Can Workers Compensation Stop Paying Without Notice?

Workers’ compensation serves as a crucial safety net for employees facing injuries or illnesses arising from their work duties. In Pennsylvania, the Department of Labor & Industry (DLI) has established guidelines to ensure fair treatment and transparency in the process. According to the DLI, insurers responsible for workers’ compensation payments are obligated to provide notice before terminating benefits.

Notification Requirements

The Pennsylvania Department of Labor & Industry emphasizes that workers’ compensation insurers must follow specific notification procedures. As a result, insurers are required to inform the injured party when their benefits are being terminated by sending a “Notice of Suspension.”

Reasons Why Workers’ Compensation Benefits Will Stop

The notice issued by the insurer should outline the reasons for terminating your workers’ compensation benefits, but typically, they will only stop for one of the following three reasons: 

1. Returning to Work

If you have recovered or reach maximum medical improvement (MMI) and are deemed capable of returning to work, even in a modified capacity, the insurer may decide to terminate benefits. The decision is often based on medical evaluations and assessments of your ability to perform job duties.

2. Termination Petition

Employers or insurers may file a termination petition to request the modification, suspension, or termination of workers’ compensation benefits. If a workers’ compensation judge reviews the case and rules in their favor, benefits may stop based on the judge’s decision. 

The primary reason a judge will allow an employer to stop paying workers’ compensation is a worker’s non-compliance with the system’s established rules. Instances where benefits may be terminated include:

• Refusal of Medical Examination: Declining a medical examination requested by the insurance company.
• Rejection of Reasonable Medical Treatment: Refusing reasonable medical treatment recommended for recovery.
• Legal Sentencing to Jail or Prison: Being sentenced to jail or prison can result in the termination of workers’ compensation benefits.
• Non-Submission of Employee Verification Form: Failure to submit the required employee verification form.

For benefits to be terminated in these cases, your employer or its insurer would have to present evidence demonstrating that you have received all entitled benefits under Pennsylvania workers’ compensation law. If you disagree with the judge’s decision, you have the option to appeal the ruling. 

3. Lump Sum Settlement Agreement

In some cases, injured workers and employers may negotiate a lump sum settlement agreement to resolve the workers’ compensation claim. When parties agree to a lump sum settlement, it often involves a one-time payment to the injured worker in exchange for closing the workers’ compensation case. The settlement agreement outlines the terms, including the discontinuation of ongoing benefits.

Should You Seek Legal Advice?

If you stop receiving workers’ compensation benefits without notice, seeking advice from a trusted Philadelphia work injury attorney is critical. They will thoroughly investigate the reasons behind it and explain your legal rights and options available to you.

If benefits were stopped unjustly, a lawyer can help you initiate an appeal and will guide you through the process from beginning to end, ensuring all necessary documentation and evidence is presented to support your claim for reinstatement of benefits.