Impairment Rating Evaluations (Insurance Company Cutting Your Benefits)

Even if you win your case, Workers’ Compensation Benefits are not a lifetime guarantee. The insurance company may try to limit your benefits with the Impairment Rating Evaluation (IRE). An IRE is a physical examination. A doctor determines your level of disability on a scale from 0 to 100. After receiving 104 weeks of benefits, the law requires an injured worker to submit to an IRE.

A doctor will examine you under the guidelines of the latest edition of the American Medical Association’s Guidelines for Permanent Impairment. The doctor must be licensed in Pennsylvania; in active practice at least 20 hours per week; and approved by the Licensing Board. While you can only be required to submit to two IRE’s in a 12 month period, there is no requirement that your condition change prior to an exam. The insurance company can use the exam to see if your condition has changed.

If the doctor finds that the worker’s impairment is over 50%, the worker will continue to receive total disability benefits, but if the doctor finds the impairment is less than 50%, the worker’s status will change from total disability to partial disability. Partial disability means your benefits will be limited to 500 weeks, as opposed to possible lifetime benefits for total disability.

One defense to an unfavorable IRE is that the injured worker was not at maximum medical improvement (MMI) at the time of the IRE. MMI means that the injury/impairment is permanent, stabilized, and unlikely to change in the next year. If surgery or some form of treatment within a year might help the worker, then the worker is not at MMI.

As with most aspects of Workers’ Compensation claims, an Insurance Company may use an IRE to limit your benefits. The best way to protect yourself is to call an attorney.