The Impairment Rating Evaluation

Greg Boles
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Partner at The Boles Firm | Experience Matters

If you've been out of work for two years in connection with a work injury, the insurance company can have you undergo an Impairment Rating Evaluation (IRE).  This is not the same as an Independent Medical Examination. If the doctor performing the impairment rating evaluation determines that you are less than 50 percent disabled according to guidelines of the American Medical Association, you may receive no more than 500 additional weeks of benefits or about 9 1/2 years.  You do have the right to challenge this determination but, the deck is stacked against you.  Certainly you should not try and challenge such a determination without a lawyer.

There is considerable controversy now about the legal effectiveness of impairment rating evaluations.  Under the Act, the degree of impairment is to be determined by looking at the most recent edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment.  In 2015 the Commonwealth Court ruled that this was an unconstitutional delegation of legislative power.  The Court went on, however, to send the case back to the Workers' Compensation Judge for the judge to apply the Fourth Edition of AMA Guides, which was the guide in place at the time the law was passed.  In March 2016, the Pennsylvania Supreme Court accepted an appeal by the claimant, who argues on appeal that the Commonwealth Court properly found that the use of the AMA Guidelines was an unconstitutional delegation of power but erred in remanding the case to the Workers' Compensation Judge for application of an earlier version of the Guides.  Thus, at present, it is unclear whether this provision of the Pennsylvania Workers' Compensation Act will be enforceable in the future.

For more detailed answers to your questions, consult the Frequently Asked Questions bar to the left or download a copy of The Consumer’s Guide to Pennsylvania Workers’ Compensation. For the definitive guide to making your way through the Pennsylvania workers’ compensation system, order a free paper copy of The Wounded Worker: Inside the Pennsylvania Workers’ Comp Maze by calling 877-959-1811 or download a free e-copy by clicking here.