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If you are receiving Pa. workers’ compensation benefits, your employer or its insurance company may require you to attend a medical examination with a doctor of its own choosing. One type of special medical examination is known as an Impairment Rating Evaluation (IRE), which can be requested up to two times within a 12 month period after you’ve been receiving benefits for 104. This exam is similar to an Independent Medical Examination, but its purpose is to try and limit your workers’ compensation benefits.

What happens during an IRE?

During an IRE, a doctor applies the American Medical Association’s (AMA) guidelines to determine if the injured worker is more than 35 percent disabled. If the doctor concludes that the worker is less than 35 percent disabled, then the injured worker’s benefits are capped at 500 weeks.

Recent updates to the law

Doctors had been using the current 6th edition of the AMA’s guidelines for evaluation, based on the law’s directive that they use the “most recent edition” of those guidelines. A recent court case determined that use of the “most recent edition” is unconstitutional because the guidelines were developed by a private company (the AMA) and not by a state agency, and because the guidelines haven’t been reviewed 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.

A new law passed in response to the decision changed the language, specifying that doctors must use the 6th edition of the AMA’s guidelines. This would require that any changes to the guidelines must receive lawmaker approval. The new law also reduced the threshold for Total Disability Benefits form 50 percent to 35 percent.

 

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