disability benefits exceeds the cap. Let's say you receive $85,000 in temporary disability benefits before you reach MMI but your impairment rating comes in below 25%, which means you have exceeded $75,000 the cap and cannot receive any permanent partial disability benefits.
And if you receive benefits up to or exceeding the cap, future benefits can be affected. Let's say you reach MMI and receive the benefits you're entitled to up to the limit. Your case isn't completely settled however so you retain your right to reopen the case within 6 years of the original injury.
A couple years after your initial MMI declaration, problems stemming from the original injury get worse or reappear. But in the original case, you had an impairment rating of 22% and received the maximum payout of $75,000. The additional treatment takes you away from your job once again but since you already exceeded the cap, your employer will be able to offset the permanent partial disability benefits you have already received against future temporary disability benefits.
For example, let's say you were injured in January, 2007 and out of work for two years in which time you receive $52,000 in temporary benefits. The treating physician declares you have reached MMI and assigns an impairment rating of 20%. Because of the $75,000 cap, you receive $23,000 in permanent partial disability benefits and return to work, perhaps in a limited role. The insurer files a “final admission of liability” and the case is closed for the time being.
But after a year back on the job, you're experiencing the same kind of pain again and have to miss work to seek treatment. Since you have reached the $75,000 cap however, the temporary disability/wage loss benefits you enjoyed before will not kick in for awhile. In fact, these benefits will not resume for 46 weeks after you reopen your case.
The 46 weeks figure is determined by dividing the permanent partial disability award of $23,000 by the weekly wage loss rate of $500, which gives you the magic number of 46. Therefore, you will not receive any further temporary disability/wage loss benefits until the insurer “offsets” the previously paid permanent partial disability award.
Having trouble obtaining the Colorado workers' compensation benefits you're entitled to? Is the diagnosis from the doctor not enough to take care of your injuries?
Contact Denver workers' compensation attorney R. Mack Babcock today for a free consultation to discuss your options.
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