Illinois Workers’ Comp Impairment Ratings: Do They Decide Settlement Value?

Do You Need an Impairment Rating for an Illinois Workers’ Comp Settlement?

Usually, no. You do not need to personally go out and get an AMA impairment rating just to settle an Illinois workers’ compensation case.

In many cases, no impairment rating is ever obtained. In other cases, the insurance company gets one through an IME doctor or another physician. But that does not mean the impairment rating controls the settlement value.

Illinois law allows an impairment rating to be considered as one factor in a permanent partial disability case. But it is only one factor. It does not replace the real-world evidence that usually matters much more, including your surgery, restrictions, job duties, age, future earning capacity, treating medical records, and whether you returned to your old job.

This is why it is dangerous to confuse an impairment rating with the actual value of an Illinois workers’ comp settlement.

What Is an Impairment Rating in Illinois Workers’ Compensation?

An impairment rating is a medical opinion that tries to measure permanent functional loss after an injury. The rating is usually expressed as a percentage, such as 5% of the whole person, 10% of an arm, or 15% of a hand.

Medical providers that perform these evaluations often use the American Medical Association’s Guides to the Evaluation of Permanent Impairment. For example,
SafeWorks Illinois describes a Permanent Partial Impairment rating as a physician-generated percentage based on the AMA Guides. Midwest Orthopaedics at Rush similarly explains that an impairment rating evaluation measures permanent functional loss using objective clinical findings, standardized measurements, and musculoskeletal function.

A doctor performing an impairment rating may look at things like:

• range of motion;
• loss of strength;
• atrophy;
• diagnosis;
• surgical history;
• physical exam findings;
• imaging studies;
• functional complaints;
• clinical measurements.

That can make the rating sound objective and final. But in Illinois workers’ compensation, the rating is still only one piece of evidence.

Impairment Rating vs. PPD in Illinois Workers’ Comp: They Are Not the Same Thing

This is the most important point in this article:

An impairment rating is not the same thing as PPD.

PPD stands for permanent partial disability. In many Illinois workers’ compensation cases, PPD is the category of benefits used to compensate an injured worker for permanent loss after reaching maximum medical improvement.

But the PPD percentage used to value a settlement or award is not automatically the same as the AMA impairment rating.

For example, a doctor may assign a low impairment rating after a rotator cuff repair, back surgery, elbow surgery, or knee injury. The insurance company may then try to argue that the settlement should be low because the rating is low. But the actual case value may be higher because the worker had surgery, ongoing symptoms, permanent restrictions, loss of job duties, or reduced earning capacity.

If you are trying to understand PPD percentages, body-part values, and basic settlement math, read my Illinois workers’ comp settlement chart. But do not confuse that chart with an impairment rating. They are related concepts, but they are not the same thing.

What the 2011 Illinois Workers’ Compensation Amendment Says About Impairment Ratings

Impairment ratings became part of the Illinois workers’ compensation conversation after the 2011 amendments to the Illinois Workers’ Compensation Act.

Under
Section 8.1b of the Illinois Workers’ Compensation Act, for accidental injuries occurring on or after September 1, 2011, permanent partial disability is determined using several criteria:

1. the reported level of impairment;
2. the occupation of the injured employee;
3. the age of the employee at the time of injury;
4. the employee’s future earning capacity;
5. evidence of disability corroborated by the treating medical records.

The most important sentence in the statute is this:

“No single enumerated factor shall be the sole determinant of disability.”

That means the impairment rating is not supposed to be the whole case.

The Illinois State Bar Association’s discussion of the 2011 rewrite of the Illinois Workers’ Compensation Act is helpful background. The ISBA article noted that the business community wanted disability to be based on AMA guidelines only, but the law did not go that far. Instead, Illinois adopted a multi-factor approach.

Illinois Case Law on Impairment Ratings: Continental Tire and Corn Belt

Two Illinois appellate decisions help explain how impairment ratings are supposed to fit into PPD decisions.

Continental Tire: The Commission Did Not Have to Adopt a 0% Impairment Rating

In Continental Tire of the Americas, LLC v. Illinois Workers’ Compensation Commission, the employer submitted an impairment report that assigned a 0% impairment rating. The arbitrator still awarded 5% loss of use of the hand, and the Commission affirmed.

The appellate court affirmed the award. The court explained that Section 8.1b required the Commission to consider a qualifying impairment report, regardless of which party submitted it. But the statute did not require the claimant to submit his own written report, did not specify the weight the Commission had to give the report, and did not require the Commission to automatically adopt the 0% rating.

In plain English, Continental Tire supports the point that an impairment rating can be considered without being automatically accepted as the final value of the case.

Corn Belt: A PPD Impairment Report Is Not an Absolute Prerequisite, But the Commission Must Explain the Factors

In Corn Belt Energy Corp. v. Illinois Workers’ Compensation Commission, the employer argued that the injured worker could not receive PPD benefits because he did not introduce a PPD impairment report.

The appellate court rejected that argument. The court held that Section 8.1b does not place an explicit requirement on either party to submit a PPD impairment report and does not make such a report an absolute prerequisite to a PPD award. If a report is submitted, the Commission must consider it with the other statutory factors. But the absence of a report does not automatically bar PPD benefits.

There is an important nuance: the Corn Belt court still remanded the PPD portion of the case because the Commission had not adequately explained the relevance and weight of the Section 8.1b factors. So Corn Belt is not a free pass for sloppy PPD findings. It supports the idea that a report is not mandatory in every case, while also reinforcing that the Commission must address the statutory factors when deciding PPD.

That is the accurate takeaway: an impairment rating may matter, but it is not automatically required in every case and it is not automatically the value of the case.

Why Workers’ Comp Insurance Companies Like AMA Impairment Ratings

In my experience, AMA impairment ratings are usually more helpful to workers’ comp insurance companies than to injured workers.

The reason is simple: impairment ratings can make a serious injury look smaller than it really is.

A worker may have a low medical impairment rating but still be unable to return to heavy labor, overhead work, repetitive lifting, airline work, construction, nursing, warehouse work, delivery work, factory work, or another physically demanding job.

That is the difference between impairment and disability.

• Impairment is a medical measurement of functional loss.
• Disability is how the injury affects the worker’s actual ability to work, earn money, and function in real life.

Other states rely much more heavily on impairment ratings. I think that is what employers and insurance companies wanted when impairment ratings were added to Illinois law in 2011. But in actual Illinois practice, impairment ratings have usually been a much smaller issue than expected.

A Real-World Example: Back Fusion Surgery and a Full-Duty Release

I recently tried a workers’ compensation case where the issue was what a back fusion surgery was worth after the injured worker, an airline flight attendant, received a full-duty release.

Defense counsel told me he considered getting an impairment rating, but he and his client decided it was not really worth it. The basic idea was that everyone involved already knew the realistic range of values for that surgery and outcome.

That is a good example of how many experienced Illinois workers’ comp lawyers and judges actually view impairment ratings. They may come up. They may be included in a report. They may be argued. But in many cases, they do not change the practical value analysis very much.

Warning: A Low Impairment Rating After Surgery Does Not Mean a Low Workers’ Comp Settlement

This is the biggest warning I want injured workers to understand.

If your adjuster says your operated shoulder is only worth 5% loss of the body because of an impairment rating, that may sound reasonable. It is a medical number. It may come from a doctor. It may sound official.

But it may not be fair.

A low impairment rating after shoulder surgery, rotator cuff repair, back surgery, neck surgery, knee surgery, elbow surgery, or hand surgery does not automatically decide the value of your Illinois workers’ compensation case.

For shoulder cases specifically, see my detailed guide on how much a shoulder or rotator cuff injury is worth in Illinois workers’ comp. Shoulder settlement value usually depends heavily on surgery, permanent restrictions, overhead limitations, job duties, and whether the worker can return to the same job.

If an adjuster is using a low impairment rating to pressure you into a low settlement, talk to a lawyer before you sign anything.

What If the Impairment Rating Comes From an IME Doctor?

This is common. An insurance company doctor may examine you during an independent medical examination, also called an IME, and then include an impairment rating at the end of the report.

That does not mean the rating is correct. It also does not mean the case is over.

An IME doctor is selected and paid through the insurance side of the case. The IME is not treatment. It is often a litigation tool. If you have been scheduled for one, read my guide to IMEs in Illinois workers’ compensation.

If the insurance company relies on an IME impairment rating to reduce settlement value, the doctor can be challenged. In the right case, we can depose the doctor and ask questions like:

• What records did you review?
• Did you review the operative report?
• Did you understand the worker’s actual job duties?
• Did you consider permanent restrictions?
• Did you measure range of motion correctly?
• Did you consider weakness, pain, or loss of endurance?
• Did you apply the AMA Guides correctly?
• Did you explain your calculations?
• Did you ignore treating medical records?
• Did your opinion change after learning more about the worker’s job?

Sometimes a rating looks much weaker after the doctor has to explain it under oath.

Can an Illinois Workers’ Comp Arbitrator Rely on an Impairment Rating?

Yes, an arbitrator can consider an impairment rating. But that does not mean the arbitrator must adopt it.

I can imagine a case where a low impairment rating affects the final number around the edges. For example, it might be used to argue that an operated tennis elbow case should be 15% loss of use of the arm instead of 20%, or that a rotator cuff surgery with a good outcome should be 10% loss of the person as a whole instead of 15%.

But that is very different from saying the rating controls the case. In my experience, impairment ratings are rarely fully adopted as the complete answer. They are usually weighed against the rest of the evidence, including surgery, treating records, permanent restrictions, job duties, testimony, age, occupation, and future earning capacity.

What Actually Drives the Value of an Illinois Workers’ Comp Settlement?

Settlement value usually depends on the real-world impact of the injury, not just a medical percentage in an impairment report.

The biggest value drivers usually include:

• whether you had surgery;
• how serious the diagnosis is;
• whether the surgery helped;
• whether you reached maximum medical improvement;
• whether your treating doctor gave permanent restrictions;
• whether you returned to your old job;
• whether you returned to any job;
• whether you now make less money;
• whether you need future medical treatment;
• whether your medical records support your symptoms;
• whether the employer can accommodate your restrictions;
• whether the case involves PPD, wage differential, loss of occupation, or permanent total disability.

That is why two workers with the same impairment rating can have very different case values.

A desk worker and a construction laborer may have the same shoulder surgery and the same impairment rating. But if the desk worker returns to the same job with no wage loss while the laborer can no longer do heavy overhead work, those cases are not equal.

For a full explanation of these settlement factors, read What Is My Illinois Workers’ Comp Case Worth?

Why Impairment Ratings Usually Do Not Decide the Biggest Workers’ Comp Cases

The biggest Illinois workers’ compensation cases are usually not driven by impairment ratings. They are driven by whether the injured worker can return to meaningful work.

These cases may involve:

• permanent total disability;
• wage differential benefits;
• loss of occupation;
• permanent restrictions that end a career;
• return to work at much lower wages;
• vocational rehabilitation;
• future medical care;
• major surgery with permanent job consequences.

A low impairment rating does not erase a career-ending restriction. It does not mean a 55-year-old laborer can return to heavy work. It does not mean a flight attendant, nurse, truck driver, warehouse worker, construction worker, or factory worker can safely do the same job again.

In those cases, the question is not just “What percentage did the doctor assign?” The better question is: “What did this injury do to the worker’s ability to earn a living?”

Should You Get Your Own AMA Impairment Rating?

In my opinion, absolutely not.

There may be unusual cases where a lawyer decides a rating is worth exploring. But in my own practice, I have never obtained an AMA impairment rating for a client.

I generally do not want to spend money creating a number that may be lower than what I believe the case is worth.

Instead, I usually care more about building the evidence that actually moves value:

• treating doctor records;
• operative reports;
• physical therapy records;
• work status slips;
• permanent restrictions;
• FCE results, when appropriate;
• testimony from the injured worker;
• testimony from the treating doctor;
• evidence about job duties;
• evidence about wage loss;
• evidence about whether the employer accommodated restrictions.

If the insurance company wants to rely on a low rating, they can pay for one and then we can fight over the value. But I do not start from the assumption that an injured worker needs to go get one.

Can You Settle an Illinois Workers’ Comp Case Without an Impairment Rating?

Yes. Most Illinois workers’ comp cases settle without the injured worker obtaining an impairment rating.

Cases settle based on the overall evidence, including medical treatment, maximum medical improvement, wage rate, restrictions, disputed issues, future medical exposure, risk at trial, and the likely range of outcomes before an arbitrator.

If the insurance company refuses to be reasonable because of a low impairment rating, that may be a reason to push the case toward hearing. I do not bluff about that. If I say I am willing to try the case, I mean it.

If you are not sure whether you should accept an offer, read Do I Need a Lawyer to Get a Workers’ Comp Settlement in Illinois?

What to Do If an Adjuster Says Your Case Is Worth Less Because of an Impairment Rating

If the adjuster or defense attorney says your Illinois workers’ comp settlement is low because of an impairment rating, slow down.

Before accepting the offer, ask:

1. Who performed the impairment rating?
2. Was it your treating doctor or an insurance company doctor?
3. Was the rating part of an IME?
4. Did the doctor review all medical records?
5. Did the doctor consider your surgery?
6. Did the doctor consider your permanent restrictions?
7. Did the doctor understand your actual job duties?
8. Is the insurance company confusing impairment rating with PPD?
9. Does the settlement offer account for your wage rate?
10. Does the offer account for your ability or inability to return to work?

Most injured workers are not in a position to evaluate those questions alone. That is why low impairment ratings can be effective settlement tools for insurance companies.

Bottom Line: An Impairment Rating Is Not the Value of Your Illinois Workers’ Comp Case

Impairment ratings exist in Illinois workers’ compensation, but they usually do not decide the case.

They are not the same as PPD. They are not the same as the percentage loss of use of your body part. They are not the same as the value of your settlement. And under Illinois law, they are not supposed to be the only factor considered.

In my experience, impairment ratings are most often used by employers and insurance companies to minimize what injured workers receive. Sometimes they matter around the edges. Sometimes an arbitrator may consider them. But the real value of a case usually depends on much bigger issues: surgery, restrictions, job loss, wage loss, future earning capacity, treating medical records, and whether the worker can return to the same work and life they had before the injury.

If an adjuster is using a low impairment rating to tell you your serious injury is worth very little, do not assume that number is fair.

Talk to an Illinois workers’ compensation lawyer before you sign anything.

McHargue & Jones represents injured workers in Chicago and throughout Illinois. To learn more, visit our main page for Illinois workers’ compensation lawyers
or start with our guide: What Is My Illinois Workers’ Comp Case Worth?