PPI is automatic but what about PPD?

**Timbytwo** · 09-29-2006, 11:47 AM

Hi All, I first want to say what an AWSOME site this is! Reading the different threads has answered more of my questions then any other site!!

I was injured on 10/03/05, diagnosed with a complete rotor cuff tear on the right shoulder and told only surgery could repair it properly. During the recovery period the doctor discovered the cuff was in need of more repair and also recommended a tenodesis procedure as well. The insurance carrier (Idaho State Insurance Fund) sent me to another DR. (for a IME) and Per their request, the IME doctor issued a 15% PPI and a 25lb weight restriction But, would not deem me stable until after viewing the ordered MRI, then agreed with my doctors findings and recomended the surgery.

The second surgery was performed 2 weeks ago on 9/13/06 and now I am starting all over again with the loooooong recovery process.

There was never any doubt about how the injury occured and I have been receiving Total Temporary Disability payments (TTD) since the day of the accident. The Insurance has been paying every associated cost and sends me a check within days of receiving a milage report of medical appointments so consulting an attorney has never been an issue. I also know that once the doctor says I am at Maximum Medical Improvement (MMI),and issues a Permenant Partial Impairment (PPI), the TTD stops and
the PPI starts based on the schedule set out by law.

Both of the doctors have stated I will never be able to return to my position as a concreate form setter due to the heavy and overhead lifting requirements and my employer has since filled my position.

My question is this:

At MMI, If my work market diminishes to Medium/Light work with obviously less starting pay will the insurer add PPD or do ALL cases have to fight or litigate to get that benifit considered (which is over and obove PPI based on non- medical factors such as diminished working market.

Thank you for any advice you can offer, Tim

**Mr. Knowitall** · 09-30-2006, 12:42 PM

That's a highly specific question, and I can't claim to be particularly familiar with Idaho laws.

My experience with insurance companies, and worker's compensation insurers are anything but an exception, is that they will work very hard to avoid paying on claims. My educated guess is that they will try to finesse the medical findings so as to avoid paying you PPD, unless (and perhaps even if) the medical facts are overwhelmingly in your favor.

I'll try to look into the specifics of Idaho, as time permits.

**Timbytwo** · 09-30-2006, 05:44 PM

Thanks for you're quick response. Based on everything I have been reading on the PPD benifit, all your information is right on target! I had a feeling that if I wanted to pursue this benifit (hypothetically speaking of course as I still am in recovery and might not need it), The complexity of this issue would be in my best interest to retain a qualified attorney to help as most insurers would probably welcome with open arms the claiments who represent themselves.

**Timbytwo** · 10-03-2006, 08:26 AM

I guess the main question I have about PPD is:

Does anyone know of a case where the insurance has added PPD payments to the scheduled PPI payments(at MMI with a PPI issued) without the claiment having an attorney? Anyone?? Is there a link where you can find settled cases that did not use a "referee" to decide judgement?