Second Permanent Partial Disability
January 2016 tore meniscus in left knee. Had a X-ray and MRI that showed a meniscus tear and little too no arthritis. March 2016 had meniscus surgery. Come June 2016 still having pain. Me and My workers comp nurse requested a MRI. It showed that I had grade 2 and 3 arthritis plus a large spur on the inside of left knee. He recommended having Synvisc shots. After the Synvisc shots. I went through the functional capacity evaluation. I passed all test at 100%. I was able to go back to work at full duty with him giving me a MMI of 10%.
Which to come to find out was very low. I received a permanent partial disability benefit In March 2017. I continued to have a lot of issues went back several times they tried different Band-Aids. April 2019 went different doctor had another x-ray which showed grade 4 arthritis bone on bone and big Spurs on inside and outside of the knee. Next step was full knee replacement surgery was scheduled for May 24th. They put me back out of work until surgery. I started receiving TTD benefits which they said had to be the same as 2016 since it was under the same claim. Even though I was making more money now. Surgery went well. The doctor let me go back to work 8/30/2019 to see how I do. I have been doing great no problems. I go back to the doctor on 9/24/2019. I believe he will release me and give me a MMI rating. I know it will be at least 40% rating. Since this will be the second PPD Benefit. I was wondering how it would work this time around? Also what I might need to know before dealing with the insurance adjuster? Thank you in advance for your advice.
Re: Second Permanent Partial Disability
Good question. The NC rating guidelines are not entirely clear on this point. For the spine, the 40% would be calculated on the 90% remaining after you were paid the first 10%. So you would get 40% of 90% rather than 40% of 100% of the spine, if it was a back injury. But you have a leg injury. (The leg is a 200 week body part, so one percentage point is worth 2 weeks of your comp rate.) The Rating Guidelines in NC do not specifically apply that calculation or adjustment to a leg rating--only to spine ratings. So you have a good argument that the adjustment calculation does not apply to the leg--if they had meant for it to apply to the leg, they would have said so in the Rating Guidelines.
I would contend that you should get the second rating in full for the joint replacement. But don't be surprised if the insurance company argues otherwise. These disputes can be resolved by the Industrial Commission through the hearing process.