Insurance companies have a lot of weapons to try to make an injured worker’s life miserable. Weapons that could affect his or her PA workers’ compensation benefits. An Impairment Rating Evaluation, also known as an IRE, is one of those weapons. Here is how an IRE works.
If you have been receiving total disability benefits because you have been injured at work and unable to do your job for at least 104 weeks (two years), you may be asked by the insurance company to undergo an IRE with a physician. If the insurance company makes this request, you will be evaluated by a physician approved by the Pennsylvania Department of Labor & Industry to conduct IREs.
You may have already been subjected to an Independent Medical Examination, or an IME. An IME is different from an IRE. When you undergo an IME, the physician will determine what injuries, if any, you sustained a work; whether you have fully recovered from these injuries; and what level of work you are able to perform – your pre-injury job or a light-duty job. Based on the opinion of the IME physician, the insurance company may file a petition to terminate, suspend, or modify your PA Workers’ Compensation benefits.
An IRE is different. The physician performing the IRE will initially determine if you have reached maximum medical improvement from your work-related injury. Maximum medical improvement occurs if your condition cannot be improved with further treatment; in other words, your ability to heal from your injury has plateaued. If the IRE physician concludes you have reached maximum medical improvement, the physician will then make a determination of your “whole body impairment” based on American Medical Association (the AMA) guidelines. The AMA defines impairment as a significant loss of the use of any body structure or function. The physician will assign a percentage rating to your level of impairment with regard to your work-related injury. No percentage will be assigned if maximum medical improvement has not been achieved.
So what does this all mean? Let’s say that you sustained an injury to your right knee while carrying a box at work, but you also have pre-existing arthritis to your back that is unrelated to your work injury. The physician will only consider your right knee condition when determining your impairment rating; your back condition is not factored in. If there is a type of treatment that likely will improve your work-related knee injury – for example, surgery to repair a torn meniscus – then the physician will probably find you have not reached maximum medical improvement, and no impairment rating will be determined.
Let’s look at the hypothetical that the physician determines you have reached maximum medical improvement, and he finds that you have a whole body impairment rating of 35% or higher. Under that scenario, your entitlement to receive total disability benefits will continue. However, if the IRE physician’s rating is less than 35%, the insurance company will notify you that your status has been changed from total disability to partial disability. This will not have any immediate effect on you because your weekly benefit amount will not change; only the length of time to which you are entitled to benefits will change. When you are on total disability status, you are entitled to receive these workers’ comp benefits indefinitely, theoretically for the rest of your life.
However, if your status changes from total disability benefits to partial disability, your entitlement to benefits will be limited to 500 weeks, which is approximately nine-and-a-half years. Anytime during the 500-week period – you can do it right away – you can challenge the change in status to your benefits from total disability to partial disability. You’ll need an experienced Pennsylvania workers’ compensation lawyer, like one of the lawyers at Pearson Koutcher Law, to challenge the change. Your lawyer will have a number of possible arguments to make, including: (1) The physician was not qualified to conduct an IRE. For example, the physician no longer sees patients for at least 20 hours per week. (2) You in fact have not reached maximum medical improvement. Your physician has recommended a surgery, and you are considering it. (3) Your impairment rating is actually 35% or higher. The IRE physician’s rating of less than 35% or less can be challenged, and you can present the testimony of one of your physicians that your impairment rating exceeds 35%.
On the surface, it may not seem that significant if your status changes from total disability to partial disability benefits. You may be thinking to yourself – I’m not planning on being on workers’ comp. for 500 weeks anyway so what’s the difference if I’m on total disability or partial disability? Trust us, though, an insurance company is likely to pay you more money in a settlement if your status is total disability vs. partial disability. If you are on total disability, the insurance company knows that it has the potential to pay you benefits for 10, 15, 20 years, or longer. But if your benefits are capped at 500 weeks, less than 10 years, then the insurance company’s potential exposure is not as high, and it may not set aside as much money for a lump sum settlement. Your injury has the potential to cause you pain, require medical treatment, and limit your ability to work for many years. If you settle your case, you want to squeeze every dollar possible out of the insurance company. Therefore, a rating of less than 35% by an IRE physician can have a significant effect on your PA workers’ comp case.
If you are injured at work — whether you have been collecting PA Workers’ Compensation benefits for 104 weeks or just got injured at work last week, whether you have been scheduled for an IRE or not — it’s very important that you are represented by an experienced lawyer with expertise practicing workers’ comp. law. At Pearson Koutcher Law, workers’ comp. is all we do. Each of our lawyers has more than 25 years representing injured workers. For a workers’ compensation attorney near me, please call us right away for a prompt, free, comprehensive consultation.