34 Pa. Code § 123.105 - Impairment rating determination
(a)
When properly requested under §
123.102 (relating to IRE
requests), an IRE shall be conducted in all cases and an impairment rating
determination must result under the "Guides to the Evaluation of Permanent
Impairment," 6th edition (second printing April 2009).
(b) To ascertain an accurate percentage of
the employee's whole body impairment, when the evaluating physician determines
that the compensable injury incorporates more than one pathology, the
evaluating physician may refer the employee to one or more physicians
specializing in the specific pathologies which constitute the compens-able
injury. Any physician chosen by the evaluating physician to assist in
ascertaining the percentage of whole body impairment shall possess the
qualifications as specified in §
123.103(a) and
(b) (relating to physicians). The referring
physician remains responsible for determining the whole body impairment rating
of the employee.
(c) The physician
performing the IRE shall complete Form LIBC-767, "Impairment Rating
Determination Face Sheet" (Face Sheet), which sets forth the impairment rating
of the compensable injury. The physician shall attach to the Face Sheet the
"Report of Medical Evaluation" as specified in the American Medical Association
"Guides to the Evaluation of Permanent Impairment," 6th edition (second
printing April 2009). The Face Sheet and report shall be provided to the
employee, employee's counsel, if known, insurer and the Department within 30
days from the date of the impairment evaluation.
(d) If the evaluation is requested and
performed during the 60-day period subsequent to the expiration of the
employee's receipt of 104 weeks of total disability compensation benefits and
results in an impairment rating of less than 35%, the employee shall receive
benefits partial in character. To adjust the status of the employee's benefits
from total to partial, the insurer shall provide notice to the employee, the
employee's counsel, if known, and the Department, on Form LIBC-764, "Notice of
Change in Workers- Compensation Disability Status," of the following:
(1) The evaluation has resulted in an
impairment rating of less than 35%.
(2) Sixty days from the date of the notice
the employee's benefit status shall be adjusted from total to
partial.
(3) The adjustment of
benefit status does not change the amount of the weekly workers- compensation
benefit.
(4) An employee may only
receive partial disability benefits for a maximum of 500 weeks.
(5) The employee may appeal the adjustment of
benefit status to a workers- compensation judge by filing a Petition for Review
with the Department.
(d.1) If the evaluation is requested and
occurs beyond the 60-day period subsequent to the expiration of the employee's
receipt of 104 weeks of total disability compensation benefits, and results in
an impairment rating of less than 35%, the adjustment of the disability status
can only be achieved through adjudication or agreement of the parties. This
adjustment cannot be achieved by completing Form LIBC-764, "Notice of Change in
Workers- Compensation Disability Status."
(e) If the evaluation results in an
impairment rating that is equal to or greater than 35%, the employee shall be
presumed to be totally disabled and shall continue to receive total disability
compensation. The presumption of total disability may be rebutted at any time
by a demonstration of earning power in accordance with section 306(b)(2) of the
act (77 P.S. §
512(2)) or by a subsequent
IRE which results in an impairment rating of less than 35%.
(f) At any time during the receipt of 500
weeks of partial disability compensation, the employee may appeal the
adjustment of benefit status to a workers- compensation judge by filing a
Petition for Review, provided there is a determination that the employee meets
the threshold impairment rating that is equal to or greater than 35% impairment
under the American Medical Association "Guides to the Evaluation of Permanent
Impairment," 6th edition (second printing April 2009).
Notes
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