How Impairment Ratings Work in a Pennsylvania Workers’ Comp Case

The Pennsylvania workers’ compensation system is set up to ensure that anyone who is hurt or becomes sick at work receives medical attention and compensation for their illness or injury. This no-fault insurance often works well for employees, but in many cases, the power of employers and their insurance companies means that laws are passed that can prevent workers from receiving the benefits they deserve.

How Impairment Ratings Work in a Pennsylvania Workers’ Comp Case

This is often the case with impairment ratings. These evaluations are used to determine just how disabled a person is as a result of their work injury — and in many situations, to limit their wage loss benefits as a result.

According to a Philadelphia workers’ compensation attorney, there have been many changes to the impairment rating system in recent years. Understanding these updates can help you understand your rights and options if you have been hurt on the job.

What are Impairment Ratings?

What Is an Impairment Rating?

Impairment ratings are part of the Pennsylvania workers’ compensation system that determines how disabled a person is from their workplace injury or illness. A potential consequence of impairment ratings is that the amount of benefits that a person is entitled to may be capped if a person is found to be impaired less than a certain percentage (currently set at 35%).

To determine impairment ratings, an employer can require an employee to undergo an Impairment Rating Evaluation, or IRE. An IRE is a medical examination that analyzes a percentage of impairment based on the work injury or illness.

The impairment is determined by assessing the worker’s loss of physical function. If an IRE determines that an employee has an impairment of less than 35%, then his or her wage loss payment benefits will be capped at a maximum of 500 weeks.

An IRE can be requested after an injured worker receives 104 weeks of temporary total disability payments and has reached maximum medical improvement (MMI). The doctor who performs the IRE must be agreed upon by both parties, or selected by the Bureau of Workers’ Compensation. The doctor must then consult the Sixth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment to determine a “Whole Body Impairment” (WBI) rating solely related to the work injury.

If an IRE results in an impairment rating of 35% or less, the employee’s benefits can be changed from temporary total disability payments to temporary partial disability payments. This does not change the amount of money that a worker receives. Instead, it impacts the length of time that an employee can receive benefits.

Under Pennsylvania law, there is no limit on how long an injured employee can receive total disability payments. In contrast, injured workers are limited to 500 weeks of partial disability benefits. As a Philadelphia workers’ compensation attorney can explain, the change from total to partial disability has a significant impact on the total amount of benefits paid.

The History and Future of the IRE Process

The History and Future of the IRE Process

The ability of employers to demand IREs first arose in 1996, when the Pennsylvania Legislature enacted revisions to the Pennsylvania Workers’ Compensation Act. Under this law, employers could require an IRE of any injured employee. If a worker had an impairment rating of less than 50%, then his or her wage loss benefits were capped at 500 weeks.

On June 20, 1017, the Pennsylvania Supreme Court declared this portion of the Workers’ Compensation Act unconstitutional. In Protz v. WCAB (Derry Area School District), the Supreme Court held that the Workers’ Compensation Board had unconstitutionally delegated its duty by having doctors rely on the American Medical Association’s guide for impairment ratings. This decision effectively ended the IRE process in Pennsylvania.

However, on October 24, 2018, the Pennsylvania Legislature enacted Act 111, which reinstated IREs — with some changes. Most significantly for injured workers, rather than the extremely high 50% threshold, the new law will cap benefits only if a worker’s impairment rating falls below 35%.

Like the previous law, Act 111 relies on the American Medical Association’s guide for IREs. This may leave the law open to a challenge, as the Pennsylvania Supreme Court has previously ruled that this type of delegation of authority to a non-legislative, non-governmental body is unconstitutional.

Work with a Philadelphia Workers’ Compensation Attorney

Work with a Philadelphia Workers’ Compensation Attorney

In the past two years, Pennsylvania has undergone significant changes in the IRE process, from the Supreme Court declaring the law unconstitutional to the Legislature enacting a new law. This can make an already complicated process even more confusing, particularly for anyone whose workers’ compensation case may have started in the period between the Protz case and the start of Act 111.

Solnick & Associates is here to help. As experienced Philadelphia workers’ compensation attorneys, we understand Pennsylvania law and know how to get results. We will work with you to help you get the results that you deserve. Contact us today at 877-415-6495 or anytime via online portal. Initial consultations are always free.