Can Workers’ Comp Benefits Be Terminated?
Often, getting workers’ Comp benefits is not as easy as it should be. So once you are approved for benefits, you might start to worry that they can suddenly be taken away. Can your workers’ comp benefits be terminated?
Although injured workers are entitled to workers’ comp benefits, there are various reasons that can lead to them being terminated. If you have been notified that this is going to happen, you should contact a workers’ comp lawyer immediately for legal advice.
The Procedure for Terminating Workers’ Comp Benefits
Injured workers who are currently receiving workers comp benefits are justified in fearing that those benefits can be taken away. Insurance companies do not like to pay these costly benefits since they are out to make money.
However, insurers cannot simply choose to end benefits whenever they feel like doing so. There are set procedures these companies must follow to legally terminate or reduce any benefits they are paying. These procedures depend on how long they have been paying.
Terminating Benefits During the First 180 Days
It is relatively easy for insurance companies to stop workers’ compensation benefits during the first 180 days of payment if they feel they have a valid reason to do so.
Insurance companies can choose to terminate benefits during this initial period without acquiring approval from the DIA (Department of Industrial Accidents). But they must notify you in writing of their intent to end your workers’ comp benefits at least 7 days in advance.
The good thing about being notified at least a week in advance of your benefits being taken away is that you will have ample time to contact a qualified attorney for help.
Your workers’ comp benefits can also be terminated by the insurer during this time if you go back to work earning the same amount as before or if a doctor clears you to go back to work.
Terminating Benefits After 180 Days
Thankfully for injured workers who have been receiving workers’ comp benefits for more than 180 days, it is much more difficult for insurance companies to take those benefits away or reduce them. At this point, the process for them to do this becomes more complicated since they cannot choose to do so on their own.
When insurance companies think they have reason to terminate or reduce your benefits after you have been getting them for more than 180 days, one of the following must take place:
- A judge at the Department of Industrial Accidents must order the termination or reduction.
- You, the employee, must agree to the termination or reduction of benefits in writing.
- You, the employee, have gone back to work at the same rate of pay as before the injury.
- The insurance company has obtained a medical report from your doctor stating that you are able to go back to work and certification that he has reviewed a written description of your job. The insurer must also have written notification from your employer stating that your job is open and ready.
- If you, the employee, have gone through the maximum period of benefits.
- If the insurer sends you a written request for your earning records and you do not provide them.
Keep in mind that if your benefits are terminated for any of the reasons outlined here or any other technicalities, you have the right to turn to a workers’ comp lawyer for legal representation.
The Agreement to Extend the 180 Day Payment Without Prejudice
Form 105 is a document that workers may sign to agree to Extend the 180 Day Payment Without Prejudice period. Insurance companies typically send injured workers this form pretending to be on their side and pretending that they are willing to keep paying benefits for another 180 days.
This is far from the truth. By signing Form 105, you will be giving up your legal rights, allowing the insurer to terminate your benefits with impunity. In this position, it could take you months or longer to recover the benefits you are entitled to.
If you get Form 105, do not sign it. Instead, you should turn to an experienced workers’ comp attorney for legal advice and assistance.
Reasons for Terminating Benefits
Insurance companies use various reasons to either terminate or reduce injured workers’ benefits. Although these reasons are often justified, this is not always the case. Sometimes, insurers will terminate benefits even if they have no proof whatsoever that there is reason to do so and will even neglect to do so in a legal way.
Some of these reasons include the findings of a private investigation, not following medical treatment, and refusing light or limited duty.
Findings of a Private Investigation
Perhaps the biggest suspicion that insurance workers often have about injured workers is that fraud is involved. This does happen and that is why these companies sometimes turn to private investigators who will look into whether your injuries are real or not.
Not Following Medical Treatment
Injured workers receiving workers’ comp benefits are expected to see their physician on a regular basis and to strictly adhere to their medical treatment plan. Missing a few appointments may not raise any eyebrows but if there are serious gaps in your treatment, the insurer can use this as a valid reason to end benefits.
Refusing Light or Limited Duty
If you cannot perform your normal duties at your workplace because of your injury, your doctor might indicate that you can perform light or limited duties. If your employer offers you such duties and you refuse them, it can lead to the termination of your workers’ comp benefits.
Get Legal Advice as Soon as Possible
No matter how long you have been getting workers’ comp benefits, if they have been terminated by an insurer, you need to get legal advice as soon as possible.
The reason behind your benefits being taken away may not be valid or perhaps legal procedures were not complied with. It is wise to consult a qualified workers’ comp lawyer to review all the evidence related to your claim to determine whether the insurance company has lawfully terminated or reduced your benefits or not.
Call us at the Law Office of Robert E Frawley at (617) 523-2929 today.