Impairment Rating Evaluation and Pennsylvania Workers’ Compensation
What is a Pennsylvania Workers’ Compensation Impairment Rating Evaluation? A Pennsylvania Impairment Rating is a determination of whole body impairment by a physician, taking into account the work-related diagnoses. It may be requested once an injured worker has received 104 weeks (ie, 2 years) of total disability compensation. The examination isn’t for treatment purposes and it isn’t identical to an Independent Medical Exam- it’s sole purpose is to establish a whole body impairment.
This, unfortunately, is a tool for insurers to put a ceiling on their exposure. If the impairment rating- stemming from an IRE- Impairment Rating Examination- results in an impairment of less than 50%, the the injured worker’s status converts to a partial disability status, and while the amount of compensation isn’t affected, there is a 500 week limit on partial disability. 500 weeks is about 9.5 years. As an advocate for injured workers, I don’t feel this is fair. Many injured workers have permanent injuries and will not even come close to the 50% threshold- thus ending their wage loss benefits artificially after the 500 weeks run.
The impairment rating examination must be requested during a 60 day window after expiration of the employee’s receipt of 104 weeks of total disability. The employee’s receipt of 104 weeks of total disability shall be calculated on a cumulative basis. Note the failure to request the IRE within the 60 day window doesn’t preclude the insurer from compelling attendance at an IRE- but the prosecution of that (Petition to Modify) conversion will take on a different evidentiary route versus the timely request during the 60 day window which makes it easier to modify benefits. Absent agreement, a request for an IRE before the expiration of the 104 weeks is not permitted.
Here are some common questions about PA Work Comp Impairment Ratings and our Answers:
What doctor performs the IRE? The physician must be licensed in Pennsylvania and certified by an American Board of Medical Specialties- approved board or its osteopathic equivalent. The physician must also be active in a clinical practice at least 20 hours per week.
How is the percentage of impairment calculated? An IRE must be established by the most recent edition of the AMA Guidelines to the Evaluation of Permanent Impairment. The doctor performing the IRE must complete Form LIBC 767- Impairment Rating Determination Face Sheet which sets forth the rating for the compensable work injury.
How will I know if my rating is under 50%? If the Impairment Rating Evaluation results in an impairment rating of less than 50%, the employee will receive benefits that are deemed to be partial in nature rather than total. To adjust the benefits, the insurer shall provide notice to the employee and his counsel, if known, using Form LIBC 7640 Notice of Change in Workers’ Compensation Disability Status. This is an important form so if you don’t receive one, make sure to call us so we can advise as to the effects.
What if my rating is 50% or higher? Then you will be presumed to be totally disabled and shall continue to receive total disability compensation. Note that the presumption of total disability may be challenged at any time by a demonstration of earning power in accord with section 306(b)(2) of the Pennsylvania Work Comp Act. Remember the goal is every insurance company is to pay as little work comp benefits as possible- so the IRE is a tool to challenge benefits and get their 500 week cap. No matter what an adjustor tells you or how friendly he or she seems, they’re not on YOUR side. We ARE.
Can I challenge the IRE findings? Yes. Any at time during the receipt of 500 weeks of partial disability compensation, the employee may appeal the adjustment of benefit status to a workers’ compensation judge by filing a Petition to Review. Some of the common challenges stem from the failure of the IRE doctor to establish that the employee has reached maximum medical improvement, or a failure to account for all of the work-related diagnoses. Maximum Medical Improvement, also known as “MMI”, essentially means a physician has determined that the injured worker is not likely to get better, or worse- in other words, their condition has leveled off.
In my experience, the Impairment Ratings do not greatly affect most cases. Why not? Well, many cases are resolved before 104 weeks. In addition, even if an IRE comes back as under 50%, the amount of the work comp checks doesn’t get reduced based on the IRE. The vast majority of cases settle long before 500 weeks. That being said, the IRE’s can be a tool for insurers to seek leverage in the settlement process. It is highly unusual for an IRE to result in a whole body impairment of 50% or greater. To reach that threshold, the injuries must be virtually catastrophic. Sometimes, CRPS- Complex Regional Pain Syndrome can be a condition causing a greater than 50% rating.
Remember- the goal of the insurers and employers is not to make sure you’re healed. Their goal is to pay as little as possible for your claim. Sounds counterintuitive right? The benefits are there to help people like you but they want to minimize the payments. It’s true. This is why you should contact our firm if you are not represented. There are no fees unless we 1) get you work comp wage loss that you’re not already receiving, 2) settle the case for a lump sum (and cases are more valuable with an attorney involved), or 3) we prevent your benefits from being reduced. All fees have to be approved by a Work Comp Judge. What this means is that if you are already getting work comp checks every week or every two weeks, we monitor your case at NO CHARGE and NO COSTS. Having a powerful firm like Cardamone Law behind you will very likely result in a much higher settlement offer when the time comes.
For more information about Pennsylvania Workers’ Compensation Impairment Ratings Evaluations, call Certified PA Work Comp Attorney Michael W. Cardamone at (215) 206-9068 or email Michael@CardamoneLaw.com
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