The Letter That Shows Up Around the Two-Year Mark
You have been out of work for close to two years. Your checks have been steady, your doctor visits are routine, and then a letter arrives saying the insurance company has scheduled you for an “Impairment Rating Evaluation.” Nobody explains what it is, only that you have to go.
That letter matters. An IRE can change how long your wage-loss benefits last. Below is a plain-English guide to the impairment rating evaluation PA process for injured workers in Bucks, Montgomery, and Delaware counties, including Bensalem, Norristown, and Philadelphia.
What Is an Impairment Rating Evaluation?
An IRE is a medical exam that gives a percentage rating of your “whole body impairment.” The doctor uses the American Medical Association’s Guides to the Evaluation of Permanent Impairment. Act 111 of 2018 sets out the current IRE rules in Pennsylvania. General information is also available from the Pennsylvania Bureau of Workers’ Compensation.
An IRE is different from an Independent Medical Exam. An IME asks whether you are still hurt or able to work. An IRE asks how impaired you are on paper, and that number decides whether your benefits stay “total” or become “partial.”
When Can the Insurance Company Ask for One?
Once you have received 104 weeks of total disability benefits, the insurer can ask you to attend an IRE. If it asks within 60 days after those 104 weeks, it can usually change your status by sending a notice. If it asks later, the change is not automatic and the insurer generally has to file a petition with a Workers’ Compensation Judge.
What Your Rating Means
| IRE Result | What Happens to Your Benefits |
|---|---|
| 35% or higher whole body impairment | You stay on total disability, with no 500-week cap |
| Less than 35% | Benefits change to partial disability |
| Changed to partial | Your weekly check usually stays the same, but it is capped at 500 weeks |
| Medical treatment | Continues for your accepted work injury |
The biggest misunderstanding is that a low rating cuts your check right away. Usually it does not. What changes is the clock: partial disability benefits are limited to 500 weeks, which is a little under 10 years. Weeks of partial benefits you already received may count toward that limit.
How to Prepare for Your Impairment Rating Evaluation
- Bring a list of every body part and condition tied to your injury, including anything added later, like depression or a second surgery.
- Be honest and specific about your pain and your limits. Do not downplay them.
- Bring your current medication list.
- Write down how long the exam lasted and what the doctor actually examined.
- Ask for a copy of the report through your attorney.
IRE doctors sometimes rate only the original injury described on the Notice of Compensation Payable and skip conditions that developed later. That mistake can drop your percentage, and it can be challenged.
Can You Challenge an Impairment Rating Evaluation?
Yes. You can present medical evidence that the rating was wrong or incomplete. If your condition gets worse later, you may be able to get a new IRE showing 35% or more and go back to total disability, as long as you are still within the 500 weeks.
When to Speak with a Pennsylvania Workers’ Comp Lawyer
An IRE notice is a sign the insurer is planning for the long term, and you should too. A lawyer can check whether the exam was requested on time, whether every condition was rated, and whether the result can be challenged. Learn more about the firm’s workers’ compensation services here, or see answers to more common questions on our FAQ page.
A Number on Paper Is Not the Whole Story
An IRE rating does not measure how hard your days are, but it can shape your future benefits. Knowing the rules before the exam puts you in a stronger position.
If you have received an IRE notice, The Law Office of Kaitlin Files LLC can help you understand your options and protect your benefits. Contact Files Injury Lawyers today by visiting filesinjurylawyers.com or call us at 215-987-6452.
FAQs
What is an Impairment Rating Evaluation in Pennsylvania?
A medical exam that rates your whole body impairment as a percentage using AMA Guides. The rating decides whether your benefits stay total or change to partial.
When can the insurer request an IRE?
After you have received 104 weeks of total disability benefits. A request made within 60 days after that point is handled more quickly.
Will my check go down after an IRE?
Usually not right away. If your rating is under 35%, your benefits become partial, which caps them at 500 weeks.
Do I lose medical coverage after an IRE?
No. Medical treatment for your accepted work injury continues.
Can I fight a low IRE rating?
Yes. Medical evidence can challenge an incomplete or wrong rating, and if your condition gets worse you may be able to get a new IRE later.
This article is general information about Pennsylvania workers’ compensation and is not legal advice. Every case is different. For advice about your situation, speak with a licensed Pennsylvania attorney.
