What is Apportionment?
Employers are only responsible to pay for the portion of a permanent disability attributable to an injury or illness that occurred at work.
A worker who is injured on the job will receive medical treatment from a physician provided through the employer’s Medical Provider Network or the employee’s own physician if the worker predesignated a physician before the accident occurred. Once the worker has reached the point of maximum medical improvement and has been declared “permanent and stationary” (P&S) by the physician, the physician will prepare a P&S report. In this report, the physician will declare whether the employee is left with a permanent disability. That report is used along with other factors to determine the employee’s permanent disability rating, which in turn determines the size and duration of the permanent disability award the employer must pay.
In preparing a report, the physician is required to address the issue of causation and make an apportionment determination. The physician is required to state an approximate percentage of the injury that was caused by work and an approximate percentage of the injury that was caused by other factors before and after the injury, including prior work injuries.
Employers are only responsible for the percentage of permanent disability directly caused by the injury arising out of and occurring in the course of employment. They are, therefore, very interested in the apportionment determination, as it can significantly reduce the amount they have to pay.
If you dispute the physician’s apportionment
Unless you predesignated your personal physician to treat you, the doctor who sees you belongs to a Medical Provider Network that contracts with the employer or their insurance carrier to provide services. They are paid by the employer. If you disagree with the physician’s apportionment determination, you can request a second opinion through a Qualified Medical Evaluator or Agreed Medical Evaluator. An experienced California workers’ compensation attorney can also help you get the maximum amount of your award by arguing your position before a judge at the Workers’ Compensation Appeals Board (WCAB) or in court.
