Eligibility Criteria for Permanent Total Disability Claims

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Permanent total disability is a legal term, as opposed to a medical one. Two variations of the term exist, though their use is interchangeable. Though these terms are legal in nature, governing bodies require a physician’s assessment to legally ratify claims of permanent disability in non-extreme cases. Benefits available to those qualifying as permanently and totally disabled comprise a very short list. However, those qualifying as permanently disabled do not face exclusion from other disability benefits.

Permanent Total Disability Terms

Two terms describe permanent disability: Permanent disability and permanent total disability. State and federal government agencies use these terms for distinct purposes. At state level, permanent disability or permanent total disability applies to the assessment of a worker’s injuries in cases of workers' compensation and medical expense coverage awarded in cases of work-related injury. At the federal level, permanent total disability, also known as total disability or permanent and total disability, applies to cases such as student loan forgiveness and military discharge and benefits.

Basic Criteria

The state of California defines permanent disability as a lasting injury or illness affecting one’s ability to earn a living, irrespective of whether the afflicted individual is able to return to work. In Ohio, a permanently disabled individual constitutes one who, in the words of the Gruhin & Gruhin law firm, cannot perform “sustained remunerative employment.” Oregon defines permanent total disability as the loss of functionality in any part of the body, such that an individual can no longer perform “gainful or suitable” employment.

Several federal definitions of permanent total disability exist. The Internal Revue Service defines the term as a physical or mental impairment lasting more than 12 months or resulting in death, and preventing gainful employment. The Armed Forces set basic criteria at the inability to find employment of a disability likely to persist for the duration of an individual’s life.

Advanced State Criteria

States require a physician’s assessment in cases of permanent disability. Through such an assessment, the appointed assessing physician is responsible for determining whether a disability results directly from employment and whether that disability is permanent. In California, physicians provide individuals with a disability number. The state uses this number to calculate the extent of a disability’s effect and extrapolate the amount of benefits due to an individual. Though permanent disability status largely hinges on the discretion of a physician, disabled individuals may seek second opinions or dispute a physician’s finding.

In some cases, states grant automatic permanent disability. The state of Ohio, for instance, awards statutory -- or automatic -- permanent disability status to individuals who lose both eyes, both hands, both arms, both legs or both feet as a result of a single work-related incident.

Federal Criteria

For the purposes of student loan forgiveness programs, the federal government uses the same assessment criteria as states; a physician’s assessment is required to prove permanent total disability.

For the purposes of military discharge and veterans' benefits, the federal government employs a sliding scale. This scale ranges from zero percent disability to 100 percent disability. The Medical Evaluation Board and Physician’s Evaluation Board evaluate disabled military personnel or veterans, assigning each individual a disability percentage in increments of 10 percent. The higher a disability percentage, the more benefits the individual is likely to receive. Individuals with 20 years of service or more may retire as disabled, regardless of the percentage of a disability.