A recent PA workers’ compensation case decided that the current review process attempting to limit workers’ compensation benefits is unconstitutional.

 

Understanding the change

When an injured worker has been receiving workers’ compensation benefits for 104 weeks, the insurance company may request an Impairment Rating Evaluation (IRE). An IRE doctor applies the American Medical Association’s (AMA) guidelines to determine if the worker is more than 50 percent disabled. If the doctor concludes that the injured worker is less than 50 percent disabled, then the injured worker’s benefits are capped at 500 weeks.

 

Doctors have been using the current 6th edition of the AMA’s guidelines for evaluation. The recent court case determined that use of the 6th edition is unconstitutional because the guidelines were developed by a private company (the AMA) and not by a state agency, and because there has been no meaningful review of the guidelines in nearly two decades. It is a violation of the constitution to give a private company the authority to determine how injured workers are evaluated under the law with no government oversight.

 

What does this change mean for Pond Lehocky clients?

Because of the court’s decision, Pond Lehocky is denying ALL IRE requests. Our clients should not be subjected to unlawful exams that may negatively affect their workers’ compensation benefits. We will continue to aggressively defend our clients’ constitutional rights. 

 

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