How Are Injury Levels and Benefit Amounts Determined Following Workplace Injury, Treatment and Recovery?
Workers’ compensation claims may seem simple at first glance. A worker is injured at work, he or she cannot work for a while and compensation is received until a return to work is possible. Simple, right?
Actually, workers’ compensation claims are often highly complex and may revolve around difficult questions such as:
• How is the accuracy and validity of Impairment Rating Evaluations (IREs) determined?
• What percentage of full-body impairment did the worker experience?
• Once time has passed, healing has occurred and treatment has been administered, when is Maximum Medical Improvement(MMI) reached?
And, perhaps most importantly, “Who answers these questions and subsequently determines the amount and duration of financial compensation?”
A recent Pennsylvania case shed light on how the accuracy and validity of IREs may be weighed in some disputes. IREs are crucial to workers’ compensation claims, because they are used by judges to measure the extent and effect of injuries and, subsequently, the level of ongoing benefits.
In 2004, Nicole Neff was injured at work and claimed serious and long-term impairment. Yet her IRE showed that, despite the fact that future surgery may improve her recovery, she had already achieved Maximum Medical Improvement. The IRE also showed that she had a full-body impairment of just one percent. The Workers’ Compensation judge accepted the IRE findings, and the Workers’ Compensation Appeal Board affirmed the decision. Neff responded by filing suit in civil court.
In Neff’s 2014 case, Neff v. WCAB, she and her attorneys claimed that she could not have achieved Maximum Medical Improvement since the IRE showed that future surgery could improve her condition. This claim seems logical and valid. Yet the court upheld the previous rulings, basing its decision on the fact that relevant guidelines instruct that an individual is at Maximum Medical Improvement when the condition is “static or stable” and when “one would not expect a change in condition at any time in the immediate future” and the clarity and credibility of the IRE doctor.
If you were injured at work, do not navigate the complexities of IREs and Maximum Medical Improvement without the help of an experienced workers’ compensation attorney. If you live in Montgomery or Bucks County, Pennsylvania, contact Louis P. Lombardi II & Associates, PC at (610)239-7600.