How Do Impairment Rating Evaluations Work in Pennsylvania?
An Impairment Rating Evaluation (IRE) is a medical examination used to determine whether an injured worker’s Pennsylvania workers’ compensation benefits should remain classified as total disability or be changed to partial disability. After receiving 104 weeks of disability benefits, an injured worker may be required to attend an IRE, where a physician assigns an impairment rating based on established medical guidelines.
What Is an Impairment Rating Evaluation (IRE)?
Impairment Rating Evaluations are used by employers and insurance companies to determine whether an injured worker’s disability status should remain classified as total disability or be modified to partial disability.
The evaluation is performed by a qualified physician who assigns an impairment rating using the Sixth Edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment.
Once an injured worker has received 104 weeks of workers’ compensation disability benefits, the employer may request an IRE.
If the impairment rating is 35% or greater, there is a presumption of continuing total disability.
If the impairment rating is less than 35%, the employer may seek to modify the worker’s disability status from total disability to partial disability.
When Can an Employer Request an IRE?
Timing is important when it comes to Impairment Rating Evaluations.
An employer cannot request an IRE until an injured worker has received 104 weeks of total disability benefits.
Unless otherwise agreed, an injured worker is generally required to attend an IRE that is properly requested after the 104-week threshold has been met.
Pennsylvania law also allows an employer to request up to two IREs within a 12-month period, even if there has not been a significant change in the worker’s medical condition.
However, injured workers are generally not required to attend more than two IREs per year.
The Impairment Rating Evaluation Process
The physician conducting the IRE must meet specific qualifications under Pennsylvania workers’ compensation law.
The evaluating physician must:
- Be licensed to practice medicine in Pennsylvania
- Hold appropriate board certification
- Be actively engaged in clinical practice
Before assigning an impairment rating, the physician must determine whether the injured worker has reached Maximum Medical Improvement (MMI).
Maximum Medical Improvement and IREs
Maximum Medical Improvement (MMI) does not mean that an injured worker is fully recovered.
Instead, MMI means that the worker’s condition has stabilized and is not expected to substantially improve with additional treatment.
Importantly, an injured worker may still require ongoing medical treatment and may still experience significant symptoms while being considered at Maximum Medical Improvement.
The physician will evaluate the worker’s condition at the time of the examination and assign an impairment rating based on objective medical findings outlined in the AMA Guides.
How an IRE Can Affect Workers’ Compensation Benefits
An IRE can have a significant impact on a Pennsylvania workers’ compensation claim.
If an employer successfully modifies an injured worker’s status from total disability to partial disability, the worker’s eligibility for future wage-loss benefits may be affected.
Because of these potential consequences, it is important to understand your rights if you receive notice of an IRE or if your benefits are modified after an evaluation.
Challenging an Impairment Rating Evaluation
Injured workers have the right to challenge changes resulting from an IRE.
If your workers’ compensation benefits are modified based on an Impairment Rating Evaluation, you may be able to file a Petition for Review and present evidence before a workers’ compensation judge.
Because strict deadlines may apply, it is important to speak with a Pennsylvania workers’ compensation attorney as soon as possible.
Talk to a Pennsylvania Workers’ Compensation Lawyer
If you receive notice of an Impairment Rating Evaluation or your workers’ compensation benefits have been modified following an IRE, Stern & Cohen can help.
Our Pennsylvania workers’ compensation attorneys can explain your rights, review the evaluation, and help you challenge an unfavorable impairment rating when appropriate.
Contact Stern & Cohen today for a free consultation.
FAQs
What is an Impairment Rating Evaluation in Pennsylvania?
An Impairment Rating Evaluation (IRE) is a medical examination used to determine whether an injured worker’s disability status should remain classified as total disability or be changed to partial disability under Pennsylvania workers’ compensation law.
When can an employer request an IRE?
An employer may generally request an IRE after an injured worker has received 104 weeks of total disability benefits.
What is Maximum Medical Improvement (MMI)?
Maximum Medical Improvement means that a worker’s medical condition has stabilized and is not expected to substantially improve with additional treatment, even if symptoms remain.
Can workers' compensation benefits be reduced after an IRE?
Potentially. If the impairment rating is less than 35%, an employer may seek to modify the worker’s disability status from total disability to partial disability.
Can I challenge an Impairment Rating Evaluation?
Yes. Injured workers may challenge an IRE and any resulting modification of benefits through the Pennsylvania workers’ compensation system.