An Impairment Rating Evaluation (IRE) is a medical exam that a Pennsylvania workers’ compensation insurer can request after you receive 104 weeks of total disability benefits. A doctor rates your whole-body impairment under the AMA Guides, Sixth Edition. If the rating is below 35 percent, your benefits change from total to partial disability, which caps wage loss benefits at 500 weeks.
Reviewed by Attorney Mark A. Buterbaugh, Managing Partner, Mooney Law, representing injured workers in Pennsylvania workers’ compensation cases since 2009. Last legally reviewed October 2026.
If you have been out of work on Pennsylvania workers’ compensation for close to two years, you may soon receive a letter scheduling an Impairment Rating Evaluation. For many injured workers, it is the first time they hear the term, and it often arrives with little explanation. An IRE does not cut off your benefits overnight, but it can put a clock on them. Understanding how the process works, and what you can do about it, is the best way to protect your income and your future.
How an IRE Works Under Pennsylvania Law
The IRE process is found in Section 306(a.3) of the Pennsylvania Workers’ Compensation Act, added by Act 111 of 2018. Act 111 took effect on October 24, 2018, after the Pennsylvania Supreme Court struck down the earlier IRE law in Protz v. WCAB (Derry Area School District) for improperly delegating lawmaking power to the American Medical Association. The current law fixes the standard to a specific version of the AMA Guides to the Evaluation of Permanent Impairment, the Sixth Edition (second printing, April 2009), and lowered the threshold for total disability from 50 percent to 35 percent.
Here is the basic sequence:
- You receive 104 weeks of temporary total disability benefits, which is roughly two years.
- The insurer requests an IRE, usually through the Bureau of Workers’ Compensation.
- A Bureau-approved physician examines you and assigns a whole-body impairment percentage under the Sixth Edition of the AMA Guides.
- If the rating is 35 percent or higher, you stay on total disability with no week limit. If it is below 35 percent, your status changes to partial disability.
What the 35 Percent Threshold Really Means
The impairment rating is not the same as your ability to work. A whole-body impairment rating measures the loss of function of your body as a whole under the AMA Guides formulas. Many workers who cannot return to their jobs still receive ratings well below 35 percent, because the Guides focus on measurable physical findings rather than job demands, pain, or work restrictions.
Switching to partial disability usually does not reduce your weekly check. What changes is that partial disability benefits are limited to 500 weeks, roughly nine and a half years. To understand how your weekly rate was set in the first place, see our guide on how much workers’ comp pays in Pennsylvania.
Timing Rules That Affect Your Benefits
When the insurer asks for the IRE, it matters. If the evaluation is requested within 60 days after you reach 104 weeks of total disability and produces a rating below 35 percent, the change to partial disability can take effect automatically as of the date of the evaluation. The insurer must still give you written notice, and it cannot reduce your benefits until 60 days after that notice.
If the insurer waits longer than that 60-day window, it cannot change your status automatically. Instead, it must file a petition with a workers’ compensation judge and prove its case, giving you the opportunity to challenge the evaluation at a hearing.
| Situation | What Usually Happens |
|---|---|
| IRE requested within 60 days after 104 weeks; rating below 35% | Status changes to partial disability as of the IRE date after required notice |
| IRE requested later than 60 days; rating below 35% | Insurer must file a modification petition and prove the change before a judge |
| Rating of 35% or higher | Total disability continues with no 500-week limit |
| During the 500 weeks, condition worsens to 35% or higher | Worker may petition to return to total disability |
| Worker does not attend the IRE without good reason | Insurer may seek to suspend benefits |
What Happens at the Exam
An IRE usually involves reviewing your medical records, asking questions about your symptoms and daily activities, and performing a physical examination focused on range of motion, strength, and other measurable findings. The doctor then applies the AMA Guides to calculate a percentage. The exam is similar to an independent medical examination, which we discuss in our article on whether you can say no to an IME, but its purpose and legal consequences differ. It is also different from a functional capacity evaluation, which tests your ability to perform work tasks.
To prepare, bring a complete list of your medications, treating doctors, surgeries, and current symptoms. Be honest and thorough about your limitations. Do not exaggerate, but do not minimize your pain or symptoms either, and do not try to push through movements that hurt. Afterward, write down how long the exam lasted and what the doctor actually did, since that information can matter if the rating is challenged.
How an IRE Rating Can Be Challenged
IRE ratings are not automatically correct. An evaluation may be challenged if the physician did not properly apply the Sixth Edition of the Guides, failed to rate all of the accepted work injuries, or performed the exam before you reached maximum medical improvement. Your own treating doctor or another qualified physician may also provide a different rating. During the 500 weeks of partial disability, if your condition worsens and a later evaluation shows impairment of 35 percent or more, you may be able to return to total disability status.
Because the accepted description of your injury affects what the doctor can rate, it is also important to review the original Notice of Compensation Payable and whether it needs to be expanded to include additional conditions.
Mark Buterbaugh on the IRE Process
“Before I represented injured workers, I spent years on the other side of the table working for employers and insurance carriers, so I know why insurers schedule these exams right at the 104-week mark. The rating that comes out of an IRE can follow a worker for the next decade. We look at whether the doctor rated every accepted injury, whether the Sixth Edition was applied correctly, and whether the worker had actually reached maximum medical improvement. A lot of IRE ratings do not hold up once someone checks the work.” Mark A. Buterbaugh, Mooney Law
Received a letter scheduling an IRE? The steps you take before and after the exam can affect your benefits for years. Mooney Law represents injured workers throughout Central Pennsylvania and Northern Maryland, and workers’ compensation consultations are always free. Call (877) 632-4656 to talk with our team.
Frequently Asked Questions
Can I refuse to attend an Impairment Rating Evaluation?
Generally, no. Once you have received 104 weeks of total disability benefits, the insurer may request an IRE, and refusing to attend without a valid reason can give the insurer grounds to ask a workers’ compensation judge to suspend your benefits. If you have a scheduling conflict or a concern about the exam, talk to your attorney before the appointment.
Does an IRE reduce my weekly workers’ comp check?
Not by itself. A rating below 35 percent changes your benefit status from total to partial disability, but your weekly amount usually stays the same. The key change is that partial disability benefits are limited to 500 weeks, which puts an end date on your wage loss benefits.
Does an IRE end my medical benefits?
No. An IRE affects only your wage loss benefits. Your right to have reasonable and necessary medical treatment for the work injury paid by the insurer continues, regardless of your impairment rating.
How often can the insurer request an IRE?
Pennsylvania law limits how often an insurer can require an IRE, generally to no more than twice in a 12-month period. Each new evaluation must still follow the AMA Guides, Sixth Edition, and you may be able to challenge each result.
Who chooses the doctor for an IRE?
The parties may agree on a physician. If they do not, the insurer can ask the Bureau of Workers’ Compensation to designate one. IRE physicians must be licensed and active in clinical practice and must be approved by the Bureau to perform these evaluations.
Can I challenge an IRE rating?
Yes. You can present medical evidence that the rating was wrong or that the evaluation was not performed correctly. During the 500 weeks of partial disability, you may also seek to return to total disability status by showing, through a later evaluation, that your impairment has reached 35 percent or more.
What happens after 500 weeks of partial disability?
Once the Social Security Administration has paid 500 weeks of partial disability benefits, wage loss benefits generally end, although medical benefits for the work injury continue. Because 500 weeks is roughly nine and a half years, many injured workers use that period to plan for retirement, Social Security Disability, or a settlement.
Common Concerns About the IRE Process
“If my rating is low, does that mean the doctor thinks I can work?” No. An impairment rating is a calculation under the AMA Guides, not a finding about your job capacity. Whether you can return to work is a separate question that may come up through other evidence or petitions.
“Should I just settle before the IRE?” Possibly, but not in a rush. An upcoming IRE can affect your case value, and settlement is a major decision. Our article on the types of workers’ compensation settlements explains the options to discuss with an attorney.
“I cannot afford a lawyer for this.” Pennsylvania workers’ compensation attorney fees are generally contingent and subject to approval by a workers’ compensation judge, so you do not pay upfront. Mooney Law offers free workers’ compensation consultations.
What Happens When You Call Mooney Law
When you contact us, a member of our team will ask about your work injury, how long you have been receiving total disability benefits, whether you have received an IRE notice or a Notice of Change of Workers’ Compensation Disability Status, and who is treating you. If you have the letter, keep it handy. We will explain what the evaluation means for your case, what deadlines may apply, and how we can help before and after the exam.
Protect Your Workers’ Compensation Benefits
An Impairment Rating Evaluation can quietly change the length of your benefits, but you have rights throughout the process. Learn more about our Pennsylvania workers’ compensation lawyers, call (877) 632-4656, or contact us online for a free consultation at one of our Central Pennsylvania or Northern Maryland offices.
