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.
What It Means to You
The IRE physician must make a determination of MMI in order to render an impairment rating. It appears that this can be done either in the report or in testimony. Practically speaking, the physician must be asked to specifically address the issue of MMI in his/her report, as it now appears to be a threshold issue. It may be possible to obtain an opinion confirming MMI from a previous IME. However, given the import of the decision, it appears best to have the IRE physician directly address the issue. Query, what if a previous IME opinion states that MMI is expected in a year, and six months later at an IRE, the IRE physician opines that MMI now has been achieved? It appears that Combine case alludes to the fact that only the IRE physician’s opinion on MMI is relevant, for purposes of the impairment rating evaluation. An attorney at Cipriani & Werner can assist you in your analysis of IRE and MMI issues in your case