How Do the Caps Apply to How Much Received in Colorado Workers’ Comp Benefits?

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.

Limitations On Amount of Temporary & Permanent Partial Disability Benefits Received Via Colorado Workers’ Comp

Caps for these types of Colorado workers’ compensation benefits are determined by several factors but in principle, the cap depends on the impairment rating the treating physician assigns. It’s important to note that benefit caps do not apply until the treating physician declares you have reached MMI.

For injuries occurring on or after January 1, 2006, the cap for combined temporary and permanent partial disability benefits is $75,000 if your impairment rating is 25% or less and $150,000 if your impairment rating is higher than 25%. For injuries occurring before 2006, the caps are $60,000 and $120,000 respectively.

Doctors assign an impairment rating based on the American Medical Association’s Guides to the Evaluation of Permanent Impairment, 3 rd Edition (Revised) or more commonly known as the “AMA Guides.” What doctors do is assign ratings to the parts of your body affected by the injury. For example, they may assign an injured arm or shoulder, neck and psychological rating.

Each of these figures is then converted to your “whole person” equivalent using the appropriate tables in the AMA Guide. Once the whole person equivalent is determined for each extremity rating, those figures are added together to give you your impairment rating.

Read How do the caps apply to how much I ultimately receive in Colorado workers’ compensation benefits? to learn more about how benefit caps can affect what you ultimately receive in benefits.

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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