Impairment Rating Evaluations
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, that means that a full recovery from your injury is unlikely and that your body will not function as it used to. The Impairment Rating Evaluation in Pennsylvania is a crucial part of the workers’ compensation claim. It can be used by the insurance carrier to limit the benefits of the injured employee, even if the doctors and the medical records state that the injury will keep him or her from working.
The Time Limits
The Pennsylvania Workers’ Compensation Act explains how an impairment evaluation works after it was amended to include it in 1996. Exactly 104 weeks after the injured employee has started to receive disability benefits, there is a 60-dayperiod during which that injured employee could be called into an IRE, or impairment rating evaluation. If the IRE is called in that 60-day time span, then the injured employee is required to attend. If the injured employee’s IRE results state that impairment is less than 50% then benefits automatically change to partial disability benefits, and there is a 500 week limit, about 9.5 years, on the amount of time that those benefits can be received. If the request happens after that 60-day window has transpired, then the petition to modify takes a different evidentiary route and is harder to modify. Even if the IRE is scheduled after the 60-day period, the insurer still does give up its right to compel the attendance of the injured employee. Even if a modification is made the injured employee is still given an opportunity to fight for the benefits he or she deserves, by filing an appeal.
The IRE Itself
The Impairment Rating Evaluation is meant to determine whether or not the injured employee has a full body impairment. In order to constitute a full body impairment, the impairment rating evaluation must conclude that the injured party is operating with half a body or less, meaning that he or she only has functionality in no more than 50% of his or her body. It is extremely rare that this determination is made, and there have only been a handful of cases in Pennsylvania where this conclusion has been made.
As stated before, if the impairment rating evaluation determines that less than half of your body is impaired, then you will be switched to partial disability benefits. When this happens, it is important to remember that the amount of compensation you will receive does not change, but the amount of time that you can receive it for changes. If your benefits change to partial disability, then there is a nine and a half year maximum placed on your benefits. Many believe that this system is unfair because even if you or your injured loved one experience a permanent disability as a result of an injury, most of the time it does not even come close to the 50% floor established by the impairment rating evaluation.
Other Information on the IRE
The Impairment Rating Evaluation is performed by a physician. However, not just any physician can perform the impairment rating evaluation. The Pennsylvania Department of Labor and Industry have a list of certified physicians who will perform the impairment rating evaluation to determine your status of disability and impairment. Even if your impairment rating evaluation shows that you do not meet the 50% threshold, it is possible to appeal that determination as long as it is within the nine and a half years that you can still receive benefits. One way to appeal is to argue that after all the treatment you have already received, nothing else can improve your condition. You are essentially proving through your medical records that you have reached your peak of medical improvement and that it is impossible for your disability to improve further.
Contact Us Today
Here at Krasno Krasno & Onwudinjo, our experienced workers compensation attorneys can help you through the Impairment Rating Evaluation process. So, if you or a loved one are facing an impairment rating evaluation or have already faced one and are looking to appeal or have any questions, do hesitate to contact us or call 877-299-0779. Our attorneys work on a contingency basis, meaning that if you don’t get paid, we don’t get paid.