What is a common low back PD rating? How does a DREII rate out? How does low back WPI become PD?

This video reviews how a lumbar spine WPI rating gets turned into a PD rating, and that into a dollar amount. If you are an injured worker with a California injury, and don’t have an attorney, this video is intended to help provide an overview of workers’ compensation topics so you can better represent yourself.
The PTP and/or the QME will find a certain level of whole person impairment. That gets plugged into the 2005 PDRS, and is adjusted for age and occupation, and potentially lowered due to non-industrial apportionment, and that results in a final PD rating. That rating has a maximum dollar amount assigned to it by the State of California. This is an example of a low back injury.
Jeremy Lusk is a certified specialist in workers’ compensation with about two decades of experience, and previously served as a Judge at the Fresno District Office of the WCAB. He has worked out of Fresno, but appeared at numerous Boards to represent both injured workers and employers/carriers.
No attorney/client relationship is created or implied by this video. This video is not offering legal advice as to what you should, or should not, do in your workers’ compensation case, but rather offers education/information as to the California workers’ compensation system for unrepresented workers so they can better represent themselves and make more informed decisions.
If you have any questions, let us know at [e-mail]

[@simorebuths7301]

Can you please do a video like this for multiple injuries.

[@myworkerscompguide]

Good idea. I'll do that soon.

[@emmyaffan4700]

Yes please I too would like to see a video for WC multiple injuries. I have a %100 combined work injuries rate from my QME and my WC denied it.

[@emmyaffan4700]

I’m also out of work for 3.5 years and I’m recovering SSDI and $290 advanced WC

[@simorebuths7301]

@@emmyaffan4700 same here I’m.

[@myworkerscompguide]

@@emmyaffan4700 It is unfortunately quite common for insurance companies to dispute a 100% PD finding, even when all signs point to that as the conclusion.

[@BrandynHigares-ng6jy]

I had a qme scheduled for Saturday 4/20/24 at 10am. My qme doctor didn’t show up and I waited in the parking lot for an hour. The whole facility is was locked too and I took pictures of the empty parking lot and videos of the locked doors. Is it normal for the insurance company to schedule a qme on a Saturday? And is it normal for them to schedule a qme at a facility that is closed on the weekend?

[@myworkerscompguide]

A QME being scheduled for a Saturday is not unusual. However, it sounds like there was a breakdown in communication somewhere. It's likely that the insurance company letter was wrong as to the date that the exam was scheduled. Or perhaps the QME had to reschedule but nobody managed to tell you. Or perhaps the QME had some sort of emergency.

[@BrandynHigares-ng6jy]

Thank you for the reply. I’ve been having curve balls thrown at me since the start of my workers comp case.

[@myworkerscompguide]

@@BrandynHigares-ng6jy Sadly that is very typical in workers' comp. Best of luck to you.

[@559FRESNOESF]

Been out of work 6-7 months already lower back injury lumbar discs bulging getting workers comp checks and the insurance offered 30k and paid job training or schooling to sign a c&r and resignation how can i negotiate by myself to make it higher? Can i email them back and just say i think my pd is worth more n see if they offer more and if i can negotiate should i wait until next doctor appointment for my doctor to determine my ppd % ? I don’t wanna wait and then the percentage is low and risk them taking away the offer or lowering it please advise even though i know you don’t have all the details

[@myworkerscompguide]

I can't give you any legal advice as to what you should, or should not, do. I can say that you can certainly negotiate if they are offering a C&R at a certain sum. You can certainly go back with a counter demand. If the PD hasn't been established by a PTP or QME report, then the PD is just being estimated. Also, the value of future medical care and closure are both being estimated as well. So there can be a lot of room to negotiate a C&R as there are a number of variables.

[@jaliscomx328]

Can someone ask for a lump sum pay out and close the case before reachibg mmi?if so what can be the pros and cons about such decision

[@myworkerscompguide]

A workers' comp case can be settled at any time - even before a P&S report. However, it is often more difficult to come to an agreement on a figure since the PD hasn't been pinned down yet, and a QME hasn't addressed future medical care. Plus, the C&R will have to provide a good enough explanation of why the parties are settling early and what the settlement is based on, so that a judge can review it and determine adequacy. It is generally best in those situations to try to work out an estimate of what the PD will be based on the current reporting, what the future medical will be based on past medical, and closure value.

[@jaliscomx328]

@@myworkerscompguide thanks for the info

[@edwardkareem6446]

Wow great video workers comp is complicated and he only hurt his low back well that number change if you would have got back surgery

[@myworkerscompguide]

Generally, yes. This fairly typical rating is for a low back strain/sprain type of injury. If there is a surgery then the injury often gets bumped up to a higher rating either due to a higher DRE category, or due to using the ROM method rather than the DRE method.

[@edwinortiz7798]

a Video of southern cali Employers give option to get Simnsa insurance in Mexico as a primary doctor and it confuse people of not getting benefits, Companies in San diego does this to reduce workers comp claims. that would help a lot of people.

[@myworkerscompguide]

That's interesting. I've had a number of clients over the years settle their cases so they can go out of the country to get treatment.

[@esperanzaserrano2883]

Right now thy have me waiting for QME? Is there an explanation date till thy let me know when i can see one? Im on permanent disability getting advances. And just waiting for that to rap up the case im thinking. But my NCS said i do have mild radiculopathy.

[@myworkerscompguide]

Either side can request a QME panel. If the insurance company hasn't gotten a QME, and if you're unrepresented, you can request a panel yourself.

[@jaliscomx328]

If your pcp reccommends sending you to a functional restoration program or pain managment programs also including injections in trigger points for pain would you say that makes for a higher value claim?also is it for the best interest for the injured worker?or could it be these programs are to try and close a claim quicker?

[@myworkerscompguide]

Generally the primary treating physician is not concerned at all with the value of the claim, and recommendations for a FRP or pain management program would not change the value of the PD at all, and could potentially increase the value of a C&R if it was authorized but not proceeded with. The goal of the PTP is to get the injured worker better, and if those programs help the injured worker get better, then they are in the best interest of the injured worker. Proceeding with them, and getting better, might make the value of the case drop, but the goal of workers' comp is to get better and not maximize the value of the case. The money in workers' comp just isn't worth it.

[@jaliscomx328]

@@myworkerscompguide thank you! And yes i agree someones well being is always first but i also think the wc system is really bad so alot of injured workers hope for a good c&r to get private care through there own insurance

[@myworkerscompguide]

@@jaliscomx328 I think you're exactly right.

[@jaliscomx328]

@@myworkerscompguide thank you very much!

[@myworkerscompguide]

@@jaliscomx328 Happy to help inform. Best of luck to you.

[@jaliscomx328]

What happens after the day the qme gets deposed by opposing counsel?how do you know if he did not change his mind about your injury/condition if he ruled in the injured workers favor from the beginning also how do you know if a body part he included in the claim gets accepted or not after his deposition?

[@myworkerscompguide]

After the QME is deposed the transcript goes to both attorneys, assuming you were represented. So both attorneys will know what the QME said during the depo, and then have a record for after. If you have an attorney, you'll have to ask your attorney what the outcome of the deposition was, and what the defense counsel said his or her client will be doing as to body part acceptance.

[@jaliscomx328]

@@myworkerscompguide thanks!

[@jaliscomx328]

@@myworkerscompguide i thought that if the qme included a body part and did not change his mind about it the insurance company had to accept it since the qme is ultimetely "the god of the case" in a way

[@myworkerscompguide]

@@jaliscomx328Every case is unique. If it is only a medical question, and if the QME report is substantial evidence, and if there is no conflicting evidence, then body part will likely be accepted. However, there are many grounds for denial, and the QME reporting will only overcome some of them.

[@jaliscomx328]

@@myworkerscompguide it is extremely overwhelming but thank you!

[@Overtimewayne]

Wow

[@Overtimewayne]

I had a evaluation done buy neurophysiology and they say I have not reached MMI,and should continue treatment,for a TBI,neck,spine, shoulders,hips,legs,and PTSD mental health,and nightmares,do to a kick to the head by and inmate,as and Texas correction officer,c/o3, first responder,the carrier never accepted me are treated me as a first responder,and is denied my claim,what should I do😊

[@myworkerscompguide]

I couldn't say. I represent many California correctional officers, but I have absolutely no experience with Texas law or their workers' comp system. Each state is different. I can only say to reach out to a local attorney for a consultation.

[@Overtimewayne]

@@myworkerscompguide Texas has the same workers compensation laws

[@jesustrades1939]

If the person would of been 25 Yrs old , Would he had gotten more money

[@myworkerscompguide]

What's really crazy about this system is that for injured workers who are younger, the rating drops down; and for injured workers who are older the rating goes up. So even though a younger injured worker will live with the effects of the injury longer, the State figures the younger person may heal (I guess).

[@jesustrades1939]

@@myworkerscompguide Wow that’s Crazy lol , it should be the other way around

[@myworkerscompguide]

@@jesustrades1939 Logic and common sense are not seen very much in workers' comp. Best of luck to you.

[@jesustrades1939]

@@myworkerscompguide Yeah i can see that , At the end of the day “They” always win, Oh well

[@amayaaguirre0427]

@@jesustrades1939my husband is 25 with a severe back injury and they dismiss him a ton because of his age