Can Workers’ Comp Just Stop Making Payments?
When an employee contracts an injury or illness on the job, he or she may be eligible to receive workers’ compensation. Commonly abbreviated as “workers’ comp”, workers’ compensation provides wage and medical benefits to employees with coverage who become ill or injured in the workplace. Compensation for individual illnesses and injuries will vary depending on state standards.
Even after employees begin receiving workers’ comp benefits, payments can stop with little or no notice. At times, workers’ compensation payments may stop for legitimate reasons. Common reasons behind workers’ compensation denial can include:
- Lack of medical evidence behind workplace injuries or illness;
- Injuries associated with, or aggravated by, pre-existing medical conditions;
- Injuries caused by drug or alcohol use;
- Workplace horseplay, negligence, or lack of safety injuries;
- Illness or injury not reported in a timely fashion.
Legal action is always an option if workers’ compensation claims are denied; in other cases, a misunderstanding can result in stopped workers’ comp payments, until that misunderstanding is corrected.
Why Would Workers’ Comp Stop Paying?
Workers’ compensation benefits can cease for legitimate reasons, oftentimes while private investigators or independent medical practitioners help validate the legitimacy of an employee’s claims. Consult the below details for more information on why workers’ comp payments might stop.
In the event an employee is unable to perform his or her original job, because of a workplace injury or illness, light-duty work offers a less-demanding regimen. Sometimes, light-duty work means an easier version of previous job duties, with less physical labor required. Examples of light-duty work include desk work, taking inventory, answering phones, data transfer, and supervising employee work.
Benefits received from workers’ comp can be affected by light-duty work performed by a sick or injured employee. For example, if an employee accepts light-duty desk work and sees an increased salary over their old job, workers’ comp payments would stop. If the employee makes less money answering phones than they originally did performing harder labor, workers’ comp benefits would continue to subsidize the difference between old and new salaries, as partial disability payments.
Refusing to perform light-duty work can result in stopped workers’ comp payments. And if a worker is offered light-duty work as an alternative and takes excessive time to accept, benefits will be delayed until light-duty work begins. If there is a delay between the agreed-upon start date of light-duty work and when the employee first shows up to the office, the employer can cancel workers’ compensation payments.
The results of a private investigation can also mean a stoppage in workers’ comp payments if investigators determine whether employees have exaggerated any aspects of their injuries, illnesses, or associated insurance claims. The use of private investigators is actually a fairly common practice when workers’ comp benefits are on the line, especially if employers suspect that an employee’s personal activities might be contributing to their claimed issues.
Private investigators use a variety of tactics when hired by companies to follow employees. They may discreetly pursue workers during the times when they should be receiving treatments, or observe them to make sure they’re being honest about their physical limitations. Private investigators can also be granted access to an employee’s internet history, or work-related cell phones, to check for any inconsistencies between their claims and reality. If investigators determine that employees are lying about their condition, workers’ comp benefits can stop.
Independent Medical Exam (IME)
Not every workers’ comp claim requires an independent medical examination, though they are used when a company’s insurance chooses to dispute a doctor’s treatment or recommendations. Independent medical examinations are often filed through a company’s insurance, enlisting a private physician to examine the employee. This independent medical practitioner will relay their findings to the company, to determine whether the employee’s claims are consistent with the illness or injury suffered.
During the examination, hired IME practitioners may ask questions about the nature of the employee’s illness or injury, symptoms, and medical history. If the practitioner determines that the employee’s claims are in line with their issues, workers’ comp benefits will continue. However, benefits can stop if the physician identifies exaggerated or untrue symptoms.
Functional Capacity Exam (FCE)
When employers believe that employees are sufficiently healthy to return to work, a functional capacity exam is requested. Typically carried out by a physical therapist, these exams test a worker’s range of motion, ability to carry heavy or large objects, overall endurance, and any other physical characteristics necessary for a fully-functional employee.
Physical therapists evaluating employees are likely to ask questions related to physical strength and stamina when deciding whether to recommend this employee for a full workload. If a functional capacity exam determines that an employee is healthy enough to return to work, workers’ compensation payments can stop as that employee’s regular wages are restored.
Inconsistent Medical Treatment
Workers’ comp will often provide covered employees with therapy, medicine, treatment, and other recovery benefits that help workers make a full recovery. However, medical treatment received must be considered both reasonable and required. If any form of treatment an employee receives under workers’ comp benefits is not considered mandatory and reasonable by the insurance provider, compensatory benefits can stop.
Specifically, any and all forms of treatment must be received in accordance with strict guidelines, outlined by the company’s insurance provider. These guidelines can limit treatment to certain therapy types, specific treatment centers or hospitals, procedures from specific healthcare providers, limited medications, and certain medical devices. Often, treatments like acupuncture, relaxing chiropractic work, or therapy offered by non-licensed providers will not be covered.
Termination of Employment
Termination of a worker’s employment can obviously mean the end of received workers’ comp benefits. While employers cannot fire employees out of retaliation because of a filed workers’ comp claim, workers can be let go if they are permanently unable to fulfill the physical requirements necessary for the position. Fortunately, even if employees are fired while on workers’ comp, they can continue to receive benefits for active claims.
In specific cases, fired employees can be cut off from receiving continued workers’ comp benefits. These include cases where employee negligence or misuse of company property played a role in injuries received. Failed drug or alcohol tests can also disqualify employees from receiving continued workers’ compensation payments after being fired.
Workers’ Comp vs. Disability Benefits
Disability benefits are paid to employees challenged by short and long-term disabilities that affect job performance. These benefits differ from workers’ comp claims, in that disability often covers injuries or illnesses developed by employees away from work. By contrast, workers’ compensation only covers employee illness or injury developed while at work.
Short-term disability payments can provide an employee with 40-60% of their initial salary after job performance is negatively affected by an injury or illness developed outside of work. Employees regularly receive short-term disability benefits for issues like childbirth, back problems, COVID-19, and car accident injuries. Long-term disability benefits can often last years, and can cover issues like cancer, nervous system disorders, and mental health problems like schizophrenia.
If workers’ comp isn’t an option to cover your issues, disability benefits may still be an option. Workers’ comp is meant to temporarily accommodate employee needs until they can return to work. In fact, workers can typically only receive workers’ comp for limited periods of time. Once workers, their company, a corporate insurance provider, or an independent medical examiner determines that injuries have healed, workers’ comp payments can end. Even after workers’ comp benefits conclude, those same employees may qualify for long-term disability benefits, depending on their situation.
What to Do When Workers’ Comp Stops Paying
Employees still have options once workers’ comp payments end. If workers’ comp payments stop unexpectedly, employees should contact their insurance provider to see if a mistake was made. Always check and see if there is a simple and clear reason for the missing payment.
If the situation needs to be legally escalated, it’s typically best to hire an attorney with experience handling workers’ comp cases for clients. Especially for complex injuries, insufficient coverage, or delayed benefits, workers’ compensation attorneys can help you strengthen court cases and earn you deserved benefits.
Work With An Experienced Local Lawyer
Hire an experienced workers’ compensation attorney as soon as the insurer or your employer shows signs of making your recovery difficult. If your injury involves an occupational illness or a cumulative injury, you may also benefit from a knowledgeable lawyer. An attorney will fight on your behalf for your rights to benefits as well as for the maximum amount of compensation. Retain the help you need at this difficult time in your life.
Submit a request online or call us today at (866) 345-6784 to get in touch with an attorney in your area!