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Pennsylvania Supreme Court Strikes Down Use of AMA Guidelines

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In a recent decision the Pennsylvania Supreme Court found that the use of American Medical Association guidelines to determine whether an injured employee is partially or totally disabled violates the Pennsylvania Constitution. The decision ends a practice that had been in place since the Workers’ Compensation Act became law over 20 years ago.

Since becoming law in 1996, the Workers’ Compensation Act allowed employers to require an injured employee receiving workers’ compensation benefits to have an “Impairment-Rating Evaluation” (IRE) by a doctor. Doctors doing IREs were required to use AMA guidelines to determine the amount the employee is impaired. Impairment ratings were from 0% to 100%, with 0% being entirely unaffected by the injury and 100% being affected to the point of being unable to work.  If the employee was found to have an impairment rating of less than 50%, their employer could request to have the employee’s disability status changed from total to partial, reducing the duration of workers’ compensation benefits to no more than 500 weeks.

The Pennsylvania Supreme Court determined that this section of the Workers’ Compensation Act went against “non-delegation” rules, which prevent the General Assembly from giving the power to carry out a law to anyone else. The Pennsylvania Supreme Court was concerned that there was no oversight of what the AMA could put in the guidelines, giving the AMA unlimited control over state-administered workers’ compensation benefits.

The impact of the Pennsylvania Supreme Court’s decision is currently unknown. There are still other ways for the insurance companies that pay workers’ compensation benefits to limit those benefits. Insurance companies can show that an injured worker can perform some of their job duties or they can offer an injured worker a settlement.

Settlement offers can be appealing for a worker that has suffered an injury and is dealing with expensive medical bills and the possibility of being unable to provide for their family. Insurance companies will often try to take advantage of stressful circumstances to convince an injured worker to accept a settlement offer that is lower than what they may be entitled to, which is why you should always have a skilled workers’ compensation lawyer on your side if you’ve been injured at work.