July 25, 2025 Workers' Comp
As someone who practices both medicine and law, I often find myself explaining the concept of permanent disability to patients and clients alike—because, frankly, the system doesn’t do a good job of making it clear. If you’ve been injured on the job, you’ve probably heard terms like “PD rating,” “maximum medical improvement,” or “impairment percentage” thrown around. But what does any of it really mean?
Let me walk you through it—from both the medical and legal perspectives—so you can understand what’s at stake and how to protect yourself.
What Is Permanent Disability?
In the context of workers’ compensation, a permanent disability is any lasting impairment that affects your ability to earn a living after a work-related injury. This doesn’t mean you’re completely unable to work—it just means that some part of your body or mind has sustained lasting damage that limits your functionality.
For example, if you injure your back and, even after treatment, you can’t lift more than 20 pounds, that may be considered a permanent physical limitation. If you suffered a traumatic brain injury and continue to struggle with memory, focus, or emotional regulation, those are considered permanent neurological impairments.
I’ve treated patients who looked fine on the surface but were struggling with debilitating headaches, dizziness, or vision problems after a head injury. These invisible symptoms are just as real—and just as disabling—as a broken leg. And unfortunately, because many of these conditions are subjective or neurologically complex, they’re often misunderstood or minimized unless someone advocates for the patient.
The Role of Maximum Medical Improvement (MMI)
Before you can be evaluated for permanent disability, your treating physician must declare that you’ve reached what’s known as maximum medical improvement, or MMI. This means your condition has stabilized—you’re not getting worse, but you’re not likely to get significantly better either.
This is a crucial turning point in your claim. Once you reach MMI, your temporary benefits (like wage replacement or temporary disability payments) may stop. At that point, the focus shifts to determining whether you have any lasting impairment—and how much it’s worth.
Who Decides Whether You’re Permanently Disabled?
This is where things get more complicated.
Your treating physician—or sometimes an independent medical examiner (IME)—will evaluate your condition using a combination of physical exams, diagnostic tests, functional capacity evaluations, and standardized medical guidelines (such as the AMA Guides to the Evaluation of Permanent Impairment).
Based on this evaluation, the doctor will assign an impairment rating or disability percentage, which is supposed to reflect how much your injury limits your ability to work. That rating is then used by the insurance company and the workers’ compensation board to determine how much compensation you’ll receive for your permanent disability.
However, that number isn’t always accurate or fair.
I’ve seen cases where a patient with clear post-traumatic cognitive dysfunction was assigned a zero percent disability rating—simply because the evaluating physician didn’t understand the neurological complexity of their condition. I’ve also reviewed legal cases where the entire outcome hinged on the credibility of the doctor’s report. That’s why it’s so critical to have a physician who not only listens but knows how to properly document and support your claim.
Permanent Partial vs. Permanent Total Disability
There are two main types of permanent disability:
The distinction between PPD and PTD has huge financial implications, so it’s no surprise that insurance companies often challenge PTD claims. I’ve represented clients whose lives were turned upside down—unable to work, facing ongoing pain, and yet still fighting to prove the severity of their condition. That’s where both medical advocacy and legal strategy must come together.
What If You Disagree With the Disability Rating?
You are not powerless if you think the disability rating is too low.
In most states, including Nevada, you have the right to:
As both a neurologist and a lawyer, I’ve helped clients challenge unfair ratings by presenting more detailed medical evaluations, clarifying ambiguous symptoms, and connecting the dots between subtle neurological findings and real-world functional limitations.
My Final Word: This Decision Shapes Your Future
Your permanent disability rating determines how much compensation you’ll receive—and in some cases, whether you’ll be able to transition to another career, qualify for vocational rehabilitation, or receive long-term financial support.
It’s not just a number on a chart. It’s a decision that affects your future income, your access to healthcare, and your ability to rebuild your life after a work injury.
That’s why I urge every injured worker to be proactive. Ask questions. Get a second opinion. Consult with someone who understands both the medicine and the law. Don’t accept a low rating if it doesn’t reflect your reality.
I’ve seen too many people accept inadequate settlements or return to work too soon—only to find themselves in worse shape months later. You deserve better. And I’m here to help make sure you get it.
