As a general rule, your workers’ compensation payments will not just stop without reason. If they do, then you need to contact a workers’ comp lawyer right away to get this issue addressed.
Your weekly check should keep coming as usual unless one of three things happens:
- You agree that payments should stop.
- A workers’ compensation judge has ordered that payments should stop.
- You return to work after your work injury.
In each of these situations, you will get notice that weekly payments still stop. However, if your insurance company simply stops payments without saying anything to you, then you need to take action.
Why Workers’ Comp Payments Stop
If they want to stop benefits, they must send the injured worker a “Notice of Suspension.” This notice is used if you return to work after recovering from your work-related injury or they have filed a petition to modify, suspend, or terminate your benefits.
A termination petition states that the insurance company wants to stop your benefits after a doctor examines you. They file this petition because they think that you have gotten all of the medical treatment you need, and you can return to work, even if you have not gone back to work yet.
Short of getting a termination petition, there are only two reasons that payments should stop: a judge says they should stop, or you agree that they should stop.
Why Would a Workers’ Compensation Judge Stop Payments?
One of the main reasons that a judge will tell the employer that they can stop paying benefits is that you are not following the rules under the work comp system in Pennsylvania. For example, benefits can stop if:
- You refuse to undergo a medical examination that the insurance company has requested.
- You are declining reasonable medical treatment.
- You have been sentenced to jail or prison.
- You do not return the employee verification form as required.
Workers’ compensation judges control any dispute that you may have regarding your medical care or benefits from your workers’ compensation case. Ultimately, if a judge says that payments should stop, then an employer will stop them, regardless of the reason.
However, to stop payments, your employer or its insurance company must present evidence as to why you have gotten all of the benefits that you are entitled to receive under Pennsylvania workers’ compensation law. If you have additional rights, then a judge will not give this order.
Of course, there are situations where you will not agree with what the judge concludes, and in those cases, you may have the option to appeal the judge’s decision.
In most circumstances, the insurance company still has to get permission from the judge to stop payments; payments should not stop automatically, even if you refuse treatment.
The Claimant Agrees to Stop Receiving Benefits
You may wonder why you would ever agree to stop receiving payments that you are entitled to receive under Pennsylvania workers’ compensation law. However, one of the main reasons that you might do this is that you have settled your workers’ compensation claim with the insurance company. If you give the insurance company permission to stop payments through a settlement, then payments will stop.
A settlement is usually appropriate if you have reached maximum medical improvement, as confirmed by a medical exam, and you do not need any additional medical treatment. Your attorney can help you determine if settling is the right thing to do at this point in your case—do not agree to stop payments for any reason unless you have talked to a workers’ compensation attorney first!
The workers’ compensation insurance company may also request that you sign a Final Receipt. This document verifies that you are fully recovered from your injury and that you agree to stop getting benefits. Do not sign this form without getting legal advice first! You can significantly cut off your rights to workers’ compensation benefits, even if you are not fully recovered by signing this document before you are ready.
The Claimant Goes Back to Work
Workers’ compensation benefits are designed to get you back on your feet so you can get back to work after a work injury. If you go back to work, then the insurance company’s job is essentially done.
However, you may not go back to work at full capacity after a work injury. You may only be able to perform light duty jobs for a short time, or you may not be able to go back to the same position that you had before. In those situations, your benefits may not stop when you go back to work. If you go back to work and earn the same or more than you did before the work injury, then stopping benefits is likely appropriate.
Even if you go back to work, remember that your employer must file a petition to terminate or modify benefits. A judge will then “sign off” on payments stopping as well. You should get plenty of notice before your weekly payments stop altogether.
Worried About Your Benefits? Speak to a Workers Compensation Lawyer
If you want to be sure that you are getting all of the benefits you are entitled to receive under Pennsylvania workers’ compensation law, including medical benefits and weekly payments, get realistic legal advice from our team. Contact our office to set up a free consultation. You can also explore more blog content and get additional resources on our website.