PPD Begins at Global MMI

On January 14, 2026, the Iowa Workers’ Compensation Commissioner issued an important decision clarifying when permanent partial disability (PPD) benefits commence for injuries involving multiple compensable conditions.

In Laird v. Trinity Health Corp., the claimant alleged that a single work injury—long COVID—resulted in multiple conditions, including pulmonary, metabolic, carpal tunnel, and mental health impairments. A deputy commissioner concluded that PPD benefits should begin when the first of those conditions reached maximum medical improvement (MMI) and awarded penalty benefits for the employer’s failure to commence PPD at that time.

Interim Commissioner Grell reversed. He held that under the plain language of Iowa Code section 85.34(2), PPD benefits cannot begin until the claimant reaches MMI for all conditions caused by the work injury. Because impairment ratings for multiple conditions are ultimately combined into a single whole-person impairment rating, the worker’s impairment—and entitlement to PPD—cannot be determined until all compensable conditions have reached MMI.

As a result, the Commissioner also reversed the award of penalty benefits, concluding that PPD benefits were not yet due and no contemporaneous explanation was required while the claimant was not at MMI for all conditions.

This decision provides helpful guidance for cases involving complex injuries and reinforces that global MMI controls the commencement of PPD benefits under Iowa law. As always, please contact any of our attorneys with questions regarding this or other workers’ compensation matters.