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The role of the impairment rating evaluation in workers’ comp

The IRE is undergoing scrutiny by PA courts

From start to finish, making a workers’ compensation claim is a fight. Injured workers must do everything they can to obtain the benefits they need. Even once benefits are received, insurers will do their best to limit the length and amount by having claimants go through an impairment rating evaluation (IREs).

An IRE occurs after two years of receiving benefits. The IRE uses a supposedly neutral doctor to evaluate the injured worker receiving benefits. If the doctor finds that the person is less than 50 percent injured (based on an overall “body impairment rating”) then workers’ comp benefits are no longer permanent. Instead, claimants go from “total” to “partial” benefits, and have 500 total weeks left to receive lost wages.

New court decisions may affect IREs

In a recent decision, the Pennsylvania Supreme Court held that an IRE was invalid because the doctor in the IRE failed to account for the injured workers’ mental health in the evaluation. While the worker did not obtain benefits based on his mental health, the state Supreme Court found that all health conditions should be factored into the overall rating.

This ruling could have far-reaching consequences. For one, many seriously injured people struggle with mental health. Living in constant pain often leads to depression, anxiety and other mental health issues.

Additionally, the state’s highest court will hear an upcoming case regarding which guidelines to use to judge mental impairments. If it holds that doctors should use the latest version created by the American Medical Association, there are clearer guidelines for how mental impairments can affect an individual’s body impairment rating. Insurers are arguing that older versions should be used until state lawmakers pass a law saying otherwise.

Cases illustrate the complexity of workers’ compensation

Few workers know the ins and outs of workers’ compensation in Pennsylvania. The above cases demonstrate how complex and contentious legal battles over obtaining full and fair benefits can become. It is only after a worker becomes injured that it becomes apparent just how convoluted and self-interested the process is, which is why many workers turn to an attorney to help guide them through the process.

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