FOR HOW LONG CAN I COLLECT TOTAL DISABILITY BENEFITS, AND WHAT IS AN "IRE"?

Contrary to popular belief, an injured worker is not automatically limited to a maximum number of weeks or years of total disability wage loss benefits under Pennsylvania's Workers' Compensation Act.  The Act, however, does allow workers' compensation insurance companies to pursue a certain type of medical determination that may set an end date for the injured worker's entitlement to those benefits.

After an injured worker receives one hundred four (104) weeks of total disability wage loss benefits, a workers' compensation insurance company can request that a physician be designated to perform an Impairment Rating Evaluation, or "IRE." Most likely, the insurance company will do so by filing a form with the Bureau of Workers' Compensation.  The very top right corner of that form states, in bold and capital letters, "REQUEST FOR DESIGNATION OF A PHYSICIAN TO PERFORM AN IMPAIRMENT RATING EVALUATION."  The injured worker should receive a copy of that form in the mail.  After receiving and accepting that form, the Bureau of Workers' Compensation will then mail the injured worker a form entitled, "RE: NOTICE OF DESIGNATION OF IMPAIRMENT RATING EVALUATING (IRE) PHYSICIAN."  That form simply tells the injured worker the name of the physician the Bureau has designated to perform the IRE.  It is then up to the insurance company to schedule the IRE with the designated physician and notify the injured worker of the time and place of the IRE.  In order to do so, the insurance company must send the injured worker a form entitled, "IMPAIRMENT RATING EVALUATION APPOINTMENT."  If the injured worker refuses to attend the IRE, the injured worker may be subject to a forfeiture of his or her workers' compensation benefits.

At the IRE, the physician will interview and physically examine the injured worker.  The physician will also review the injured worker's medical records. Based on that information and certain American Medical Association guidelines, the physician will then determine an impairment rating for the injured worker.  The impairment rating is simply the percentage of permanent impairment the injured worker has suffered to his or her whole body as a result of the work injury.  If that percentage is less than fifty percent (50%), the injured worker may then be limited to only five hundred (500) more weeks of wage loss benefits.  If that percentage is fifty percent (50%) or greater, the duration of the injured worker's benefits are not affected by the IRE.

If an insurance company requests that a physician be designated to perform an IRE within sixty (60) days of the injured worker receiving one hundred four (104) weeks of workers' compensation benefits and the IRE physician finds the injured worker less than fifty percent (50%) disabled, the insurance company can automatically limit the injured worker to five hundred (500) more weeks of wage loss benefits from the date the injured worker came into receipt of one hundred four (104) weeks of workers' compensation benefits.  To do so, the insurance company must mail the injured worker a form entitled, "NOTICE OF CHANGE OF WORKERS' COMPENSATION DISABILITY STATUS."

If an insurance company does not comply with the strict time deadlines outlined above, the injured worker may be able to challenge any change to his or her benefit status and/or the validity of the IRE.  For instance, if the insurance company requests that a physician be designated to perform an IRE before the injured worker has received one hundred four (104) weeks of workers' compensation benefits, the request is premature, and the IRE the injured worker eventually undergoes may be deemed null and void.  (See Dowhower v. WCAB (Capco Contracting), 919 A.2d 913 (Pa. 2007)).  Also, if the insurance company requests that a physician be designated to perform an IRE more than sixty (60) days after the injured worker has received one hundred four (104) weeks of workers' compensation benefits, the insurance company is not entitled to automatically limit the duration of the injured worker's benefits through the "NOTICE OF CHANGE OF WORKERS' COMPENSATION DISABILITY STATUS." (See Gardner v. WCAB (Genesis Health Ventures) and Wal-Mart Stores, Inc. v. WCAB (Rider), 888 A.2d 758 (Pa. 2005); Diehl v. WCAB (IA Constr.), 5 A.3d 230 (Pa. 2010)).

Insurance companies often do not comply with the strict deadlines outlined above and other requirements regarding the IRE examination and determination itself.  For that reason, injured workers often can challenge IRE determinations and notices limiting the duration of their benefits.  In order to successfully do so, however, the injured worker must file a timely challenge.  Therefore, the injured worker should contact our law firm (412-288-6000) immediately upon receipt of any correspondence regarding an IRE or change in disability status.