The Commonwealth Court has issued a decision with wide ranging consequences to those cases in which an IRE has already been completed or is contemplated.

In Combine, the Court ruled that if a physician who is conducting the IRE does not believe that the claimant is at maximum medical improvement (“MMI”), then no impairment rating can be calculated and the claimant will continue to receive total disability benefits, with no limit on the duration of those benefits.

The Court examined the Workers’ Compensation Act and the American Medical Association “Guides to Permanent Impairment.” It noted that the AMA Guides states that a permanent impairment may be rated only after the MMI status has been determined. In Combine, the Court held that the IRE physician was first required to determine whether the claimant was at MMI, prior to determining the claimant’s impairment rating. Since that was not done, the Court ruled that the claimant’s disability status is that of total disability.

It is interesting to note that the IRE physician apparently made no MMI determination in his report. Rather, he was asked point blank if the claimant had reached MMI. The doctor evaded the question and adding that the question required a “different kind of evaluation.” The Court was clearly bothered by the IRE physician’s response to the direct question.