If you’ve received a notice requesting an Impairment Rating Evaluation (IRE), you likely have some questions. How will an IRE affect your total disability benefits? What is an IRE exactly?
Understanding how an IRE works will help you know what to expect during and after the evaluation. It is also important to remember that you have rights as an injured worker, and experienced workers’ compensation lawyers are available to help you navigate the IRE process. Here are answers to common questions to clarify the meaning of an IRE and how it may affect your case.
What Is an IRE?
An IRE is a medical examination. The purpose of an IRE is to determine the extent of your disability resulting from a work-related injury. Your employer’s insurance company can request an IRE after you’ve received 104 weeks of total disability compensation.
Under Pennsylvania’s workers’ compensation law, total disability is when a worker is paid while they are unable to perform any work due to an occupational injury. The worker receives compensation until they are able to work again. Until then, they will get two-thirds of their average weekly pay to compensate for missed work.
An IRE is used to determine whether or not you should stay in total disability status. Your employer’s insurance company does not want to provide compensation longer than necessary. An IRE gives them a chance to shorten the length of time you receive payments for your injury. An insurer has the right to request two IREs during a 12 month period.
What Happens During an IRE?
First, you will receive a notice stating the IRE request. The notice will tell you the time, date, location and name of the doctor who will perform the evaluation. It is the insurance company’s responsibility to schedule an appointment with a doctor. An insurer has 60 days before 104 weeks have passed to request an IRE. The insurance company may likely tell you that you are required by law to attend and may lose your benefits. However, many attorneys who represent workers advise their clients to intentionally skip the exam as a legal maneuver to challenge the legal validity of the IRE process. That is, the IRE process may not be Constitutional under Pennsylvania law, and failing to attend the IRE is one way to challenge the IRE process. Another avenue to challenge the IRE process is to attend, and then file a legal challenge in court.
During the IRE, you’ll be examined by a licensed physician. The doctor will use standards set by the American Medical Association (AMA) to judge your condition and level of whole-body impairment. The AMA defines impairment as a significant loss in the use of any body structure or function.
The doctor will consider your symptoms and problems resulting from the injury during the exam. They may test your ability to balance, move your limbs, lift and other skills affected by the injury. Using the AMA’s guide, they will assign a percent rating to your level of impairment. The percent rating only represents the impairment resulting from the work-related injury. Preexisting or nonwork-related injuries do not count and will not increase the rating.
After the IRE, the doctor must complete an impairment rating form and medical evaluation report. They shall send these documents to you and your employer’s insurer within 30 days of the IRE.
How Will an IRE Affect My Pennsylvania Workers’ Compensation Case?
The result of the IRE will determine the type of benefits you’ll continue to receive. If the physician rates your impairment level equal to or greater than 35%, you will continue to receive wage loss benefits without any change. If you are found to be less than 35% impaired according to the doctor’s evaluation, the insurance company will likely change your status “partial disability.” You will still receive the same amount of weekly benefits, but now their will be a time limit on how long you can continue to receive wage loss benefits of 500 weeks maximum.
Your employer’s insurance company must notify you if your disability status changes. You will have a right to appeal the change to your benefits at any time during the period of partial disability status.
What Is House Bill 1840?
Before 1996, IREs did not exist. On June 24, 1996, Governor Tom Ridge amended the Workers’ Compensation Act by signing Act 57 into law. According to the amended act, employers could request IREs and change a worker’s disability status if their impairment rating was less than 50%. The goal of the IRE law was to reduce costs for employers while still protecting injured workers.
Workers’ compensation supporters felt the IRE was unconstitutional and unjust. On June 20, 2017, the Pennsylvania Supreme Court ruled IREs unconstitutional, deciding that the AMA could not fairly determine the criteria for evaluating impairment.
These changes did not last. On October 17, 2018, Pennsylvania lawmakers passed House Bill (HB) 1840. HB 1840 reestablishes impairment ratings. Under HB 1840, physicians must use the AMA’s 6th edition guidelines to determine an injured worker’s level of impairment.
On October 24, 2018, Governor Tom Wolf signed HB 1840 into law as Act 111. The new law decreases the 50% impairment rating to 35%. While this may seem like an improvement, it is still a high level of impairment to meet as an injured worker.
Act 111 is an attempt to remedy the faults of the prior IRE law. However, this current version of the law is also being challenged in the Courts as unconstitutional. If you receive notice of an appointment to attend an Impairment Rating Evaluation, you should immediately call one of our lawyers to discuss whether you should go and the current state of the law regarding IREs.
Work With a Workers’ Compensation Attorney
With constantly changing laws, it can be challenging to know whether or not you are receiving fair compensation for your work-related injury. Pennsylvania workers’ compensation laws can be confusing and difficult to navigate. At Frommer D’Amico, we are experts in workers’ compensation, and we’re here to help.
Suffering a work-related injury puts life on hold. You still need a way to pay your bills when you’re unable to work. Our lawyers are driven to help you get the compensation you deserve.
We are available 24/7 and will travel to your home to assist you with workers’ compensation challenges. We will manage your case for free, and we only get paid if we settle your case. With one of our dedicated, trustworthy attorneys on your side, there’s no need to turn to your employer or insurance companies for advice. We are here to fight for you and bring you peace of mind throughout the process. To learn more about our services and how we can help, contact us today for a free consultation.