An injured workers’ right to benefits can be limited in several ways, typically:
- Based on medical evidence that the injury has resolved, or improved to the point the claimant can work, AND
- Evidence that the employer has actual work available within the injured workers’ capabilities, OR
- By evidence of work “generally” available within their restrictions.
What is an IRE?
An IRE is a “different” type of medical evaluation, where a doctor uses charts and tables developed by the American Medical Association to mathematically calculate the percentage of bodily ‘impairment’ due to the work injury. Impairment is different than disability. Disability is based on the injured worker’s inability to work. ‘Impairment’ is a mathematical determination of how much bodily function is affected by the work injury. If the impairment is determined to be below 35%, the injured worker’s legal classification is changed from “totally” disabled to “partially” disabled – even if there is no evidence of available work within their limited capabilities. By definition, these evaluations involve “permanent” injuries. The injured worker may realistically be disabled for the rest of their life. Depending upon their educational background and skillset, they may never be able to find another job. In other words, the claimant may be severely “disabled”, yet restricted in the length of time they can receive benefits based on the level of their “impairment.”
The sole purpose of these exams is to reduce the length of time an insurance company must pay workers’ compensation benefits. These examinations are authorized by the Pennsylvania Workers Compensation Act; Section 306 (a.2)(1) of the PA WC Act; 77 P.S. Sect. 511.2. An IRE may be performed by a doctor chosen “by agreement” of the parties (extremely rare) or by a physician “designated by the Department” of Labor and Industry (most common). The doctor must maintain a certain level of qualifications to be “Approved” to conduct such exams, though it is presently unknown whether the Department of Labor conducts ANY investigation of any given doctor’s application. Based on their review of medical records – supplied by the insurance company – and their own, single examination of the injured worker – the IRE physician will first determine whether the injured worker’s condition is “reasonably presumed to be permanent”, often referred to as Maximum Medical Improvement (MMI) – (even though the AMA Guides define the two words differently). If MMI is reached, then the doctor will apply the diagnosis of the work-related injury to a host of tables and charts set forth in a book called The Guides to the Evaluation of Permanent Impairment. Based on these charts, the doctor will identify the injured worker’s percentage of bodily impairment due to the work injury. If the injured worker is determined to be less than 35% impaired (an almost impossible standard to reach, but for the most catastrophic injuries, involving multiple body parts) the injured worker will (likely) be restricted to receiving 500 weeks of disability benefits (at a maximum, subject to other insurance company tactics to further reduce the amount of benefits they must pay).
These provisions of the Pennsylvania Workers’ Compensation Act were first created in 1996. It took until 2017 for the Court to determine the law was Unconstitutional. Less than 1 Year after that Court Ruling, the Pennsylvania General Assembly rewrote the law. Claimant Lawyers across the Commonwealth are once arguing the ‘new law’ is Unconstitutional; but it may again take 20 years to find out.