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How IRE’s Can Impact Your PA Workers’ Comp Rates

  • Dave Brown, Esquire
  • 02/28/2022

How Can IRE’s Impact Your PA Workmans Comp Rates

In December 2021, the Commonwealth Court of Pennsylvania issued a decision in favor of an injured worker, James Smith, who was represented by Pearson Koutcher Law’s highly experienced Philadelphia workers comp lawyers. This case involved an IRE and the PA workmans comp rates and benefits associated with it.

What is an IRE?

An IRE is an impairment rating evaluation, which is a medical examination done by a doctor that gives a total body impairment amount in association with whatever injury took place. Pennsylvania workers’ compensation law provides that if an injured worker (the claimant) has been collecting total disability benefits because of an inability to do his or her job for at least 104 weeks (two years), the claimant may be requested by the insurance company to undergo an IRE with a physician designated by the Pennsylvania Department of Labor and Industry.

The physician performing the IRE will initially determine if the claimant has reached maximum medical improvement from the work-related injury. Maximum medical improvement occurs if the claimant’s condition cannot be improved with further treatment. If the IRE physician concludes the claimant has reached maximum medical improvement, the physician will then make a determination of the claimant’s “whole body impairment” based on American Medical Association (AMA) guidelines. The AMA defines impairment as a significant loss of the use of any bodily structure or function. The physician will assign a percentage rating to the claimant’s level of impairment with regard to the work-related injury. No percentage will be assigned if maximum medical improvement has not been achieved.

How Have IRE’s Changed?

When the section of the Pwnnaylvania Workers’ Compensation Act pertaining to IREs was enacted in 1996 — Section 306 (a.3) — physicians determined impairment ratings based on the most recent edition of the AMA Guidelines; the 4th Edition was in place at the time Section 306 (a.3) was enacted. If a physician determined that the claimant’s whole body impairment was less than 50%, the claimant’s benefits could be converted from total disability to partial disability. When a claimant is on total disability status, these benefits could continue indefinitely, theoretically for the rest of the person’s life. However, if a claimant’s status changes from total disability to partial disability, the injured worker’s entitlement to benefits will be limited to 500 weeks, which is approximately nine-and-a-half years. The amount of benefits does not change based on an IRE, just the length of time that the claimant is entitled to benefits.

In 2017, the Pennsylvania Supreme Court issued a landmark decision in a case called Protz, in which the Court ruled that the section governing IREs is unconstitutional; therefore any IRE that resulted in the conversion of a claimant’s benefits from total disability to partial disability was deemed illegal. This decision prompted Philadelphia workers comp lawyers for claimants whose benefits were modified based on an unconstitutional IRE, to file petitions with Workers’ Compensation Judges’, seeking reinstatement of benefits from partial disability to total disability. James Smith is one of those claimants.

How These Changes Made a Difference In PA Workmans Comp Benefits

While working for Eastman Kodak, he injured his wrist at work in 2007 and began to receive total disability benefits. On July 20, 2011, Smith underwent an IRE. The physician utilized the most recent edition of the AMA Guidelines, which at the time was the 6th Edition, and determined that Smith’s whole body impairment was 23%. Thus, his benefits were converted from total disability to partial disability, thereby limiting the amount of time to which he is entitled to workers’ comp. benefits to 500 weeks.

Following the Protz decision, Smith’s Pennsylvania workers compensation lawyer, Jonathan Koutcher of Pearson Koutcher Law, filed a Reinstatement Petition, seeking to restore his benefits to total disability status. Evidence was presented by Smith’s workers comp attorneys PA establishing that Smith remained disabled from his work injury. The Workers’ Compensation Judge granted the petition and Smith’s total disability benefits status was reinstated. Smith’s employer, Eastman Kodak, appealed to the Workers’ Compensation Appeal Board and then to the Commonwealth Court of Pennsylvania, both of which held that the Workers’ Compensation Judge properly ruled that the Protz decision entitled Smith to reinstatement of his total disability benefits.

Why it Matters

In its decision in Eastman Kodak v. WCAB (Smith), the Commonwealth Court ruled that Smith was entitled to reinstatement even though he filed his petition after the Protz case was decided; it did not matter that Smith did not challenge the validity of the IRE back at the time it was conducted. The Commonwealth Court further decided that the effective date of Smith’s reinstatement to total disability benefits was the date that the petition was filed on his behalf in 2017, not the date of the original IRE six years earlier.

This decision by the Commonwealth Court is a victory for Smith as well as other claimants whose benefits were converted from partial disability to total disability before the Protz ruling. Had it not been for these rulings, Smith’s 500 weeks of partial disability benefits would have been exhausted in 2021, and consequently, his weekly PA workmans comp rates and benefits would have ended. Smith is now back on total disability benefits status and his entitlement to weekly benefits is not in jeopardy.

Incidentally, after the Supreme Court’s decision in Protz, the Pennsylvania legislature replaced Section 306 (a.3) with a new provision providing that IREs must be conducted in accordance with the 6th Edition of the AMA Guidelines, and that if a claimant’s whole body impairment is less than 35%, the injured worker’s benefits are subject to modification from total disability to partial disability. This matters because insurance companies continue to schedule IREs for claimants who have been collecting total disability benefits for more than 104 weeks in an effort to change their status from total to partial.

Pearson Koutcher Law | Philadelphia Workers Comp Lawyers

If you are injured at work — whether you have been collecting benefits for 104 weeks or just got injured at work last week, whether you have been scheduled for an IRE or not — it’s very important that you are represented by experienced Philadelphia workers comp lawyers with expertise practicing workers’ compensation law. At Pearson Koutcher Law, we are workers comp attorneys PA and workers’ comp. is all we do. You can be assured that the Philadelphia workers comp lawyers handling your case have more than 25 years of experience representing injured workers so you will be in good hands. Please call us right away at 215-627-0700 for a prompt, free, comprehensive consultation.