The Pitfalls of Impairment Rating Evaluations in PA Workers Compensation.

New Method for Workers Compensation Carriers

In 1996 the PA Legistlature created a new method for Workers Compensation Carriers to limit an injured workers entitlement to receive wage loss benefits as a reslult of   work -related injury. In that regard, after an injured worker has received 104 weeks of temporary total disability the WC carrier can request the claimant to undergo an Impairment Rating Evaluation (IRE) with a doctor chosen by the Bureau of Workers Compensation. As long as the request is made within 60 days, the injured worker is required to attend the examination. In 2003 the PA Supreme Court held that even if the request was "untimely" the injured worker could still be subjected to the examination if a Workers Compensation Judge found the request for an examination to be "reasonable and necessary." Even though not contemplated by the Legislature in 1996, the PA Supreme Court has created a method for Insurance Carriers to get another bite at the apple in those cases where they failed to request a timely Impairment Rating Exam.

Due to the advent of the "untimely" request for an IRE now being permitted, there are two different remedies for the Insurance carrier to limit the claimant's enttlement to receiprt of on-going benefits subsequest to the IRE.

In all cases where an IRE is performed if the IRE results in an impairment rating of more than 50 % the injured worker is presumed "totally disabled" and entitled to continue to receive workers compensation benefits.

In PA, the IRE is performed pursuant to the "most recent edition of the AMA Guides to Permanent Impairment." Currently the most recent edition is the 6th Edition. Although the 6th Edition has come under attack in many parts of the country PA continues to use the 6th Edition for IRE's. As a result it is nearly impossible to have an IRE result in an impairment rating of more than 50 %.

Once the IRE is completed the doctor performing the IRE is required to provide the results on a form prescribed by the Bureau of WC.

If the IRE was "timely" then the WC carrier is entitled to automatic relief and merely has to file a Notice of Change of Status with the injured worker and the Bureau of Workers Compesation and the claimant's status changes from being Totally Disabled to Partially Disabled. Although the amount of the injured workers weekly check does not change, the Change in Status results in a limitation of 500 weeks of partial disability benefits.

Although the WC Carrier is entitled to automaticve relief if the IRE was requested in a timely manner, it must provide 60 Days notice of its intention to Change the Injured workers status. Accordingly the Commonwealth Court recently held that the claimant has 60 days to challenge the IRE results by filing a Petition to Review. If the Claimant files such a Petition he/she can attack the findings of the IRE on several grounds including but not limited to the doctor's failure to address all of the injured workers' work-related injuries. Unfortunately if the claimant fails to file the Petition within that 60 Day period, the only way to overturn the IRE is by showing the he/she has an impairment rating of greater than 50 %.

If the IRE was not timely, the WC carrier must rely upon the "traditional administrative process" and file a Petition for Modification and there will be many more defenses available to the claimant in such a proceeding, including but not limited to failure to address all claimant's injuries, attacking the doctor's credibility, failure to follow the AMA Guides to Permanent Impairmen, Etc. If the Judge findsin favor of the Defendant, the Claimant's status changes to partial disability effective the date of the IRE.

If you have received a Request for Designation of a Physician to Perform and IRE form in the mail, or undergone an Impairment Rating Evaluation, you should contact an experienced workers compensation lawyer to learn about all your rights pursuant to the Workers Compensation Act, so that you can get all the benefits that you deserve.

The information in this article is a cursory look at some important aspects of the workers’ compensation system.  Only an experienced and competent workers’ compensation attorney can actually determine what the best course of action is for each individual injured worker.

An attorney client relationship requires a signed agreement between the client and attorney.  Nothing in this article should be taken as legal advice to a client and no relationship with The Law Offices of Richard A Jaffe is created without a written agreement for legal services.