An impairment rating evaluation (IRE) uses a medical records review and physical examination to assign a rating between 0-100% regarding a worker's ability to return to work after an injury. This helps determine benefit eligibility and duration. Independent medical examiners refer to standards like the AMA Guide to evaluate permanent impairment. IREs typically occur after 104 weeks of benefits to assess maximum medical improvement and decide if the worker can return to their prior job or requires alternative duties due to partial or total disability.

1. How Impairment Rating
Evaluation Can Help in
Workers’ Comp Claims
An IREuses medical records
review and helps solve disputes
in a workers’ comp claim related
to a worker’s ability to return to
work, and extended benefits.
MOS Medical Record Reviews
8596 E. 101st Street, Suite H
Tulsa, OK 74133

2. www.mosmedicalrecordreview.com (800) 670 2809
Medical review services are useful to independent medical examiners evaluating the injury
sustained by an injured worker at his/her workplace. In fact, it is especially important to
understand the extent of the injury because it is on the basis of this that benefits are
determined. Two important considerations in this regard when it comes to social security
disability benefits, workers’ compensation claims, and other possible benefits are whether the
worker is unable to return to work because of the health condition and whether they can return
to some type of different, lighter work. The employer and employee may differ in this regard
with the employee claiming she cannot return to her job and the employer claiming she can
and therefore doesn’t qualify for extended disability benefits.
The Post-injury Scenario and Impairment Rating Evaluation
What happens after a worker sustains an injury at the workplace? An IME or independent
medical examination may be ordered to understand how seriously the worker is affected by an
injury. A functional capacity evaluation or FCE may also be ordered to decide what jobs the
employee can do after his/her injury. The independent medical examiner should provide an
unbiased view of the injury so that disputes can be settled about what happened. This helps to
move a legal or insurance claim forward.
Employers and insurers are very concerned about workers’ comp insurance fraud and
exaggeration of injuries through which employees may claim benefits not due to them. Such
practices increase costs for employers and others.
Medical impairment rating or impairment rating evaluation (IRE) is used to address this
situation. In this an independent medical professional would give a rating between 0 and 100
to the level of impairment. This will help the worker, employer and insurer to clearly
understand the extent of injury and how much the impairment will affect work. This will also
help determine how long a person may receive benefits, how much the benefits will be and
whether he is expected to return to work.
• A worker whose medical impairment rating shows she can return to work at a lower
paying and less stressful job is considered partially disabled. The rating will be used to
apply for benefits to compensate the income loss.
• A worker whose impairment rating shows she is unable to return to work is considered
totally disabled. The rating can be used to help her secure benefits to pay for
day-to-day expenses.

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Typically, an IRE is conducted after a person has received 104 weeks of benefits. An IRE will be
performed only if the impairment is considered permanent and the patient has reached
maximum medical improvement. The IRE helps to determine the extent of the disability.
• It helps decide whether the worker can return to his job and earn the same income or
whether she should be assigned to a less demanding job because of her disability and
receive lesser earnings.
• A rating of less than 50% will result in the worker being limited to benefits for no more
than 500 weeks.
• A rating of more than 50% will entitle the employee to continue receiving benefits for
as long as required.
Impairment rating guides vary among different states, and the system of compensation also
differs. However, the rating is the basis of every state’s disability workers’ compensation
system. In most states, the physician will refer to the AMA’s Guide to the Evaluation of
Permanent Impairment to assign a rating.
Permanent vs. Temporary Impairment and Partial vs. Total Disability
The issue of impairment is important in a workers’ compensation claim. It is a problem that
affects the functioning of a part of the body and makes someone unable to use that part in the
same way as they did before the injury. These impairments could be mental as well and be
permanent or temporary, severe or mild. The type of impairment can have a significant impact
on the claim.
• Permanent or temporary impairment
• Partial or total disability
Permanent impairments and total disability situations could ensure more compensation for a
longer period of time. Impairment and disability are not the same with regard to benefits.
• Impairment is the problem that affects the neurology or physical condition of the
person
• Disability signifies the limits and restrictions on a person’s ability to complete tasks.
The Impairment Rating Evaluation Process
➢ The employee receives a letter requesting him/her to attend an IRE.
➢ The employee makes an appointment for the IRE.
➢ He/she will arrive for the IRE and be examined by a doctor. Examination would include
physical examination, review of medical records, and medical tests if required.

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➢ The doctor will use the latest version of standardized guides to assign an impairment
rating to the employee.
➢ The doctor makes a report of the medical findings and sends the official rating to the
insurer. The employee also receives information regarding the IRE results and how it
might affect benefits.
➢ The employee is allowed a specific period of time to appeal/challenge the IRE rating if
he/she feels the rating is not correct.
The medical examiner performing the IRE must be especially cautious to assign the correct
rating. Ideally, to assign a fair rating the following must be ensured.
➢ Review the patient’s medical history and medical records preferably with the support of
professional medical review services. Using multiple sources of information will ensure
objectivity and help avoid bias.
➢ It is important to ensure that the patient’s medical condition is stable and unlikely to
change in the future even with appropriate treatment.
➢ The clinical information must be extracted from physical examination and medical
records. To ensure consistency of this data, it can be compared with information from
various sources. Any disparity identified must be resolved when possible.
➢ Whenever data is available, make use of medically accepted and scientifically procured
data based on the patient’s normal functioning.
Given the importance of IRE rating, the physician should assign a rating derived from thorough
and well-thought out observations. For a fair and just impairment rating, the patient’s medical
documentation must be complete and reliable, and this also makes the process of medical
records review very significant. The AMA Guides recommend that if the medical evidence is not
sufficient to verify that an impairment of a certain intensity exists, then the physician should
modify the impairment rating accordingly. In this case, the physician should describe the
modification and explain the reason.