Court Opinion

ID: 9746427
Source: CourtListenerOpinion
Date Created: 2023-08-27 14:15:07.611605+00
Date Added: 2024-06-11T07:25:13.026807
License: Public Domain

DISSENTING OPINION BY
Judge COHN.
Respectfully, I dissent. I do not believe, as the majority concludes, that an insurer is precluded from ever requesting an impairment rating evaluation (IRE) if one is not requested within the 60-day time period set forth in Section 306(a.2)(l) of the Act. Rather, I believe that the various sections of the Act at issue in this case contemplate two separate instances when an insurer may request a medical examination of the claimant to determine the status of impairment.
The first instance is after a claimant receives 104 weeks of disability, provided, however, the request is made within 60 days “upon the expiration of the one hundred four weeks.” If an insurer requests an IRE outside the 60-day time limit, it would be precluded from changing total benefits to partial under Section 306(a.2)(l). However, I disagree with the majority that, if an insurer fails to make the request at this time, it is precluded from ever obtaining an IRE, a necessary step to reducing benefits from total to partial.
There is also a second instance where an IRE may be requested. Under Section 306(a.2)(6), an employer may request an independent medical examination at any time after the injury pursuant to Section 314 “to determine the status of impairment.” Section 314 allows an employer to request a physical examination at any time after an injury, provided a claimant is not required to undergo more than two examinations in a 12-month period; there is no indication that this broad provision is to be conditional upon an earlier request. To give effect to the broad language of Section 306(a.2)(6) of the Act, an employer must be allowed to request the medical examination at any time, and the purpose of the examination can be, inter alia, to reassess the impairment rating, irrespective of how long it has been since the 104 weeks, referred to in subsection (a.2)(l), have passed.
Under the majority view, an insurer may determine that an evaluation of impairment at 104 weeks is not necessary because it is clear that a claimant’s impairment is greater than 50%. However, a claimant may steadily improve after that time period, and an insurer may, at that point, determine that an evaluation is necessary to determine a claimant’s status. Under the majority’s holding, the insurer would not be able to do so because it did not request that the claimant submit to an unnecessary medical examination within 60 days of the receipt of 104 weeks of disabili*888ty. The legislative intent of the Act would be frustrated. The purpose behind' this statute, enacted as an amendment to the Act in 1996, was to reduce the rising costs of workers’ compensation and restore efficiency to the workers’ compensation system. Torrey and Greenberg, Workers’ Compensation Law and Practice, Section 15:10 at 294. To compel an insurer to request, pay for, and have a claimant undergo an unnecessary medical examination at the. expiration of the 104-week period would undermine the purpose of the legislation. It is important to keep in mind the fluid, ongoing nature of workers’ compensation proceedings. The majority’s interpretation of the Act, requiring that an employer request an examination within 60 days of the receipt of 104 weeks of disability or be forever barred, creates a hyper-technical requirement not intended by the legislature. Consequently, I would affirm the Board.