Low Back Strain: Am I Entitled to a PPD Award?

By Jason Weinstock on January 11, 2011

Whether or not you are entitled to receive a permanent partial disability award for your  low back strain depends on the following three factors:

1. Whether your treating physician writes after your final visit that you may have a ratable impairment. 

Your insurance adjuster will only schedule a rating exam if your treating physician checks a box on the physician progress report  (or otherwise writes in the final report ) that it is likely that you have  a ratable impairment.  Unfortunately, some treating doctors don’t know what is a ratable impairment under the AMA Guide to Evaluation of Permanent Impairment, 5th edition, the book that must be used to determine percentage of impairment.  For information on what to do if the insurer refuses to schedule a rating evaluation, click here.

2. If you do get a rating,  whether the rating doctor finds that  you still have objective signs of a permanent back injury.

 Regardless of how bad your low back strain was at the time of your injury and in the months afterward, if you have no objective signs of a low back injury when you go for your rating evaluation, the rater will likely find a 0% impairment.  Objective findings of an injury would be observable muscle guarding or  spasm by the rating doctor, or positive  neurological studies, or positive MRI findings that correspond to what the doctor finds on her exam.  Pain complaints alone are subjective, and are not sufficient to support an impairment percentage.

3. Whether the rating physician properly applies the criteria of the Guides.

Most of the rating doctors on the current DIR list of approved rating doctors are capable of properly rating a chronic low back strain.  However, some are not.  If you feel that you have a permanent low back injury, and the rating doctor gives you a 0% impairment, you may want to obtain a second rating evaluation and appeal the insurer’s letter closing your claim with a 0%.   Many attorneys, will provide a free consultation to advise you of your options and discuss whether it is worth spending the money on a second rating exam.  The cost of a second rating exam depends on the number of body parts to be rated.  Expect to spend at least $673  for a second rating exam.