Two years into a claim, a letter arrives scheduling you for an exam with a doctor you have never met, and nobody explains what it is for. Zavodnick & Lasky Personal Injury Lawyers represent injured workers in Philadelphia at that point in a claim.
An IRE notice is not a denial, and the doctor who performs it is not deciding whether you can go back to work. It is the step an insurer takes to move your claim from one category into another, and the new category has an expiration date on it.
The time to call is before the appointment, not after the rating comes back: (215) 875-7030.
What is an impairment rating evaluation?
An IRE is one exam by a physician the Bureau of Workers’ Compensation designates from its approved list, not your treating doctor and not a doctor the insurer picks. The physician answers a single question: what percentage of whole-body impairment your accepted injury has left behind. Whether you can lift, drive, stand, or do your old job is not part of it.
That percentage comes out of the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Sixth Edition (second printing, April 2009), the standard Act 111 wrote into Pennsylvania law in 2018. The Bureau assigns a physician near your home from its roster of approved IRE physicians.
Why did the insurer request an IRE after 104 weeks?
Because 104 weeks of total disability is the point at which the law lets them ask. The request has nothing to do with your recovery or your doctor’s notes. It is a calendar event, and insurers calendar it.
Weeks paid before Act 111 took effect in October 2018 count toward that total on older claims. If the insurer files inside the window that makes the change of status automatic, it arrives as a notice in the mail. File late and the insurer has to bring a modification petition and prove the rating to a workers’ compensation judge, which is a different fight with a different burden.
So the first thing worth checking on any IRE notice is whether those 104 weeks were actually paid and counted correctly. Call (215) 875-7030 if a notice of assignment is already in your hands.
What the 35 percent threshold changes, and what it leaves alone
A rating below 35 percent whole-body impairment moves you from total disability to partial disability. Your weekly check does not drop the day that happens, which is exactly why the change gets waved off. What changes is how long the checks can last.
| Total disability | Partial disability after a rating under 35% | |
| Weekly wage-loss check | About two-thirds of your average weekly wage | Same amount, no immediate cut |
| Medical treatment for the injury | Open-ended | Still open-ended |
| Limit on how long wage loss is paid | None | 500 weeks, roughly nine and a half years |
| What drives the next move | Surveillance, IME, job offers | The 500-week clock runs on its own |
Pennsylvania’s guide for injured workers lays out both halves: the 104-week exam and the 500-week ceiling on partial disability. A 41-year-old permanently restricted from the trade he spent twenty years in can run out of wage-loss benefits while the disability is still there.
What happens if the rating comes back under 35 percent?
You can challenge it, and not only by arguing about arithmetic. The rating rests on which body parts the physician was told to evaluate, which records he read, and whether your condition had stabilized on the day of the exam.
Three problems show up often enough to look for every time. The physician rated only the body part named on the original notice of compensation payable, leaving out conditions accepted later. The exam happened while you were still in active treatment, before maximum medical improvement, which makes the number premature. Or the physician’s specialty had little to do with your injury.
Any of those is worth raising in front of a judge who hears the evidence fresh. The 500 weeks are not the end of the line either: a later rating at or above the threshold, or a worsening that leaves you unable to work at all, can support a petition to reinstate total disability.
Going to the exam unrepresented is where claims get expensive
Injured workers tend to do two things at an IRE that cost them: they play down how bad an ordinary day is, and they talk about the body part that hurts most instead of all of them. Both are natural in a doctor’s office, and both pull a whole-body number down.
Here is what happens when an IRE notice comes into this office. We pull the notice of compensation payable and compare the described injury against everything currently in treatment, because what is missing from that description tends to go unrated.
We ask your treating physician for a narrative covering each accepted condition and get it to the designated physician before the appointment. We check the 104-week math against the payment ledger, including any credit claimed for pre-2018 weeks. And we walk you through what the exam consists of, so none of it is a surprise.
Questions Philadelphia workers ask about IREs
Do I have to go to the IRE appointment?
Skipping a properly scheduled IRE puts your benefits at risk, so yes, go. Go prepared, with your records already in the designated physician’s hands. Call a lawyer first, because what happens before the exam matters more than anything that can be fixed after it.
Can my own doctor do the impairment rating instead?
No. The rating has to come from a physician the Bureau designates off its approved list, which is the part of this neither side controls. Your treating doctor’s job is to document every accepted condition well enough that the designated physician has to account for all of it.
Does an IRE affect my medical treatment?
No. An impairment rating reaches your wage-loss status, and your medical benefits for the accepted injury stay open. Insurers challenge treatment through a separate proceeding called utilization review, which is a different filing with a different outcome.
How long do I have to fight an IRE rating?
The deadlines are short and they run from the notice, not from the day you understand what the notice means. Bring the paperwork in the week it arrives.
Can the insurer send me for a second IRE later?
It can ask, and the answer depends on where your claim stands and when the last rating happened. A second request is worth reviewing rather than simply attending, since what the first rating covered shapes what the second one can do.
Bring the notice in before the exam date
An IRE is one of two tools an insurer uses to shrink an accepted claim without denying it. The other is the utilization review, which goes after your treatment instead of your wage-loss status.
Zavodnick & Lasky Personal Injury Lawyers represent injured workers across Philadelphia and the surrounding counties on a contingency basis, so the fee comes out of what is recovered and a judge approves it. If you have an IRE notice, a change of status notice, or a denied claim, call (215) 875-7030. Our Philadelphia workers’ compensation page and workers’ comp FAQ cover how Pennsylvania claims work generally.
