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How Do Impairment Rating Evaluations Work in Pennsylvania?

Impairment Rating Evaluations are used by Employers to attempt to adjust the status of Workers’ Compensation benefits between total and partial disability. This involves attending an evaluation with a physician who will assign an “impairment rating” according to the sixth edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment.

What is an Impairment Rating Evaluation (IRE)? 

An Impairment Rating Evaluation is a medical examination that an Employer is entitled to have an employee attend if that employee has received 104 weeks (2 years) of workers’ compensation disability benefits. Once an injured worker has received 104 weeks of disability benefits, a physician will determine, under the AMA guidelines, what the injured worker’s impairment rating is. This number is a percentage. If the impairment rating is 35% or greater, then there is a presumption of continuing disability. However, if the impairment rating is less than 35%, then the employer will file a Modification Petition to reduce workers’ compensation benefits from total disability benefits to partial disability benefits.

When Does an IRE Need to Be Conducted? 

An IRE is conducted at expiration of an employee’s receipt of 104 weeks of total disability benefits. The timing of an IRE is important. Unless otherwise agreed to, submitting to an IRE is required after 2 years of benefits if the employer requests one. This, however, means that an employee does not have to submit to an IRE prior to 104 weeks of total disability benefits. In fact, an employer is not even allowed to submit a request for an IRE prior to the date of 2 years of benefits.

Additionally, an employer is allowed to have an employee submit to 2 IRE’s in a 12-month period. This is true even if there is not a change in your condition. However, an employee is not required to submit to more than 2 IRE’s per year.

The Impairment Rating Evaluation Process

The physician performing an IRE must be a physician licensed in Pennsylvania who is certified by the American Board of Medical Specialties Approved Board or its osteopathic equivalent and who is active in clinical practice. The examining physician must first determine whether the employee is at maximum medical improvement. What this means is that your condition must be static or stable. In other words, your condition has plateaued, even if your symptoms wax and wane. Then, and only then, can a physician assign an impairment rating calculation.

It is important to understand that “maximum medical improvement” is a medical determination. Thus, even if surgery is a possibility and may help improve a person’s condition, that does not preclude a person from being found to be at maximum medical improvement. The AMA Guides use only objective evidence of a condition in order to rate it. It is your condition at the time of the IRE that is rated.

How an IRE Will Affect Your Workers’ Compensation Case

An IRE has the ability to change your Workers’ Compensation benefits from total disability to partial disability. Thus, it has a direct and significant impact on cases. However, you have the right to appeal the adjustment of disability status to a workers’ compensation Judge by filing a Petition for Review.

Seek Help From a PA Workers’ Compensation Attorney

We can help you navigate this process. If you get notification regarding attending an IRE, or you have already attended an IRE and your benefits are being modified based upon the IRE, contact us right away. There are many important timing aspects to this type of evaluation. We can help walk you through what to expect as well as file any petitions that are needed to rebut the IRE.

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