Navigating the Pennsylvania workers’ compensation system can be overwhelming—especially when it comes to impairment rating evaluations. These assessments play a key role in determining the future of your benefits after a work-related injury. For injured employees, understanding how these evaluations work, what they mean for your claim, and how to prepare is essential for protecting your rights and income.

How the Workers’ Compensation System Works in Pennsylvania

Pennsylvania law requires most employers to carry workers’ compensation insurance, which provides wage replacement and medical benefits to employees who suffer work-related injuries or illnesses. Once a claim is accepted, the injured worker receives benefits without needing to prove employer fault.

These benefits typically include:

• Coverage for all reasonable medical treatment
• Partial wage loss compensation (usually two-thirds of the average weekly wage)
• Specific loss benefits for amputation or disfigurement
• Death benefits to dependents (if applicable)

Initially, all wage loss benefits are considered “temporary total disability” (TTD). But the duration of these benefits can change after an Impairment Rating Evaluation (IRE) is performed.

What Is an Impairment Rating Evaluation (IRE)?

An IRE is a medical assessment used to evaluate the degree of permanent impairment from a workplace injury. It’s not about whether you can work—it’s about how severely your injury has affected your body’s function as a whole.

Under Pennsylvania law, once you’ve received 104 weeks of TTD benefits, your employer or its insurer may request that you undergo an IRE. This evaluation follows American Medical Association (AMA) Guidelines, most recently aligned with the Sixth Edition.

When Is an IRE Requested?

An IRE can only be scheduled after the injured worker has received 104 weeks of total disability benefits. If you reach this threshold, your employer has the right to file a request for an impairment rating exam through the Pennsylvania Bureau of Workers’ Compensation.

Who Conducts the IRE?

A physician licensed in Pennsylvania and certified by the Bureau is selected to perform the evaluation. The physician reviews your medical records, conducts a physical exam, and uses the AMA guidelines to calculate your whole-body impairment percentage.

Impairment Ratings and Their Legal Impact

The 35% Threshold

This number is critical. If your impairment rating is less than 35%, your benefits status can be changed from total to partial disability. This means:

• You may continue receiving benefits for up to 500 weeks, but not indefinitely.
• You are still considered injured but not permanently totally disabled under PA law.

If your impairment rating is 35% or higher, you remain eligible for total disability benefits without the 500-week cap.

Partial vs. Total Disability

• Total Disability: Full benefits without a time limit, based on inability to work or a rating of 35% or higher.
• Partial Disability: Limited to 500 weeks, typically based on a rating under 35% or a finding that the worker can perform some type of work.

It’s important to understand: a lower impairment rating doesn’t mean you must return to work immediately. It only affects how long you can continue to receive benefits.

Contesting an IRE Decision in PA

Workers do not have to passively accept the results of an impairment rating. If you believe the exam was unfair or inaccurate, you have legal options to challenge it.

Filing a Petition

You can file a Petition for Review with the Bureau of Workers’ Compensation, requesting a hearing before a judge. Reasons to challenge the IRE might include:

• The physician did not follow AMA guidelines properly
• The exam was rushed or incomplete
• The medical evidence supports a higher level of impairment

You will need evidence, such as medical reports or expert testimony, to support your claim. Consulting with a workers’ compensation attorney is highly recommended when filing a challenge.

Legal Developments That Shaped IREs in Pennsylvania

The rules governing impairment rating evaluations have evolved due to recent legal decisions.

The Protz Decision

In Protz v. WCAB (Derry Area School District), the Pennsylvania Supreme Court ruled that earlier laws requiring adherence to unspecified future versions of AMA guidelines were unconstitutional. This temporarily halted the use of IREs.

Legislative Update

In 2018, Pennsylvania passed Act 111, reinstating the IRE process using a fixed edition (the Sixth Edition) of the AMA Guides. The law also reintroduced the 35% impairment threshold and clarified how benefit duration is handled moving forward.

Preparing for an Impairment Rating Evaluation

The outcome of your IRE can directly affect your financial security. Taking the following steps can help ensure the evaluation reflects your actual condition:

1. Document All Symptoms and Limitations

Keep a detailed record of pain, movement limitations, and how your condition affects daily activities. Share this with your doctor during the exam.

2. Bring Updated Medical Records

Provide the IRE physician with the most recent imaging, surgical reports, and treatment updates so they have complete context.

3. Do Not Minimize or Exaggerate

Exams are designed to measure function objectively. Be honest about what you can and cannot do.

4. Consult With a Workers’ Compensation Attorney

Legal guidance can help you prepare for the IRE, understand your rights, and act quickly if the outcome negatively impacts your benefits.

How an IRE Affects Long-Term Workers’ Comp Benefits

Many injured workers worry that an IRE will cause them to immediately lose benefits. That’s not the case. If your rating is under 35%, your status changes—but you may still receive partial disability benefits for up to 9.6 years (500 weeks).

Employers may use this new status as a stepping stone to further reduce or stop your benefits. For instance, they might claim you’re capable of earning wages elsewhere based on a labor market survey. These are complex scenarios where legal representation becomes critical.

Conclusion

Impairment rating evaluations are more than just medical exams—they can fundamentally shift the course of your workers’ compensation benefits in Pennsylvania. Whether you’re approaching the 104-week mark or have already received notice of an IRE appointment, preparation is key. A low impairment rating doesn’t mean your injury isn’t serious, but it may limit how long you’re eligible for benefits. Knowing your rights, understanding the process, and seeking expert help can ensure you’re not left vulnerable in the aftermath of a work injury.

Need Legal Help? Brandon J. Broderick, Attorney at Law is One Phone Call Away

Navigating Pennsylvania's Workers Compensation Claims can be challenging. Fortunately, you don't need to do it alone. The experienced lawyers at Brandon J. Broderick, Attorney at Law, are available 24/7 to help you understand your legal options, gather necessary evidence, and build a strong case to secure the settlement you deserve.

Contact us now for a free legal review.