When Can Permanent Partial Disability Be Reassessed?

It is a terrible thing to be injured at work, and even worse to suffer a permanent injury. This potential for injury and disability is just one of the reasons that workers’ compensation exists. If you have been assessed as having a permanent partial disability in Minnesota you may have been awarded either a lump sum or structured payouts based on the rating of that disability, but what can you do if your condition worsens?

When Can Permanent Partial Disability Be Reassessed?

Permanent partial disability compensates injured workers for the permanent loss of use or function of a body part or system due to a work-related injury. It is different from, and is paid separately to, wage loss benefits. While it is generally considered a “final” determination once the rating is issued, the law allows for reassessment under certain conditions.

How Initial Assessment Works

The initial assessment of your disability is based on your condition after a doctor determines that you have reached the point of maximum medical improvement. That means that they consider there to be no more medical treatment available that could lessen the effects of the injury and that you have healed as well as is possible.

You then receive a rating (or multiple ratings if you sustained multiple injuries), which is expressed as a percentage of total body impairment. This rating is medical rather than vocational, so it does not take into account potential reduced earning capacity or job loss.

Reasons for Reassessment

Worsening of the Injury After the Initial Rating

It is unfortunate but true that injuries can evolve and that your condition may worsen over time through no fault of your own. If you have experienced this, you can apply to have your rating reassessed.

To be reassessed, you will need to provide updated medical information showing a genuine and significant deterioration of function. This medical documentation can also show this is more than an anticipated progression of your condition and is not an issue that you yourself have caused. A physician must then perform a new examination and apply the PPD rating schedule.

For example, if you suffered a lumbar disc herniation after a warehouse accident, you might initially receive a 10% PPD rating. If, however, you later develop worsening nerve compression, you may qualify for a reassessment and a higher rating.

Necessary Surgery After Initial Rating

Surgery performed after the initial PPD rating may change the classification and thus the percentage of disability. Surgical intervention often alters the condition and may qualify the worker for a higher PPD rating under the Minnesota disability schedule.

Let’s go back to the example of the lumbar disc herniation. Having initially been treated conservatively, you were given that 10% PPD rating. However, if you later need to undergo lumbar fusion surgery for the condition, you should be reassessed, as courts allow new PPD determinations if the surgery materially changes the worker’s functional limitations or structural anatomy.

Incorrect Initial Rating

You’ve had your herniated disc evaluated, and the documentation shows that there is nerve root involvement causing weakness in your leg. However, when your PPD rating is assigned it is 7%, which is appropriate only for disc injuries without objective neurological findings, rather than the 10% you were expecting. How could this have happened, and what can you do about it?

Sometimes, the initial PPD rating is issued incorrectly due to error, oversight, or incomplete diagnosis. If you believe that this has happened to you, you can have the rating corrected. The first thing you need to do is challenge the initial rating through filing, or having your attorney file a Claim Petition or Request for Formal Hearing.

The next stage of the process is when a compensation judge at the Office of Administrative Hearings evaluates the claim. At that time, either party may present expert medical testimony to support their position. Challenges based on incorrect ratings are subject to time limits. However, if the case remains open, for example if benefits are still being paid or not fully settled, the issue can often be revisited.

Settlement Terms Allowing Future Medical Reassessment

Many workers’ compensation settlements in Minnesota close out certain benefits, including future PPD. However, not all settlements include a full PPD closure. In a settlement, the parties might agree to terms that close out wage-loss and PPD benefits but leave future medical treatment open, allowing for reassessment if the worker’s condition worsens.

For example, as part of your lumbar disc herniation settlement you may receive a lump-sum payment based on a 10% PPD rating, but made sure that the terms of the statement specifically state that future medical care like surgery, pain management, or physical therapy remain covered. If your symptoms flare up or new complications develop, you can be compensated without having to reopen the entire claim.

Reopening a Final Award (Vacation of Award)

In rare cases, a final PPD award may be reopened through a legal mechanism known as vacation of award. You can petition to vacate an award based on substantial change in medical condition, mistake, fraud, or newly discovered evidence.

Let’s say that you were told by your doctor that there was no nerve involvement with your herniated disc. You accepted a 7% PPD rating and closed out most benefits. Still experiencing pain several months later, you sought a second opinion. Your new doctor ordered an EMG and updated MRI, which revealed clear evidence of radiculopathy that was missed in the original evaluation. This constitutes newly discovered medical evidence of something that existed at the time of settlement but wasn’t known or reasonably discoverable. You can then petition the Minnesota Workers’ Compensation Court of Appeals to vacate the award and argue that this new evidence would have materially changed the outcome of the original settlement.

Reassessment Limitations

The legal ability to reassess PPD is limited. One of these limits is the statute of limitations as it relates to the employer’s primary liability. If primary liability, that is, the employer’s responsibility for the accident, was denied and not pursued within three years of the denial or six years of the injury, a claim is likely to be barred. The other limit relates to settlement and case closure. If the case has been settled or closed, reassessment may not be possible unless the specific terms of the settlement allow it or the case is reopened through vacation of award.

Practical Considerations for Workers With Permanent Partial Disability in Minnesota

If you are considering a PPD reassessment, there are some steps that you should take to get you on the right track. The first of these is to consult an experienced workers’ comp attorney. The second of which is to get an updated medical evaluation of your condition, ideally by a doctor who can confirm the significant deterioration or difference from that in your initial rating. It is also important to act quickly not just because of the statute of limitations, but because your time is precious, and you deserve to be living it well sooner rather than later.

Your disability may be permanent, but the PPD ruling doesn’t have to be. To take advantage of our 70 years of combined experience representing injured workers, get in touch with us at Atkinson Gerber at one of our locations in St Paul, MN, or Minneapolis, MN.