Many injured workers in Pennsylvania do not fully recover from a work injury. Depends on the severity of the injury, surgeries that may have happened, and ongoing symptoms from the work injury. So what happens if my doctor gives me permanent work restrictions?
First, if your claim has been accepted, your employer must provide light duty within those permanent restrictions. If they do not have permanent light duty for you, then the employer and insurance carrier are responsible for ongoing wage loss benefits. However, that does not mean your workers’ compensation case is over or they will just voluntarily keep paying wage loss benefits and leave you alone. That is unlikely to happen. Here are some measures the insurance carrier can take in your case.
- Schedule an Independent Medical Examination (IME)
- Schedule an Impairment Rating Evaluation
- Schedule a vocational evaluation to eliminate or reduce wage loss benefits
- Attempt to settle of your case
We will briefly look at all four below.
Independent Medical Evaluation
The workers’ compensation insurance carrier is entitled to send you for an IME twice per year. You must attend. When permanent work restrictions are issued by your doctor, the insurance carrier may schedule an IME because they disagree with the restrictions and the permanency of the restrictions. The IME report may very well disagree on the limits of the restrictions, permanency of the restrictions, or may even disagree to the point that they find you to be fully recovered. At that point, the insurance carrier may file a suspension or termination petition against you, which threatens your benefits. The result is workers’ compensation litigation.
Impairment Rating Evaluation
Permanent restrictions for workers’ comp often times may lead to a request for an Impairment Rating Evaluation (IRE). IREs are different than IMEs and are very different from an IRE in a Maryland workers compensation case. IREs in Pennsylvania are NOT used to determine extent of disability for settlement purposes, like in Maryland, rather they are a tool for the insurance carrier to limit your wage loss benefits.
Generally, you will be assigned by the Bureau to be examined by a doctor to provide an opinion on your impairment percentage in accordance to the 6th edition of the AMA Guides to Evaluation of Permanent Impairment. It is important to note that the insurance carrier cannot file for an IRE until they have paid at least 104 weeks of temporary total full wage loss benefits. Based on this evaluation, the IRE doctor will determine the percentage of your entire body function that is impaired by the work injury.
Essentially, if the IRE doctor finds your impairment percentage to be below 35%, then your status changes to partial disability, rather than total disability. Your actual wage rate will not be impacted. Instead, it limits your entitlement to wage loss benefits to a maximum of 500 additional weeks of wage loss benefits. Upon payment of the 500th week of benefits, your checks are stopped, even with permanent restrictions.
The issuance of permanent restrictions may also lead the insurance carrier to engage a labor market survey process. What will follow is the scheduling of a vocational evaluation. Again, this is another tool for the insurance carrier to try and reduce or suspend your wage loss benefits. The only time a vocation evaluation and subsequent labor market survey are appropriate measures is if the employer is unable to accommodate your permanent work restrictions.
What happens is the insurance carrier will schedule you for a vocational interview with a vocational expert they choose. That interview will include information about your age, education, work history, medical treatment, physical limitations, and previous job specific duties. Based on that interview, the vocational expert will then search and identify jobs that are available within your permanent work restrictions or the restrictions of the IME doctor. Upon receipt of the report, you will then have to contact each job.
The insurance carrier will then subsequently file a suspension or modification petition to reduce your benefits or eliminate the benefits, based on the wages of those jobs. If you would make less, then your wage loss benefits may be reduced. If you would make the same or more, then your benefits will end.
Workers’ Comp Settlement
If you receive permanent work restrictions, the insurance carrier may wish to engage settlement discussions. You can be assured that any offers they make will not be fair and reasonable value for you. What is your case worth? Should I settle? Is it time to settle? My strongest advice again is to retain experience workers’ compensation representation. Why? It’s simple. You get one shot. If you settle your case, it is settled forever and can never be reopened.
So what does this all mean to you, the injured worker? If you receive permanent work restrictions, my strongest advice is to retain an experienced workers’ compensation attorney. The insurance carrier is not just going to accept permanent restrictions, continue paying you wage loss benefits, and simply leave you alone. Your rights and entitlement to workers’ compensation benefits are too important to do nothing. Protect yourself. Call Mooney Law for an absolutely FREE consultation. We are experienced, proven, and trusted in workers’ compensation. We have fought for and won tens of millions of dollars for injured workers in Pennsylvania and Maryland. What does it cost you to talk with me? Nothing. Consultations are always free. Call today at 717-200-HELP or 717-632-4656. You can also email us at firstname.lastname@example.org. You can also schedule a consultation at our website at Mooney4Law.com.