Certified Specialist in California Workers’ Compensation

When your work injury results in lasting impairment—meaning you’ll never fully recover—you’re entitled to permanent disability (PD) benefits. The amount you receive depends on your permanent disability rating, expressed as a percentage from 1% to 100%.

Here’s the problem: Insurance companies routinely underrate permanent disability. Their doctors minimize your impairment, apply excessive apportionment (claiming your disability was pre-existing), or make calculation errors that can cost you tens of thousands of dollars—or more.

A difference of just a few percentage points can mean $20,000, $50,000, or even $100,000+ in lost benefits.

At the Law Office of Joseph T. Todoroff, we specialize in maximizing permanent disability ratings for injured workers throughout Northern California. As a Board-Certified Specialist in Workers’ Compensation Law, Joseph understands the complex permanent disability rating system and knows how to fight for accurate ratings that reflect the true extent of your impairment.

Don’t leave money on the table. Let us review your permanent disability rating for free.

• Total disability – You can still work in some capacity
• Social Security disability – Different system with different standards
• Long-term disability insurance – Private insurance, separate from workers’ comp

Types of Permanent Disability:

Permanent Partial Disability (PPD)

You have lasting impairment but can still work in some capacity. This is the most common type of permanent disability. Ratings typically range from 1% to 99%.

Permanent Total Disability (PTD)

Your work injury has left you unable to engage in any gainful employment. This is rare and typically reserved for catastrophic injuries like paralysis or severe brain injury. Rated at 100%.

Step 1: Permanent and Stationary (P&S) Status

Before you can receive a permanent disability rating, your doctor must declare you “permanent and stationary”—meaning:

• You’ve reached maximum medical improvement
• Your condition is unlikely to improve with further treatment
• Your permanent limitations can now be assessed

Timing:
Most injured workers reach P&S status 12-24 months after injury, though some reach it sooner or later depending on injury severity and treatment response.

Step 2: Impairment Rating Using AMA Guides

A physician evaluates your impairment using the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment, Fifth Edition.

The Doctor Assesses:

• Range of motion limitations
• Strength deficits
• Sensory losses
• Organ function impairment
• Pain levels
• Loss of use

Each body part is rated separately:

• Spine injuries
• Upper extremity injuries (shoulder, arm, hand)
• Lower extremity injuries (hip, leg, foot)
• Internal organs
• Psychiatric impairment
• Multiple body parts (combined rating)

The result: A whole person impairment (WPI) percentage

Step 3: Convert to Permanent Disability Using California Formula

California converts the WPI percentage to a permanent disability percentage using complex formulas that consider:

Age: Younger workers receive higher PD percentages (longer working life ahead)

Occupation: Based on your job at time of injury:

• Group 1: Professional, executive, managerial
• Group 2: Semi-skilled, clerical
• Group 3: Skilled labor
• Group 4: Semi-skilled labor
• Group 5: Unskilled labor

Higher occupational groups generally result in lower PD ratings (more alternative jobs available)

Adjustment Factors:
California uses adjustment tables that can increase or decrease the PD percentage based on age and occupation

The result: Your permanent disability percentage (1% to 100%)

Step 4: Calculate Monetary Value

Your PD percentage is multiplied by your average weekly earnings to determine the dollar value:

Permanent Partial Disability:

• PD percentage × weeks of compensation (based on rating) × payment rate (based on earnings)
• Paid either as biweekly payments or lump sum settlement

Permanent Total Disability:

• Lifetime weekly payments equal to 2/3 of your average weekly wage (subject to minimum/maximum)
• Paid for life

Example Calculation:
45% PD rating for a worker earning $1,000/week might result in total benefits of $150,000+, while 35% might only yield $90,000. The 10% difference equals $60,000.

Step 5: Apply Apportionment (If Applicable)

Apportionment reduces your PD award by allocating a portion of your disability to non-industrial causes:

• Pre-existing conditions
• Prior injuries
• Degenerative conditions
• Congenital defects
• Other pathology unrelated to work

Example:
Your total disability is rated at 50%, but the doctor apportions 20% to pre-existing arthritis. Your work-related PD becomes 30% (50% – 20% = 30%), significantly reducing your benefits.

This is where insurance companies most aggressively fight to reduce your benefits.

1. Underrating Impairment

The Problem:
Insurance company doctors minimize the severity of your impairment using:

• Overly optimistic assessments of range of motion
• Downplaying pain levels
• Ignoring functional limitations
• Using improper rating methodology
• Failing to rate all affected body parts

Real Example:
You have severe shoulder pain limiting overhead activities. The insurance doctor finds “full range of motion” by having you move your arm while lying down (gravity-assisted), then concludes no significant impairment—even though you can’t lift your arm overhead while standing.

How We Fight It:

• Obtain thorough evaluation from qualified medical evaluator
• Video documentation of functional limitations
• Multiple physician opinions
• Challenge improper rating methodology
• Ensure all affected body parts are rated

2. Excessive Apportionment

The Problem:
Insurance doctors aggressively apportion disability to non-industrial causes, claiming most of your disability is from:

• Normal aging
• Pre-existing arthritis
• Prior injuries (even minor ones)
• Degenerative disc disease
• Obesity
• “Constitutional factors”

Common Apportionment Tactics:

• Finding pre-existing conditions on old X-rays that never caused problems
• Attributing cumulative trauma entirely to non-work activities
• Claiming degenerative changes would have occurred anyway
• Excessive apportionment based on age alone

Real Example:
A 55-year-old construction worker suffers a new herniated disc from lifting at work. Insurance doctor sees some degenerative changes on MRI and apportions 80% to “age-related degeneration,” despite the fact the worker was asymptomatic before the work injury.

How We Fight It:

• Establish you were asymptomatic before work injury
• Distinguish new acute injury from pre-existing condition
• Show work substantially contributed to disability
• Challenge unsupported apportionment opinions
• Obtain medical evidence showing distinct new injury

Legal Standard:
Apportionment must be based on substantial medical evidence—not speculation. If doctors can’t reliably separate industrial from non-industrial causes, no apportionment should apply.

3. Combining Multiple Body Parts (Combined Values Chart)

The Problem:
When multiple body parts are injured, they’re combined using the Combined Values Chart—which results in a combined rating that’s LESS than the sum of individual ratings.

Example:

• 20% PD for shoulder = 20%
• 15% PD for knee = 15%
• Sum would be 35%, but combined chart gives only 32%

Why This Happens:
The Combined Values Chart is based on actuarial assumptions about disability—it assumes multiple disabilities don’t simply add together.

The Insurance Company Tactic:
They try to rate body parts separately at lower percentages, resulting in even smaller combined ratings.

How We Fight It:

• Ensure each body part is rated at maximum appropriate level
• Consider whether injuries should be rated together as one body region
• Challenge arbitrary separation of body parts
• Fight for accurate individual ratings before combining

4. Failing to Rate Psychiatric Impairment

The Problem:
Many injured workers develop secondary psychiatric conditions from their injuries:

• Depression from chronic pain
• Anxiety about financial future
• PTSD from traumatic workplace incidents
• Sleep disorders
• Social isolation due to disability

Insurance companies often:

• Ignore psychiatric symptoms
• Claim psychiatric injury doesn’t meet threshold for compensation
• Refuse to evaluate psychiatric component
• Minimize psychological impact

How We Fight It:

• Document psychiatric symptoms and treatment
• Obtain psychiatric evaluation and rating
• Establish compensability of psychiatric injury
• Add psychiatric rating to physical impairment rating

Important: Psychiatric impairment can add significant percentage points to your overall PD rating.

Disputes Over Future Medical Care

The Problem:
Even if you get a fair PD rating, the insurance company may try to limit or eliminate future medical care—arguing you don’t need ongoing treatment.

Why This Matters:
Future medical care can be worth more than your PD award over time, especially for serious injuries requiring ongoing treatment.

How We Protect Your Rights:

• Ensure future medical care is preserved in settlement
• Document ongoing treatment needs
• Obtain life care plans for catastrophic injuries
• Structure settlements to protect medical benefits
• Address Medicare Set-Aside requirements

Agreed Medical Evaluator (AME)

What is an AME?
When both sides have attorneys, you can agree on a medical evaluator rather than using the QME panel process.

Benefits of AME:

• Both sides select doctor together
• Generally more balanced and credible
• AME reports are given more weight by judges
• Can select doctor with specific expertise

How We Use AME Process:

• Negotiate with insurance company for fair, qualified evaluator
• Select physicians with expertise in your specific injury
• Avoid biased evaluators on both sides
• Ensure thorough, comprehensive evaluation

Maximizing Your Permanent Disability Rating

Our Strategic Approach

At the Law Office of Joseph T. Todoroff, we use a comprehensive strategy to maximize permanent disability ratings:

Step 1: Thorough Case Evaluation

We Analyze:

• Your medical records and treatment history
• Prior PD ratings and medical reports
• All affected body parts
• Potential for psychiatric injury rating
• Apportionment issues
• Calculation methodology

Step 2: Strategic QME/AME Selection

We Ensure:

• Selection of qualified, fair evaluators
• Doctors with expertise in your injury type
• Research of evaluator track records
• Strategic striking on QME panels
• Negotiation for appropriate AME when possible

Step 3: Comprehensive Medical Evidence

We Develop:

• Detailed injury documentation
• Functional capacity evaluations
• Vocational assessments
• Psychiatric evaluations when appropriate
• Multiple medical opinions if needed
• Video or photographic evidence of limitations

Step 4: Proper Rating Methodology

We Ensure:

• All body parts are properly rated
• Correct AMA Guides sections are used
• Age and occupation factors are properly applied
• Combined values are calculated correctly
• No improper deductions or errors

Step 5: Fight Excessive Apportionment

We Challenge:

• Unsupported apportionment opinions
• Speculation about pre-existing conditions
• Excessive attribution to non-work factors
• Age-based apportionment without medical basis
• Apportionment when you were asymptomatic before injury

Step 6: Maximize Total Recovery

We Pursue:

• Highest supportable PD rating
• Additional psychiatric rating when appropriate
• Supplemental Job Displacement Benefits (SJDB)
• Future medical care provisions
• Life pension for ratings over 70%
• Third-party claims when applicable

Retraining Vouchers When You Can’t Return to Your Job

If your permanent disability prevents you from returning to your previous job, you may be entitled to Supplemental Job Displacement Benefits:

SJDB Voucher:

• Up to $6,000 for education, retraining, or skill enhancement
• Can be used for community college, vocational training, certifications
• Pays for tuition, books, fees, and related expenses

Eligibility:

• Employer doesn’t offer modified or alternative work within your restrictions
• Your permanent disability prevents return to usual occupation
• Not available if you’re permanent and total

How We Help:

• Establish your inability to return to previous work
• Fight employer claims of available modified work
• Ensure you receive maximum SJDB benefits
• Negotiate SJDB voucher value in settlements

Stipulations with Request for Award (Stips)

Structured Award:

• Agree on permanent disability rating
• Receive biweekly payments over time
• Keep case open for future medical care
• Retain limited right to reopen

Advantages:

• Retain future medical care for life
• Can reopen for new and further disability in some cases
• Guaranteed payment schedule
• No Medicare Set-Aside issues

Disadvantages:

• No lump sum payment
• Payments spread over months or years
• Ongoing relationship with insurance company
• Limited access to funds

Free Permanent Disability Rating Review

If you’ve received a permanent disability rating from the insurance company, don’t accept it without having it reviewed by an experienced workers’ compensation attorney. Insurance company ratings are almost always lower than what injured workers are entitled to receive.

We offer a free, no-obligation review of your permanent disability rating.

During your review, Joseph will:

• Analyze your PD rating and supporting medical reports
• Identify potential errors or undervaluation
• Explain how apportionment was applied
• Calculate what your rating should be
• Explain how we can help increase your rating
• Answer all your questions

Even a small increase in your PD percentage can mean tens of thousands of dollars in additional benefits.