Common Reasons Workers’ Compensation Checks May Stop Coming In
Workers’ compensation benefits can provide a much-needed lifeline if you’re recovering from workplace injuries. These payments typically cover lost or reduced wages and medical expenses, helping you to maintain financial stability while you recover after being injured on the job.
The Bureau of Labor Statistics reports 2.6 million nonfatal workplace injuries and illnesses among private industry workers in 2023, with worker’s compensation paying out a total of $43.5 billion for claims that year, according to the National Council on Compensation Insurance.
However, some people may find that their workers’ compensation checks suddenly stop, and wonder why and what to do.
Understanding how this happens can help you navigate the system and take the best course of action, and an experienced worker’s compensation lawyer at Belsky & Horowitz, LLC, can help.
Completion of Medical Treatment
One common reason that you might stop getting workers’ compensation payments is the completion of medical treatment.
Workers’ compensation benefits often continue until you reach what is called “maximum medical improvement” (MMI). This means your doctor has determined that your condition is as improved as it is likely to get with medical care.
Once you reach MMI, your benefits may stop or shift to a different form, such as a settlement or partial disability benefits, depending on your case.
Return to Work
If you return to work, even in a limited capacity, your workers’ compensation checks may stop.
This is particularly true if you’re earning a wage similar to or greater than what you earned before the injury. However, if you’re working fewer hours or earning less due to restrictions from your injury, you may still qualify for partial benefits.
To avoid misunderstandings, always keep your employer and insurance company updated about your work status and any changes.
Noncompliance with Medical Treatment
Workers’ compensation benefits typically require you to follow your doctor’s recommended treatment plan. Failing to attend medical appointments, refusing treatments, or not following prescribed care can result in your checks being suspended or terminated.
Noncompliance signals to the insurer that you may no longer need the benefits, so staying consistent with your treatment plan is essential.
Insurer Denial or Dispute
Insurance companies regularly review claims to ensure continued eligibility. If they believe your condition has improved enough for you to work, they may dispute your need for ongoing benefits.
Insurers may also investigate claims if they suspect fraud or discrepancies in your documentation.
For example, if surveillance shows you performing activities inconsistent with your injury, the insurer could stop your payments.
If they do, you can appeal the decision or seek legal assistance to challenge the denial.
Missed Deadlines or Paperwork Issues
Workers’ compensation claims require that paperwork be filled out accurately and submitted on time.
If you miss the deadlines for filing reports, fail to submit medical updates promptly, or overlook an employer’s or insurer’s request for additional documentation, your benefits could be suspended.
Make sure that you stay on top of these administrative details and requirements, and always respond as quickly as possible to any requests from your employer or insurer.
Independent Medical Examination (IME) Results
In some cases, the insurance company may request an Independent Medical Examination (IME) to assess your condition.
The doctor conducting the IME evaluates whether your injury still prevents you from working. If their report contradicts your treating physician’s assessment, the insurer could reduce or terminate your compensation benefits.
If this happens, you have the right to dispute the findings and present evidence supporting your case.
Settlement Agreements
Accepting a lump-sum settlement may also stop your workers’ compensation checks.
These agreements provide you with a one-time payment to completely resolve your claim. While this may provide immediate financial relief, it also means that you’re giving up your ongoing regular benefits.
Before accepting any settlement, you should consult with an attorney to make sure that you clearly understand the long-term implications of doing so.
Employer-Provided Evidence
Employers may also play a role in terminating workers’ compensation payments. If your employer believes you’ve recovered or suspects you’re exaggerating your injury, they may submit evidence to the insurance company.
This could include surveillance footage, eyewitness statements, or internal reports. Companies often want to reduce their workers’ compensation costs, so make sure that your claim is well-documented and supported by medical evidence.
Voluntary Resignation or Termination
If you voluntarily resign from your job or are terminated for reasons unrelated to your injury, your workers’ compensation payments will likely stop. It’s important to note, however, that if you think that your being fired was retaliation for filing a work injury claim, this could be considered wrongful termination, and you may have legal recourse.
To protect your rights, be sure to keep complete records of all communications regarding your employment.
If your workers’ compensation checks stop unexpectedly, and you don’t know why, you should take action immediately to address the issue. Acting quickly can make all the difference in successfully resolving your claim and getting your benefits started again.
By understanding the potential reasons for the interruption of your workers’ compensation checks, you’ll be better prepared to protect your financial security while recovering from your workplace injury.
If you believe that your benefits have been terminated in error, the experienced professionals at Belsky & Horowitz, LLC, can help.
