You just suffered an injury at work. After filing for workers’ compensation benefits, you’ve been getting regular payments that are helping to cover your medical bills and lost wages. Then one day, the checks suddenly stop coming. What happened? Can workers comp really stop paying without any warning?
The short answer is no—there is a process that must be followed before your benefits can be terminated. But it’s understandable to feel anxious if those vitally important payments pause unexpectedly. In this comprehensive guide, we’ll walk through everything you need to know about workers comp suspending or ending your benefits, and what you can do about it.
What Exactly Are Workers’ Comp Benefits?
Before we dive into cancellations, let’s step back for a quick overview of what workers’ compensation provides in the first place.
Workers’ comp is insurance that nearly all employers are required to carry to provide medical, disability, and other benefits to employees who get hurt or sick due to their jobs. It functions as a safety net when you suffer an injury like getting burned, cut, or crushed by equipment or machinery in a factory or plant; getting injured in a construction accident; respiratory issues from exposure to chemicals or dangerous materials; and so forth.
If the injury prevents you from working for a period of time, workers’ comp kicks in to cover:
- Medical costs like doctor visits, surgery, hospitalization, prescriptions, physical therapy, assistive devices like wheelchairs or crutches, and more
- Lost wages to replace a portion of your income while you are recovering and unable to work
- Potential permanent disability benefits if your injury causes long-term impairment
- Vocational rehab expenses if needed to help transition you into a new career field if you can’t return to your previous job
- Death benefits for surviving dependents if you died due to a workplace accident
This financial support can be an absolute lifeline if you suffered a serious injury that puts you off the job for weeks or months. Which is why it can feel so worrisome and destabilizing if those payments suddenly cease without explanation.
Reasons Your Workers’ Comp Could Stop
In most cases, there is some kind of reason prompting the suspension or termination of your workers’ comp benefits. Here are some of the potential causes:
You Return to Work
Once you recover and are able to resume working, your temporary total disability payments (to replace lost wages) will end. Your employer’s workers’ comp insurance company will receive documentation from your doctor indicating you’ve been cleared to go back to your normal duties.
Doctor Says You’re Fit for Work
Similarly, if the doctor provides updated medical reports stating that you have fully recovered from your injury, the insurer can move to stop benefits on the basis that you’re no longer disabled. Be sure to get written confirmation of your working status from your physician.
A Workers’ Comp Judge Decides
Disputes over workers’ comp claims often go before an administrative law judge if the injured employee and insurer can’t agree on benefit amounts and duration. The judge hears evidence and testimony from both sides before rendering a decision on whether benefits should continue.
You Agree to Stop Benefits
In some cases, the insurer might offer you a lump-sum settlement to close out your workers’ comp claim. If you accept the settlement amount, you voluntarily agree to cease receiving ongoing payments. Make sure to consult an attorney so you fully understand the implications before signing off.
You Don’t Comply with the Rules
There are certain rules you must abide by to continue receiving your entitled benefits. For example, refusing to submit to a medical examination or declining recommended treatment could prompt termination of benefits. The insurer may argue that you are preventing assessment of whether ongoing disability compensation is justified.
You Are Incarcerated
If you are convicted of a crime and sentenced to time in jail or prison, your workers’ comp payments will likely be suspended for the period you are incarcerated. This stems from the inability to verify disabilities while incarcerated.
You Don’t Return Key Forms
In most states, you have to submit regular forms verifying that you have not returned to work while collecting disability payments. Failure to return these forms can get your benefits cut off.
Suspicion of Fraud
Strong evidence that you are working another job and collecting income while receiving workers’ comp disability benefits could indicate fraud. Insurers will investigate and terminate benefits if fraud is substantiated.
That covers the range of potential reasons—some justified, some questionable—that your payments could abruptly cease. But regardless of the cause, there remains one pivotal requirement before the plug can be pulled.
Written Notice Must Be Provided Before Benefits Are Terminated
Here’s the most crucial point to remember: Your employer’s workers’ comp insurance carrier cannot randomly decide to stop sending payments without telling you.
By law, you must be provided with written notification that your benefits are being suspended or terminated. The notice comes in the form of a letter and should clearly explain:
- The exact reason your benefits are ending
- The date when your last payment will be issued
- The process for contesting the termination if you disagree
This advance warning gives you a chance to challenge the decision or otherwise prepare for the sudden loss of income.
How Much Notice Do You Get?
Most states require at least 30 days advance notice before cancelling benefits. Some states mandate more time, such as:
- 60 days notice in Wisconsin
- 45 days notice in Indiana
- 14 days notice in Texas
So generally, you will receive a letter or Notice of Suspension from the insurer within 1-2 months before your final payment.
Can You Keep Getting Paid During the Appeal Process?
In many cases, you can continue receiving benefits while you dispute the termination. But this varies by state. Some stop payments during the appeal while others allow them to continue until a final ruling.
Check with an experienced workers’ comp lawyer in your state to fully understand your rights during the appeals process. They can help ensure you continue getting your entitled benefits while fighting an unjust cancellation.
How to Contest a Termination of Benefits
Let’s say you get slapped with a Notice of Suspension out of the blue. Or perhaps you disagree with the reason stated for stopping your benefits. Don’t panic—you have options to fight back.
Here are some steps to take if you receive word that your workers’ comp payments are ending:
1. Consult an attorney immediately.
Have a lawyer review your notice letter to advise if the stated reason for termination seems justified or not. They can explain your rights and options to challenge the decision. Never try to handle a wrongful suspension on your own without legal guidance.
2. File a notice of petition.
In most states, you can petition to contest the termination of benefits. This starts the official appeals process. Deadlines are strict, so work with counsel to quickly submit your petition and any supporting documentation.
3. Request a hearing.
As part of the appeals process, you can request a hearing before a workers’ compensation judge or mediator. This gives you a chance to present evidence and make your case for why benefits should continue.
4. Undergo an independent medical exam.
If the termination stems from being deemed medically fit to work, get examined by an independent doctor to provide a second opinion on your condition. Their assessment can counter that of the insurer’s doctor.
5. Gather medical evidence.
Get your treating physician to write a detailed letter explaining your ongoing injuries, treatment needs, and inability to work. Medical proof is hard to refute.
6. Submit verification forms.
If your benefits were cut off for failure to return wage verification forms, promptly send in the completed forms to rectify the issue.
7. Testify at your hearing.
Use the hearing to tell your story and describe how you remain disabled and in need of benefits. Bring any corroborating witnesses or evidence.
With the help of a knowledgeable lawyer, you can take the right steps to get your benefits reinstated and avoid financial catastrophe. Don’t let wrongful termination go unchallenged.
Why Hiring an Attorney Is Crucial
By this point, you’ve probably noticed a recurring theme: consult a qualified workers’ compensation attorney. This bears emphasizing. Having legal counsel to protect your rights and interests is critical when dealing with something as disabling as a lost income stream after an already devastating injury.
Here are some key reasons why working with a lawyer is so important:
- They understand all procedural rules and deadlines for disputing a termination of benefits. Missing a deadline could tank your case.
- They have experience representing clients in hearings before workers’ comp judges and mediators. Most applicants are denied if they try to advocate for themselves without an attorney.
- They can request and compel specific documents, reports, and evidence from the insurer relevant to your case. You likely can’t obtain those on your own.
- They can interpret complex laws, regulations, and insurance company policies that confuse laypersons. Navigating the appeals system alone is extremely hard.
- They can estimate the full value of your claim based on your medical condition, prognosis, expenses, and lost income. This allows you to fight for your maximum entitled benefits.
While not strictly required, any wise applicant faced with a suspension of their vital income stream would be foolish not to seek legal support. Don’t leave yourself vulnerable.
The Bottom Line: Benefits Don’t Randomly Stop Without Notice
- Workers’ comp insurance may terminate your benefits if evidence indicates you’ve recovered, returned to work, declined treatment, committed fraud, or for certain other reasons
- However, they cannot arbitrarily decide to stop payments without notifying you first
- You will receive written notice explaining why your benefits are ending
- This gives you time to appeal the decision and provide counter evidence demonstrating your need for ongoing benefits
- Consulting a workers’ comp attorney ensures you take the proper steps to contest wrongful suspension of your benefits
While benefit terminations unfortunately occur, you have recourse to fight back and get reinstated. With legal support and thorough documentation, you can overcome wrongful denial and continue getting the crucial income you need.