Disability Ratings and NC Accident Settlements

The Bottom Line

A permanent disability rating is a percentage assigned by a physician that quantifies how much your injuries have permanently reduced your body's function. In NC personal injury cases, higher ratings generally correlate with higher settlement values, but there is no formula -- the rating is one piece of evidence among many. The defense will send you to their own doctor for a competing rating that is almost always lower. Understanding what the rating measures, how it is assigned, and how to ensure your rating accurately reflects your limitations is critical to maximizing your claim.

What a Permanent Disability Rating Is

When your injuries reach maximum medical improvement -- the point where your condition has stabilized and your doctors do not expect further significant improvement -- a physician can assign a permanent disability rating. This rating is a percentage that represents the degree to which your injury has permanently reduced your whole-body function.

A 10% whole-person impairment rating means your body permanently functions at 90% of its normal capacity. A 25% rating means your body functions at 75% of normal. A 50% rating means half your pre-injury function is permanently gone.

The rating is not a subjective guess. It is calculated using the AMA Guides to the Evaluation of Permanent Impairment -- a standardized reference published by the American Medical Association that provides detailed criteria for rating impairments by body system, injury type, and functional loss. Most evaluations in NC use the 5th or 6th edition of the AMA Guides.

Who Assigns the Rating

Your Treating Physician

Your treating physician -- the doctor who has managed your care throughout your recovery -- is typically the first person to assign a permanent impairment rating. They know your medical history, your treatment course, your response to therapy, and your residual limitations from direct observation over months or years of treatment.

The treating physician's familiarity with your case is a strength. They can speak to the full scope of your recovery, the treatments that were tried, and the limitations that remain. Their rating is informed by the most complete picture of your medical condition.

Independent Medical Examiner

An independent medical examiner (IME) is a physician retained by one side -- typically the defense -- to evaluate you and provide their own opinion. Despite the name, an IME is not truly independent. The physician is being paid by the insurance company, is selected by the defense attorney, and often has a track record of assigning ratings that favor the party that hired them.

The IME doctor will review your medical records, conduct a physical examination, and assign their own impairment rating. In the vast majority of cases, the IME rating is lower than the treating physician's rating.

Your attorney may also retain a medical expert to provide a rating. In complex cases, having both a treating physician's rating and an independent expert's rating supporting a higher number strengthens your position against the defense IME.

How the Rating Is Calculated

The AMA Guides provide specific criteria for rating impairments to each body system and region. The process is technical but follows a structured methodology.

Range of Motion and Functional Testing

For musculoskeletal injuries, the physician measures range of motion (how far a joint can move compared to normal), strength (how much force the affected limb or body part can generate), and functional capacity (what activities the person can and cannot perform). These measurements are compared to the AMA Guides' criteria to produce a rating for that specific body part.

Diagnostic Criteria

Some ratings are based on diagnostic findings rather than functional testing. A herniated disc confirmed on MRI, a fracture that healed with malunion (abnormal alignment), or a joint that required fusion surgery each have specific rating criteria in the AMA Guides regardless of the patient's subjective symptoms.

Combining Multiple Impairments

When a person has injuries to multiple body parts -- as is common in serious car accidents -- the individual ratings are combined using a formula in the AMA Guides. The Combined Values Chart produces a whole-person impairment that accounts for all injuries together. Importantly, combined ratings are not simply added -- a 10% arm impairment combined with a 15% leg impairment does not produce a 25% whole-person rating. The combined value is calculated using a formula that produces a lower number than simple addition.

How It Affects Your Settlement

The General Correlation

Higher permanent disability ratings generally correlate with higher settlement values. This makes intuitive sense -- a person with a 30% whole-person impairment has suffered more permanent harm than a person with a 5% impairment. Insurance adjusters, attorneys, and juries all consider the rating when assessing claim value.

As a rough general guide:

• Ratings below 5% may not significantly increase claim value beyond the underlying medical treatment costs
• Ratings of 5% to 15% represent meaningful permanent injury and typically add $20,000 to $100,000 to the claim value
• Ratings of 15% to 30% indicate serious permanent impairment and can add $100,000 to $500,000 or more
• Ratings above 30% represent severe, life-altering impairment and are associated with claims valued at $500,000 and up

These ranges are rough generalizations only. There is no formula that converts a rating percentage into a specific dollar amount. The rating is one factor among many -- including medical bills, lost wages, lost earning capacity, pain and suffering, age, and the specific ways the injury affects the individual's life.

NC Does Not Use a Statutory Schedule for PI Claims

This is an important distinction from workers' compensation. NC workers' comp has a specific schedule that assigns a set number of weeks of compensation for the loss or impairment of specific body parts -- for example, a certain number of weeks' compensation for the loss of a hand, foot, or eye.

NC personal injury claims have no such schedule. In a PI claim, the impairment rating is evidence presented to the jury. The jury considers it alongside all other evidence and decides what the total damages should be. This gives the jury more flexibility but also means the value is less predictable than in workers' comp.

The IME Dispute

In virtually every case involving permanent injuries, the defense will demand an independent medical examination. The resulting IME report will almost always assign a lower impairment rating than your treating physician's rating. This creates dueling ratings that the jury must resolve.

Why IME Ratings Are Lower

Defense IME doctors tend to assign lower ratings for several reasons. They see you once, for a brief examination, and do not have the longitudinal perspective of your treating physician. They are selected by the defense precisely because their ratings tend to be favorable to the defense. Their financial incentive is to maintain a relationship with the defense firms that hire them, which means providing opinions the defense wants.

This does not mean IME doctors are dishonest -- many are credentialed, experienced physicians who genuinely believe their ratings are accurate. But the structural incentives produce a consistent pattern of lower ratings.

How to Handle the IME

When you attend a defense IME, be thorough and honest. Report every symptom accurately. Do not exaggerate, but do not minimize either. Complete all requested testing -- range of motion, strength testing, functional assessments -- with maximum effort. If a movement causes pain, say so. If you cannot complete a test, explain why.

After the IME, write down everything that happened while it is fresh -- how long the examination lasted, what tests were performed, what questions were asked, and what you reported. If the examination was cursory (10 minutes for what should have been a 45-minute evaluation), your attorney can use that to challenge the credibility of the resulting report.

Getting an Accurate Rating

The quality of your permanent disability rating depends on the information available to the evaluating physician. You can help ensure accuracy by:

Reporting all symptoms. Do not leave out symptoms because they seem minor or because you have gotten used to living with them. Chronic low-level pain, stiffness, weakness, numbness, tingling, difficulty sleeping due to pain -- all of these affect your rating. If you do not report them, they will not be factored in.

Completing all recommended testing. Range of motion measurements, grip strength testing, functional capacity evaluations, and diagnostic imaging all contribute to the rating. Follow through on every test your physician recommends.

Documenting functional limitations. Write down how your injuries affect your daily life -- what activities you can no longer do, what modifications you have had to make, how your work capacity has changed. Share this information with the rating physician. The AMA Guides consider functional limitations in addition to objective findings.

Being consistent. Your reported symptoms and limitations should be consistent across all medical visits, the impairment rating examination, and any defense IME. Inconsistencies -- saying one thing to your doctor and something different at the IME -- undermine credibility and give the defense ammunition to challenge your rating.

Frequently Asked Questions

Frequently Asked Questions

What is a permanent disability rating?▾

A permanent disability rating is a percentage assigned by a physician that represents how much your injury has permanently reduced your whole-body function. It is typically assigned when you reach maximum medical improvement -- the point where your condition has stabilized and further significant improvement is not expected. A 10% whole-person impairment rating means your body permanently functions at 90% of its pre-injury capacity. Ratings are assigned using the AMA Guides to the Evaluation of Permanent Impairment, usually the 5th or 6th edition.

Does NC have a statutory disability schedule for personal injury claims?▾

No. Unlike workers' compensation claims -- which assign specific dollar values to specific body parts and injuries -- NC personal injury claims do not use a statutory disability schedule. In a PI claim, the permanent disability rating is one piece of evidence presented to the jury. The jury considers the rating alongside all other evidence of your damages, including medical bills, lost wages, pain and suffering, and the impact on your daily life. There is no formula that converts a specific rating percentage into a specific dollar amount.

Will the insurance company send me to their own doctor for a disability rating?▾

Almost certainly, yes. In any claim involving permanent injuries, the defense will request an independent medical examination (IME) with a physician of their choosing. The IME doctor will evaluate you, review your medical records, and assign their own impairment rating -- which is typically lower than your treating physician's rating. This creates dueling ratings that the jury must weigh. The credibility of the respective physicians and the thoroughness of their evaluations determine which rating the jury finds more persuasive.

How can I make sure I get an accurate disability rating?▾

Be thorough and honest with the examining physician. Report every symptom you experience -- do not minimize or omit symptoms because you feel they are minor. Complete all recommended testing, including range of motion measurements, strength testing, and diagnostic imaging. Bring a written list of your symptoms, limitations, and how your injuries affect your daily activities. The rating is only as accurate as the information the physician has. If you downplay your symptoms during the examination, the rating will be artificially low and will not reflect the true impact of your injuries.