To answer an often asked question, in Pennsylvania, there is no limit to how long an injured worker can receive total disability workers’ compensation benefits. However, as a practical matter, it is difficult to receive total disability benefits in PA for more than two years. After an injured worker in Pennsylvania has received total disability benefits for 104 weeks, the workers’ compensation insurance company can request the injured worker attend an Impairment Rating Evaluation (IRE).
An IRE is somewhat different than an Independent Medical Examination (IME), as the doctor who performs an IRE is selected by the Pennsylvania Bureau of Workers’ Compensation (the workers’ compensation insurance carrier selects the doctor in an IME). The doctor who performs the IRE will examine the injured worker and review records. Subsequently, the doctor will decide what percentage the injured worker is impaired from the work injury. This percentage is determined by guidelines developed by the American Medical Association.
If the injured worker is found to be less than 50% impaired by the work injury, the workers’ compensation insurance carrier may be able to have the status of the disability changed from “total” to “partial.” While this change does not effect the amount of workers’ compensation benefits the injured worker receives, it does put a time limit on how long the benefits can be received. An injured worker in PA can only receive partial disability benefits for a maximum of 500 weeks.
You will notice that I said the workers’ compensation insurance company “may” be able to change the status. If the workers’ compensation insurance carrier requests the IRE within 60 days of when the injured worker has received 104 weeks of total disability, the workers’ compensation insurance company need only file a Change of Status form and the status of benefits automatically changes from total to partial.
However, the situation is very different if the workers’ compensation insurance carrier requests the IRE after the 60 day period (after the 104 weeks of total disability). In that case, according to a recent decision by The Commonwealth Court of Pennsylvania, apparently, the workers’ compensation insurance carrier must actually prove some form of job availability to have the status changed to partial. This decision, in the case of Diehl v. W.C.A.B. (IA Construction), filed on April 28, 2008, makes the question of when the IRE request was made very important.