Finally, the Pa Supreme Court has ruled on the Impairment Rating Exam (IRE). The court unanimously voted to remove the section of the PA WC Act allowing for IREs. They deem the section to be unconstitutional.
You’ll recall this section was created within the reforms of 1996. It allowed us to have a claimant’s disability rate at the 104 week mark of his disability. If the claimant was under 51% disabled his indemnity benefits would be capped after another 500 Total Indemnity weeks of benefits were paid.
I will not go into what we will do with the past, present and pending claims involving IRE’s in this email. However, I do want to point out that our reserving philosophy has to change as there is no longer a cap on the time frame indemnity benefits are paid. We will need to be much more aggressive with any claim that threatens to look like a long term disability exposure. We will have to work hard to prove lack of a disability and an ability to work in order to diminish the exposures. We will be required to re-institute vocational work up, surveillance, ongoing IMEs to curtail the alleged medical disability and get the employer’s cooperation in light duty RTW opportunities. We will have to use new tactics, such as social media searches, face to face meeting with claimant to observe activity and work on convincing the claimant and his/her attorney, that the best result is getting these folks back to work. We will also need to recognize that litigation will likely rise and we will be burdened to proves lack of cooperation with the RTW process, which is quite a hurdle to over come in the courts eyes.
Our reserving practices will also be altered and we expect to see higher exposures as a result.
We’ll see how things develop and how the industry reacts. Who remembers how we handled claims pre-1996? As that is where we are!