Why Have My Workers’ Compensation Checks Stopped and What Should I Do?
Under Virginia workers compensation, the employer and its insurance carrier must pay for reasonable medical treatment as long as necessary to treat your work-related injury. And your wage replacement benefits may last the remainder of your lifetime if you have a permanent and total disability. Otherwise, your wage replacement benefits will end at some point. When this compensation ends depends on many factors, including the body part you injured in the work accident, your permanent impairment rating, and whether you can return to some type of work.
This article explains common reasons that your workers’ compensation disability benefits stopped and the options you have if you think you should continue receiving benefits. Please keep reading to learn more about your legal rights, and don’t forget to check out our Virginia Workers Compensation Questions and Answers page. Then contact workers’ comp lawyer Corey Pollard for a free strategy session.
Why Did My Workers’ Comp Benefits Stop?
Receiving an Award Order from the Virginia Workers’ Compensation Commission based on award agreement forms or winning your case at the workers’ compensation hearing is a good first step. But it’s just that – a first step in the workers compensation claims process.
The Award Order protects your benefits; however, the insurance company may be able to try to terminate your workers’ comp benefits if it finds a valid reason.
Here are some common reasons that insurance companies try to stop workers’ compensation benefits:
1. You refused light duty work. If the employer offers you light duty work, you must accept the light duty assignment if it is within your doctor’s work restrictions. The insurance carrier does not have to pay you temporary total disability benefits if you refuse to accept a light duty position within your restrictions.
2. The Independent Medical Exam finds that you can return to your regular work. In Virginia the insurance company can send you to one of its doctors for an Independent Medical Exam (IME). The IME doctor is hand picked by the insurance company. As such, we see many IME doctors find that the injured worker is able to return to his or her pre-injury work or that any ongoing work restrictions are unrelated to the compensable work injury. Call a workers’ comp attorney immediately if the IME doctor finds that you’re capable of your regular work. You can fight back. But you have to act quickly.
3. You fail to follow your doctor’s medical advice. If you have an Award of lifetime medical benefits but fail to do what your doctor asks, the insurance company may try to stop your workers’ comp benefits.
4. You have a gap in medical treatment. Often we are contacted by injured workers who have a lifetime medical award but who have not received treatment for their work injury in a year or more. They continue to have symptoms, however, so they try to make an appointment with the authorized treating physician. When they call the doctor’s office, they’re told that the workers’ comp insurance carrier will not approve the appointment. This is why you should obtain consistent medical care. Your doctor must be able to say that your ongoing symptoms or restrictions are related to the workplace accident. If there is no connection, or the doctor cannot say there is a connection because it’s been so long since you treated, then workers’ comp may not cover the treatment.
5. You suffered an intervening accident. If you’re receiving wage loss benefits but get hurt in a new accident – either at work or otherwise, then the workers comp insurance carrier may stop your benefits. You should call an attorney immediately. You’ll need to prove that the new accident caused a worsening of your work injuries to continue to receive benefits. Or you may have a new claim for benefits based on subsequent accident.
6. The Functional Capacity Evaluation. Your doctor or the insurance company may send you to a Functional Capacity Exam (FCE) when you reach maximum medical improvement. If you refuse to cooperate with the physical therapist conducting the FCE, or if you do not give full effort, the therapist may report this to your doctor. The insurance company can try to use a negative FCE report to stop workers’ comp benefits.
Your Options When the Insurance Company Stops Workers’ Comp Benefits
If your employer’s insurance carrier files an Employer’s Application for Hearing to stop benefits, you can object to the application and submit evidence against the application. The Commission will then decide whether to refer the application to a workers’ compensation hearing or to deny the application.
We recommend contacting an attorney even before your workers’ comp benefits are stopped. If you act quickly, you may be able to defeat the employer’s application for hearing and to prevent it from getting referred to the hearing docket. Otherwise, you may have to go months without workers’ comp benefits while waiting for a hearing date. And months after the hearing while you wait for a decision and go through all possible workers’ comp appeals.
Corey Pollard is committed to protecting the legal rights of injured workers in Virginia. Contact us today to schedule your free consultation. We can help you negotiate a fair workers compensation settlement.