Impairment Ratings & Pennsylvania Workers' Compensation Claims

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In 2017, after nearly 20 years of stability, Pennsylvania’s workers’ compensation system underwent change. The Pennsylvania Supreme Court struck down impairment ratings for workers’ compensation, calling the language used for the law unconstitutional. In October 2018, Pennsylvania Governor Tom Wolf signed House Bill 1840 into law. This law restored the use of impairment rating evaluations (IRE) in workers' compensation claims made in the state.

Created in 1996, the IRE process was a cost-saving measure that placed caps on the benefits that employers owed injured workers. This law allowed an employee’s benefits to change from total disability to partial disability if a doctor determined that they were less than 50 percent impaired. Once changed to partial disability, an injured worker faces a 500-week limit on their benefits.

Impairment ratings made a significant impact on the workers’ compensation market throughout Pennsylvania. Supporters of IREs claim that they add predictability to disability benefits and enable insurers to offer lower rates. However, many viewed the laws as an unfair way to obtain a lowered settlement for employers. Opponents of IRE assert that there are more fair and accurate ways to determine an injured worker’s ability to work. Pennsylvania’s IRE law brings back portions of the old law with different impairment rating thresholds.

What House Bill 1840 Means for Workers

Now that it is law, House Bill 1840 brings back a modified version of Pennsylvania’s former IRE law. It now uses the AMA Guides to the Evaluation of Permanent Impairment to accomplish impairment rating evaluation. Now, employers can use the IRE process to cap a worker’s benefits if a doctor determines that they are less than 35 percent impaired.

How Do Pennsylvania Impairment Ratings Work?

An IRE is essentially a medical evaluation that is used to determine the extent of a worker’s disability. Workers’ compensation insurance companies can request IREs to see if they need to continue total disability benefits—after a worker has received 104 weeks of benefits.

If the insurance company requests an IRE within 60 days of the worker’s first 104 weeks of benefits, the change in status is automatic. If the IRE is requested outside of that 60-day timeframe, the workers’ compensation insurance company must file a Petition for Modification. Insurance companies have the right to request 2 IREs within 12 months.

The overall IRE process may go as follows:

  • You’ll receive a notice of the IRE request, which will include the name, date, and information of the doctor who will perform your medical evaluation.
  • During an IRE, a licensed physician will perform an examination to determine your level of impairment, based on standards set forth by the American Medical Association (AMA).
  • Based on the AMA impairment guide, the physician will assign a rating to your level of impairment. This may include an assessment of every way that your work-related injuries affect your ability to balance, move, perform fine motor skills, walk, and more.
  • The physician will then complete an impairment rating form and medical evaluation report, which they must send to you and the workers’ comp insurance company within 30 days.

It is important to note that IREs affect indemnity benefits, which cover lost earnings. Medical benefits are separate and may continue even if a worker is only partially disabled. There is no maximum length of time that a disabled worker can receive indemnity benefits—the 500-week limit is only placed on workers who, after an IRE, are found to be less than 35% impaired.

Challenging IREs & Impairment Ratings

If you have received an IRE request, you may feel that your only option is to attend the evaluation and suffer the consequences of whatever impairment rating the physician assigns to you. The truth is that a 35 percent impairment rating is an unfair limit to place on total disability benefits, and you have the right to challenge the outcome of an IRE or even an IRE request in the first place.

Before you make any important decisions about your workers’ compensation claim, accept your impairment rating, or skip an IRE, talk to an experienced attorney about your rights and options. The choices you make at every stage of your case could have a significant impact on your ability to receive workers’ comp benefits now and into the future.

Call Handler Henning & Rosenberg Today for Help with Your Benefits

At Handler, Henning & Rosenberg, we know that IRE laws can limit benefits for injured workers who need them. Since we’ve existed since 1922, our firm has seen workers’ compensation laws change for nearly 100 years. One thing has not changed during this time: our commitment to our clients and earning results for them. We’ve won tens of millions of dollars for clients throughout our history, and we are ready to use our experience to fight for you.

Contact us today at (888) 498-3023 for a free consultation with a member of our team. Best of all, you don’t have to worry about money because you’ll only pay a fee if we win your case!

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