Another Landmark Victory Allows Injured Workers to Have a Change in Condition After a Permanent Partial Disability Classification

The Workers’ Compensation Law has four kinds of benefits for periods of disability from work: permanent total disability, temporary total disability, permanent partial disability and temporary partial disability. “Total” disability benefits are paid for periods in which someone is unable to do any work of any kind. “Partial” disability benefits are paid for periods in which you cannot go back to your previous job, but can do some kind of work, even on a part-time basis. In most cases, the benefit rate for total disability is higher than the benefit rate for partial disability – in general, the more disabled you are the higher your weekly benefit rate is, and the less disabled you are the lower your weekly benefit rate will be.

 

Most people have a period of temporary total disability immediately after the accident and become temporarily partially disabled as their condition improves. Many return to work, but some are never able to do so and are eventually found to have a “permanent partial disability.”

 

For accidents after March 13, 2007, the Workers’ Compensation Law has time limitations, or “caps” on how many weeks of permanent partial disability benefits can be paid (ranging from 225 weeks to 525 weeks).

 

However, sometimes a person who was “classified” as permanently partially disabled has a change in their condition – usually resulting from surgery – and becomes temporarily totally disabled for a period of time.

 

In 2019, the Workers’ Compensation Board decided that after someone was classified permanently partially disabled, they could never have a change in condition. No matter what happened to them after their classification, their weekly benefit rate would never change, and their period of permanent partial disability benefits would never be extended.

 

We challenged the Board’s policy in a case where – after being classified permanently partially disabled – the injured worker had two spine surgeries and was totally disabled for fifteen months. The Board counted all fifteen months of temporary total disability as weeks of permanent partial disability and refused to increase the weekly benefit rate during that time. It also refused to consider a “reclassification” to a higher degree of disability by creating an arbitrary time frame for that request.

 

In another landmark opinion, the Court agreed with our position and reversed the Board’s decision, holding that the Board was wrong in refusing to increase the weekly benefit rate during the period of total disability, wrong in counting the weeks of temporary total disability as part of the period of permanent partial disability, and wrong in creating a rule that limited an injured worker’s ability to request reclassification if he or she had a change in condition after being classified.

 

This important decision preserves the right of injured workers across the state to receive proper benefits under the law and to pursue appropriate benefits if their condition changes after a classification of permanent partial disability.

 

You can watch the argument in Sanchez v. Jacobi Medical Center here and read the Court’s decision Sanchez DecisionSanchez Video

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