After 104 weeks of receiving workers’ compensation benefits in Pennsylvania, the insurance company can require you to attend an Impairment Rating Evaluation (IRE). If your impairment rating is below 35%, you benefits may be changed from total disability to partial disability. This limited how long you can receive wage loss benefits. It is important to note that it does not change you weekly benefit amount you receive in wage loss benefits.
What is the 104 week rule?
In Pennsylvania, injured workers can receive total disability benefits for the first 104 weeks after a work injury. After that point, the insurance company has the right to request an IRE. It does not mean they will, it means they can.
What is an impairment rating (IRE)?
An IRE is a medical exam performed by a doctor to determine the percentage of whole-body impairment. If you are familiar with impairment ratings in Maryland, it is critical you understand that an IRE in Pennsylvania is not the same. The IRE is not used for a permanency award, it is used to limit your wage loss benefits. Here is how the IRE works
• If impairment rating is 35% or higher –> You remain totally disabled
• If impairment rating is below 35% –> your benefits change from total to partial
How does that effect your benefits?
If you are changed from total to partial disability;
• You will still receive weekly wage loss benefits.
• The weekly amount will not change.
• But, they are capped at 500 weeks
Key Takeaways
• The 104 week mark could be a turning point in your case
• An IRE can reduce your benefit status, but the amount you receive
• Changing to partial triggers a 500 week cap
• You may be able to challenge the IRE
Frequently Asked Questions
Do I have to attend the IRE?
Yes, if requested by the insurance company to attend an IRE, you are generally required to attend.
Can I Fight the IRE Decision?
Yes. You can challenge the results of the IRE through the workers’ compensation litigation process.
Do my check amounts get reduced by the IRE?
No. Your actual wage loss check amount will not be reduced. Your benefit period does get reduced to 500 week limit.
Do you have questions about your workers’ compensation case? Call Mooney Law today for a FREE CONSULTATION at 717-200-HELP or 717-632-4656. You can also visit our website.
