The legality of Independent Rating Exams (IRE’s) in workers’
compensation cases has been called into question by a September Appellate
After an injured worker has collected
workers’ compensation benefitsfor two years (104 weeks), the employer may request that he or she be examined
by a doctor to determine his impairment rating. If that rating is less
than 50%, then his benefits can be converted from total to partial disability.
The amount of the weekly benefit does not change, but partial workers’
compensation cannot be paid for more than 500 weeks. Total benefits, on
the other hand, can last a lifetime.
In rating an injury, the doctor must first conclude that the injured worker
has reached “maximum medical improvement”, that is, that more
medical treatment is unlikely to make a significant change in his condition.
Then the statute requires that in rating the worker, the doctor use “the
most recent edition of the American Medical Association (AMA) Guides to
the Evaluation of Permanent Impairment”.
At the time the impairment rating evaluation (IRE) process was added by
the Legislature to the Workers’ Compensation Law, in 1996, the AMA
4th edition guidelines were in effect. By the time Mary Ann Protz, an
employee of the Derry Area School District who had fallen at work and
injured her knee, was evaluated in 2011, the AMA had published its 6th
Edition. The doctor who examined her used this newer edition, as required
by law, and the result of his IRE changed her benefits from total to partial.
Each new edition of the Guides published by the AMA can change the impairment
rating for an injury. Ms. Protz argued that the Legislature’s requirement
that the most recent AMA Guide be used by the doctor in making his evaluation
was an abdication by the Legislature of its obligation under the Pennsylvania
Constitution to make the laws.
By a slim majority of four to three, the Commonwealth Court agreed with
her and remanded her case to a Workers’ Compensation Judge, with
instructions that her medical condition be re-evaluated using the 4th
Edition Guidelines which were in effect when the Legislature instituted
the impairment rating evaluation.
As a result of this development, until the Pennsylvania Supreme Court weighs
in on this issue, the legality of IRE’s being performed in workers’
compensation cases throughout the Commonwealth of Pennsylvania will remain