An Impairment Rating Evaluation (IRE) is a critical process used in the context of workers' compensation cases in Pennsylvania. This evaluation is conducted to assess the degree of a worker's permanent impairment resulting from a workplace injury or illness. To calculate the percentage of whole-body impairment, a qualified healthcare professional performs the IRE in accordance with the standards set by the American Medical Association.
The outcome of this evaluation plays a significant role in determining the nature and extent of workers' compensation benefits an injured employee is entitled to receive. Specifically, it helps to establish whether the worker is eligible for total or partial disability benefits and can influence the duration and amount of compensation. The IRE process is a key component in the administration of workers' compensation claims, ensuring that benefits are fairly allocated based on the severity of the impairment suffered by the employee.
In the following article, we will explore the specific ways in which an impairment rating evaluation (IRE) can influence your workers' compensation benefits in Pennsylvania. Whether you've been notified to undergo an IRE or have already completed one and are experiencing changes to your benefits as a result, it's crucial to consult with a knowledgeable workers' compensation lawyer in Pennsylvania immediately.
What Is an Impairment Rating Evaluation (IRE) and How Does It Work?
An Impairment Rating Evaluation (IRE) is a medical assessment that an employer is permitted to request an employee undergo after the employee has received workers' compensation disability benefits for 104 weeks (two years). Should the insurance provider initiate this process, a physician sanctioned by the Pennsylvania Department of Labor & Industry to perform IREs will conduct your evaluation.
Following this period, a physician evaluates the injured worker's level of impairment according to the American Medical Association's (AMA) guidelines, expressing it as a percentage. If this impairment rating is 35% or higher, it generally implies an ongoing disability. Conversely, if the rating falls below 35%, the employer may initiate a modification petition aiming to adjust the worker's compensation from total to partial disability benefits.
Under What Conditions Must an IRE Be Performed?
An Impairment Rating Evaluation (IRE) is scheduled after an employee has received 104 weeks of total disability benefits. It's crucial to note the significance of the timing for an IRE. Unless there's an agreement to the contrary, an employee is obligated to undergo an IRE upon the employer's request after receiving two years of benefits. This stipulation also implies that an employee is not required to participate in an IRE before reaching the 104-week threshold of total disability benefits. In fact, an employer is prohibited from requesting an IRE before the employee has received two years of benefits.
Furthermore, an employer has the right to require an employee to undergo up to two IREs within a 12-month period, regardless of whether the employee's condition has changed. Nonetheless, an employee is not obliged to undergo more than two IREs within a year.
If you've received a notice for an IRE or have already undergone one, leading to alterations in your benefits, seeking immediate advice from a PA workers' comp attorney is essential.
What Is the Evaluation Process for Impairment Ratings in Pennsylvania?
The physician conducting an IRE must hold a license in Pennsylvania and be certified by the American Board of Medical Specialties or its osteopathic counterpart, actively engaging in clinical practice. The initial step for the examining physician is to assess whether the employee has reached maximum medical improvement (MMI), meaning the condition is stable or unchanging, despite potential fluctuations in symptoms. Only after determining that the condition has stabilized can the physician proceed with calculating an impairment rating.
It's crucial to recognize that reaching MMI is a medical determination. Therefore, the potential for surgical intervention that could enhance the individual's condition does not necessarily prevent a finding of MMI. In the impairment evaluation, the AMA Guides rely strictly on objective evidence to assess the condition, focusing on the individual's state at the time of the IRE.
When Is It Not Possible To Determine an Impairment Rating?
What does this mean in practical terms? Imagine you injured your left knee while lifting something while on the job, but you also suffer from pre-existing arthritis in your back, which isn't related to the work incident. In determining your impairment rating, the physician will only evaluate the condition of your left knee; the unrelated back issue will not be considered. If a specific treatment, like surgery for a torn meniscus, could potentially enhance your work-related knee injury, it's likely the physician will conclude that you haven't achieved maximum medical improvement, and therefore, an impairment rating will not be determined.
How Will an IRE Impact My Pennsylvania Workers’ Compensation Benefits?
Consider the scenario where the examining doctor concludes you have reached maximum medical improvement and assigns you a whole body impairment rating of 35% or more. In such a case, you would maintain your eligibility for total disability benefits. On the other hand, if the IRE physician's impairment rating is less than 35%, the insurance company will let you know that your classification has changed from total to partial disability. This change doesn't immediately impact your weekly benefits amount; rather, it affects the duration for which you're eligible to receive benefits. Being under total disability status means you can theoretically receive workers' compensation benefits for life. Nevertheless, should there be a change in your disability status, you possess the option to challenge this decision by filing a Petition for Review with a workers' compensation judge.
How Long May I Receive Workers’ Compensation Benefits When My Condition Changes From Total Disability to Partial Disability?
If your status changes from total to partial disability status, it caps your benefit entitlement at 500 weeks, or roughly nine-and-a-half years. At any point within this period, you can contest the shift from total to partial disability. For such a challenge, it's crucial to engage a skilled workers' compensation attorney from a reputable firm like Brandon J. Broderick. Your attorney can employ several strategies in your defense, such as: (1) questioning the physician's qualifications to perform an IRE, perhaps due to not actively seeing patients for a minimum of 20 hours per week; (2) arguing that you have not yet reached maximum medical improvement, especially if there's a recommended surgery you're considering; and (3) disputing the impairment rating if it's stated as less than 35% by presenting evidence or testimony from your physician that your impairment exceeds 35%.
The difference between total and partial disability status might seem negligible at first glance, particularly if you don't anticipate needing workers' compensation for 500 weeks. However, being classified as having a total disability can significantly influence the settlement amount an insurance company might offer. With total disability status, the insurer recognizes the possibility of disbursing benefits for potentially 10, 15, 20 years, or more. Conversely, with a cap of less than 10 years under partial disability, the insurer's risk is reduced, possibly leading to a smaller lump-sum settlement offer. Given the long-term implications of your injury—including ongoing pain, medical needs, and work limitations—it's imperative to maximize your settlement from the insurance company. Thus, a rating below 35% from an IRE physician can crucially impact your workers' compensation case in Pennsylvania.
PA Workers’ Compensation Lawyer Brandon J. Broderick Is Available To Assist You With Your IRE and Workers’ Comp Claim
Experiencing a work-related injury can significantly impact your life, potentially leading to prolonged periods away from work. Whether you're in the early stages of receiving PA Workers’ Compensation benefits, have been in the system for 104 weeks, have an upcoming Impairment Rating Evaluation (IRE), or have already undergone one that affects your benefits, the importance of legal representation cannot be overstated. In Pennsylvania, while the workers' compensation system aims to cover medical expenses and compensate for lost earnings, navigating the claims process and securing rightful benefits can be complex.
This underscores the importance of engaging with a knowledgeable PA workers' compensation lawyer who can offer guidance and advocate on your behalf throughout the process. If you're facing an IRE or your benefits are being adjusted as a result, immediate action is necessary due to the critical timing involved in these evaluations. Our team can guide you through the expectations and manage any necessary legal challenges against the IRE's findings.
The seasoned workers' compensation lawyers at Brandon J. Broderick bring decades of expertise to the table and are prepared to assist you. Contact us for a free consultation at any time. Our dedicated team is available 24/7 to provide the support you need.