by Karl Voigt
The insurance company wants to send me to Impairment Rating Evaluation (IRE). What is this? Well, first and foremost, it’s not another IME (independent medical examination). It’s another tool the insurer has to reduce the amount of workers’ compensation wage loss benefits you receive.
In order to determine whether you remain entitled to the temporary total disability (TTD) you’re getting, the insurer can send you to an IRE after you have received 104 weeks of TTD benefits. There are very specific rules and time constraints for when this exam can be requested. If, however, the IRE request is timely, an American Medical Association-certified doctor will examine you to gauge your percentage of whole body impairment resulting from the work-related injury. The degree of impairment is based on the most recent edition of the AMA guidelines, currently in its 6th edition.
You must first be considered at “maximum medical improvement” (MMI) In order for an IRE Determination to be imposed upon you. The examination will occur whether or not you believe you are at MMI. Therefore, if your IRE determination is appealed, one common challenge we make is that our client was not at MMI and therefore the IRE should be discarded. As an example, an the 500 week IRE limit should not be imposed on an injured worker who is scheduled to undergo further surgery for his work injury.
Nevertheless, if the doctor finds that your impairment to be equal to or greater than 50 percent, then you are presumed to be totally disabled and benefits continue. If you are determined to be less than 50 percent impaired, your TTD benefits will be limited to 500 more weeks. This “ticking clock” can only be stopped if it can be proven that you are more than 50% disabled. This is extraordinarily difficult. To put things into perspective, there are some injured workers who are limited to wheelchairs who have been gauged to be less than 50% disabled.
Naturally, during the 500 weeks after the IRE, you may attempt to reinstate your TTD benefits if you can show that your condition has worsened significantly.