When it comes to workers’ compensation claims, understanding the timeline for a permanency evaluation is crucial. Do you know when your insurance must complete this evaluation? Failing to meet this deadline could have significant implications for your claim. At Katz, Leidman, Freund & Herman, we understand the importance of ensuring that insurance companies fulfill their obligations in a timely manner. Knowing when your insurance must complete a permanency evaluation is vital to protecting your rights and securing the compensation you deserve. Let’s delve into the details of this critical process and how our experienced team can guide you through it.
What is a Permanency Evaluation?
A permanency evaluation is a critical component in the workers’ compensation process, especially for cases involving long-term or permanent injuries. This evaluation assesses the extent and impact of an injury or illness on an individual’s ability to work and perform daily activities, determining whether the condition is permanent or if there is a likelihood of future improvement.
During a permanency evaluation, a qualified medical professional—typically an orthopedic surgeon, neurologist, or another specialist relevant to the injury—conducts a thorough examination of the injured party. This examination may include a review of medical records, imaging studies, and a physical assessment to gauge the severity of the injury.
The evaluator will also consider the injured individual’s functional limitations and the impact of these limitations on their capacity to engage in work-related activities. They may use established guidelines and rating systems, such as the American Medical Association’s (AMA) Guides to the Evaluation of Permanent Impairment, to assign a percentage of impairment. This percentage reflects the degree to which the injury has impaired the person’s overall function and ability to perform their job or other daily tasks.
The results of the permanency evaluation play a crucial role in the workers’ compensation claim process. They help determine the amount of compensation the injured worker is entitled to, including potential benefits for permanent disability or impairment. This evaluation also assists in negotiating settlements and ensuring that the injured worker receives appropriate financial support for their long-term needs.
In summary, a permanency evaluation provides a comprehensive assessment of how an injury impacts an individual’s long-term well-being and work capacity, guiding decisions about compensation and ongoing care.
When Must Your Insurance Complete a Permanency Evaluation?
The workers’ compensation process involves coordination between the injured party’s insurance and the insurance company. Specifically, the insurance company must adhere to certain deadlines to ensure that their own evaluation is conducted within the required timeframe.
When you undergo a permanency evaluation, the Board will issue an EC-81.7 form to the insurance company. This form notifies the insurer of the evaluation results and sets a timeline for them to complete their own evaluation if they wish to conduct a separate assessment.
Typically, insurance companies have 75 days from the issuance of the EC-81.7 form to perform their own permanency evaluation. This 75-day window allows them to review the findings and determine if they agree with the initial assessment or need to conduct a separate evaluation to verify the results.
However, recent changes and upheavals in healthcare had previously allowed for some flexibility regarding this timeline, but these extensions and leniencies are no longer in effect. Insurance companies must now complete their secondary evaluation within the 75-day period for it to be valid and considered in the claim process.
If the insurance company fails to complete their evaluation within this timeframe, the initial permanency evaluation results may be accepted as the final determination for compensation purposes. Thus, it is crucial for insurance companies to adhere to this deadline to ensure their evaluations are taken into account and to avoid potential delays or complications in the claims process.
What Affects Permanency Awards?
Permanency awards in workers’ compensation cases are designed to compensate injured workers for permanent impairments that impact their ability to work and perform daily activities. Several factors influence the amount and determination of these awards, and understanding these factors can help ensure a fair evaluation and compensation. Here are the key elements that affect permanency awards:
1. Severity of the Injury
The extent and severity of the injury play a crucial role in determining a permanency award. Injuries are assessed based on their impact on the individual’s physical function and overall quality of life. More severe injuries, which result in significant impairment or disability, typically lead to higher permanency awards. The evaluation often includes a detailed assessment of the injury’s effects on mobility, strength, and ability to perform job-related tasks.
2. Medical Evidence and Permanency Evaluation
The results of the permanency evaluation conducted by a qualified medical professional are central to determining the award. This evaluation provides an objective assessment of the injury and its long-term effects. Factors such as the percentage of impairment assigned by the evaluator, the presence of any permanent restrictions, and the expected progression of the injury all contribute to the permanency award.
3. Functional Limitations
The degree to which the injury limits the individual’s ability to perform work-related duties and engage in daily activities is also a significant factor. The evaluation considers how the injury affects the person’s capacity to return to their pre-injury job or to find suitable alternative employment. Greater functional limitations generally result in higher permanency awards.
4. Pre-existing Conditions
Pre-existing conditions or previous injuries can influence the permanency award. If the current injury exacerbates or compounds a pre-existing condition, the compensation may be adjusted to reflect the combined impact. Medical records and history are reviewed to determine the extent to which pre-existing conditions contribute to the overall impairment.
5. Impact on Earning Capacity
The injury’s effect on the injured worker’s ability to earn a living is a critical consideration. If the injury severely impacts the individual’s ability to work or results in a loss of income, this will be factored into the permanency award. This includes assessing whether the person can return to their previous occupation or if they require vocational retraining for a different role.
6. Legal and Policy Guidelines
Workers’ compensation laws and policies set forth guidelines for determining permanency awards. These guidelines can vary by jurisdiction and may include specific formulas or rating systems used to calculate compensation. Legal precedents and case law can also influence how awards are determined.
How a Workers’ Compensation Lawyer Can Help
Navigating the workers’ compensation system can be complex and challenging, especially when it comes to securing a fair outcome for your claim. At Katz, Leidman, Freund & Herman, we understand the intricacies of this process and are here to guide you every step of the way. Here’s how our experienced workers’ compensation lawyers can assist you:
Expertise in Legal Procedures
Workers’ compensation claims involve numerous legal procedures and requirements that can be overwhelming. Our team has extensive knowledge of the workers’ compensation system and can help ensure that all necessary forms, such as the EC-81.7, are correctly filed and submitted in a timely manner. We handle the paperwork and legal formalities so you can focus on your recovery.
Coordination with Medical Professionals
Securing a comprehensive and accurate permanency evaluation is crucial for your claim. We work closely with medical professionals to ensure that the evaluation accurately reflects the extent of your injuries and their impact on your ability to work. Our team can also assist in interpreting the results and determining the best course of action based on these findings.
Dealing with Insurance Companies
Insurance companies often have their own agendas and may try to minimize their payout or delay the process. Our lawyers are skilled in negotiating with insurance companies to ensure that they meet their deadlines, including the critical 75-day window for completing their secondary evaluations. We advocate on your behalf to protect your rights and ensure you receive the compensation you deserve.
Representing Your Interests
If disputes arise or if the insurance company challenges the permanency evaluation, we provide strong representation to protect your interests. Our team is prepared to handle any legal challenges that may come your way and to work diligently to resolve any issues that may affect your claim.
Maximizing Your Compensation
Our goal is to ensure that you receive fair compensation for your injuries and losses. We thoroughly evaluate your case, including the permanency evaluation results, to ensure that all aspects of your injury and its impact on your life are considered. We strive to secure the maximum compensation available for your medical expenses, lost wages, and other damages.
Having a dedicated workers’ compensation lawyer from Katz, Leidman, Freund & Herman on your side can make a significant difference in the outcome of your claim. We provide expert guidance, handle complex legal matters, and advocate fiercely for your rights to help you achieve the best possible result.
Need Assistance with a Permanency Evaluation? Let Us Advocate for You
Understanding the complexities of permanency evaluations and how they impact your workers’ compensation claim is essential for securing fair compensation for your injuries. At Katz, Leidman, Freund & Herman, we are dedicated to guiding you through every step of the process, from navigating the intricacies of permanency awards to ensuring timely and accurate evaluations. Our experienced team is here to advocate for your rights and help you achieve the best possible outcome for your claim. If you have questions or need assistance with your workers’ compensation case, don’t hesitate to reach out to us for expert legal support and personalized guidance. Your path to fair compensation starts here.