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Navigating the Pennsylvania workers’ compensation benefits process can be overwhelming. Under Pennsylvania law, employees participate in an additional impairment rating evaluation after they receive a cumulative total of 104 weeks of benefits payments. The goal of the evaluation is to determine if the employee is better, worse, or the same and thus requires a change in the amount of benefits they receive. 

At the conclusion of the evaluation, the physician submits an impairment rating, which may result in the insurance company asking to change the worker’s benefit status. In most cases, a change in status does not change how much compensation you receive. But it can place a limit on how long you receive benefits. In this article, we explore what an impairment rating evaluation is, how it impacts you, and what happens after an impairment rating evaluation. 

The team at Krasno Krasno & Onwudinjo understands how impactful an impairment rating evaluation can be and that many injured workers may have more questions than answers during the process. Our experienced Pennsylvania workers’ compensation lawyers have won over 300,000 workers’ compensation cases, helping those injured on the job get the benefits they need to stay afloat and cover their medical expenses. 

What Is an Impairment Rating Evaluation?

When a work injury occurs, it can leave you impaired or disabled. For example, if you break your arm, you are disabled for the period of time it takes your arm to fully heal. On the other hand, if the injury leaves you impaired, a full recovery from your injury is unlikely, and your body may not function as it used to. 

An Impairment Rating Evaluation (IRE) is an exam that a physician performs after an injured employee receives 104 weeks of workers’ compensation benefits. In the course of the exam, the physician seeks to determine the percentage of the worker’s whole body that is still experiencing an impairment. Generally speaking, if the impairment rating is 35% or greater, the worker may still be eligible for benefits, but the insurance company may seek to change the employee’s benefit status. Alternatively, if the worker experiences an impairment rating of less than 35%, the insurance company may seek to decrease the length of time that it pays out benefits to the worker.  

The Impairment Rating Evaluation in Pennsylvania is a crucial part of the workers’ compensation claim. The insurance carrier can try to use the evaluation’s results to limit the injured employee’s benefits, even if the doctors and the medical records state that the injury will keep the employee from working. For that reason, injured workers typically benefit from talking to a lawyer for workers’ compensation to help them navigate the impairment rating evaluation process and advocate for their rights. 

When Do I Get an Impairment Rating Evaluation?

The Pennsylvania Workers’ Compensation Act explains the impairment rating evaluation process. After the worker receives 104 weeks of benefits, there is a 60-day period during which the insurance company may request that the injured employee participates in an IRE. 

If the insurance company calls the IRE in that 60-day time span, the injured employee must attend the evaluation. If the injured employee’s IRE results state that the impairment rating is less than 35%, then benefits may automatically change to partial disability benefits, and there is a 500-week limit on the amount of time that the employee can receive the benefits. 

If the insurance company submits the request after the expiration of the 60-day window, it may be more difficult for the insurance company to modify the benefits. That said, they can still request that the employee participates in an IRE. The insurance company has the right to request an IRE twice during a 12-month period. Even if the insurance company requests a modification to the benefits the employee receives, the worker can object to the change by filing the appropriate paperwork with the workers’ compensation judge. Additionally, if the insurance company’s modification request is successful, the injured employee may fight for their rights to receive benefits by filing an appeal. 

What Happens During an Impairment Rating Evaluation?

The purpose of the Impairment Rating Evaluation is to determine if the extent of the injured employee’s impairment and see if their injury still qualifies as a total impairment. A total impairment is one that results in an impairment rating of 35% or more.

The physician conducting the evaluation examines the injured worker to understand the impacts of the injury on their ability to function. To qualify as an IRE physician, the provider must meet the requirements under Pennsylvania law, which include that the physician currently practices medicine for at least 20 hours per week. To gain a complete understanding of the worker’s condition, the physician may request the worker to see additional specialists. The doctor may request evaluations by specialists if the worker has or may have more than one type of condition that is impacting their overall ability to function. In making the final determination, the physician uses the American Medical Association’s most recent “Guides to the Evaluation of Permanent Impairment.” The physician must submit their findings within 30 days after completing the impairment evaluation. 

Who Performs an Impairment Rating Evaluation??

A qualified physician performs the Impairment Rating Evaluation. Pennsylvania law contains requirements a physician must meet to be eligible to conduct these evaluations. If you do not believe that the insurance company’s chosen physician meets the qualifications, you may be able to request a different physician. A workers’ compensation attorney can help you accomplish this. 

What Happens After an Impairment Rating Evaluation?

Within 30 days after the impairment rating evaluation, the physician submits the “Impairment Rating Determination Face Sheet,” which explains their decision. After the physician files their decision, the insurance company may begin the process of amending the employee’s benefits status. 

If the impairment rating evaluation determines that less than 35% of your body is impaired, then the benefits you receive may decrease to partial compensation. When this happens, it is important to remember that the amount of compensation you will receive may stay the same. In other words, you may still qualify for workers’ compensation benefits, but the amount of time you can receive compensation may change. Usually, workers receiving partial disability benefits cannot receive payments for more than 500 weeks. If the employee disagrees with the decision to adjust the status of their disability, they can file a Petition for Review with the appropriate workers’ compensation judge. 

Contact the Workers’ Compensation Firm Trusted by Pennsylvania Since the 1930s

The Impairment Rating Evaluation process can be confusing and daunting, particularly when you depend on the benefits to make ends meet and support your loved ones. Having an advocate there to guide you through the evaluation process and help you understand what to expect can be incredibly beneficial. 

The experienced workers’ compensation attorneys at Krasno Krasno & Onwudinjo can help you through the Impairment Rating Evaluation process and help you get your life back on track after a work injury. Our team includes Eileen Pomento, who has practiced workers’ compensation law at our firm for over 25 years. She was recognized as a Rising Star for many years and has given multiple presentations on Pennsylvania workers’ compensation law. 

So, if you are facing an impairment rating evaluation or would like to appeal an IRE result, call us at 844-243-4843 or contact us online to schedule a FREE consultation. Our attorneys work on a contingency basis, meaning that if you don’t get paid, we don’t get paid.