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Can my workers’ compensation benefits be stopped by my insurance company without me agreeing?

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201910.31
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Can my workers’ compensation benefits be stopped by my insurance company without me agreeing?

  1. You do in fact return to work at greater pay, or if you were out of work completely and you return to work at some rate of pay but not equal to what you were making before you were injured, then your employer can stop paying you your wage loss benefits or reduce your wage loss benefits if it is on a partial disability basis, however, you will receive a notice that they are suspending or modifying your benefits and if by the time you receive that notice you are no longer working because you are unable to work with your work injury you have the right to challenge that suspension or modification and it is very important that you do so by going to a lawyer immediately. The form for that challenge is a Form LIBC-751.
  2. You agree to your benefits beings suspended or modified through a document called a Supplemental Agreement or an Agreement for Compensation. You should never agree to this unless you have in fact returned to work at full or some rate of pay that is consistent with what is set forth on that document. That document is called a Supplemental Agreement and it will be checked off for either a suspension or modification.
  3. A Judge issues an Order directing the insurance company to suspend or modify your workers’ compensation benefits.
  4. You settle your case whether it be a total settlement of your entire case both your wage loss and medical benefits or if you are capable of settling just your lost wage benefits separately. This is called a Compromise and Release Agreement.

In the absence of one of these four occurring, your wage loss benefits should not be unilaterally stopped by the workers’ compensation insurance company.

Also your wage loss benefits under the Workers’ Compensation Act should be paid at the same frequency with which you were paid your wages before you were hurt. In other words, if you were paid weekly by your employer then your wage loss benefits should be paid weekly by your workers’ compensation insurance company. If your wage loss benefits were paid biweekly by your employer before your injury then your workers’ compensation benefits will likewise be paid biweekly.

We briefly alluded to the difference between total disability and partial disability. There is a set schedule for how your wage loss benefits are calculated and once calculated there is another schedule (see below) which essentially determines what your compensation rate will be. Simply stated your compensation rate as a general rule is two-thirds of your average weekly wage. As you can see from the schedule there are times that it can be more than two-thirds if your average income wage is at the lower end of the spectrum than it can be up to 90% of your average weekly wage. If you are at a very high wage you will not even be able to recover two-thirds of your average weekly wage because there is a state maximum for each year. You can see from the chart the state maximum for 2013 was $917.00, 2014 was $932.00 and the state maximum for 2015 is $951.00. Partial disability occurs when you have earnings because of your work injury and restrictions associated therewith less than your average weekly wage. In that case your partial disability will be calculated by subtracting from your average weekly wage your modified earnings where you were earning less than you were making before you got hurt because of your work injury. After you obtain that figure by subtracting your modified earnings from your average weekly wage you then multiply that figure by two-thirds or .666. This is called partial disability (also known as TPD). Partial disability in one amount or another can continue on for 500 weeks.


2017 – 2018 – 2019

Maximum:
$995.00
01/01/17
$1,492.50
66 2/3%
$746.26
$746.25
$497.50
$552.78
$552.77
or  90%
Less
Maximum:
$1,025.00
01/01/18
$1,537.50
66 2/3%
$768.76
$768.75
$512.50
$569.44
$569.43
or  90%
Less
Maximum:
$1,049.00
01/01/19
$1,573.50
66 2/3%
$786.76
$786.75
$524.50
$582.78
$582.77
or  90%
Less

2014 – 2015 – 2016

Maximum:
$932.00
01/01/14
$1,398.00
66 2/3%
$699.01
$699.00
$466.00
$517.78
$517.77
or  90%
Less
Maximum:
$951.00
01/01/15
$1,426.50
66 2/3%
$713.26
$713.25
$475.50
$528.33
$528.32
or  90%
Less
Maximum:
$978.00
01/01/16
$1,467.00
66 2/3%
$733.51
$733.50
$489.00
$543.33
$543.32
or  90%
Less

The purpose of this article is to allay some of your concerns and fears that a workers’ compensation insurance company can just for no reason at all just stop your benefits because they cannot. If they do try to do that the Workers’ Compensation Act allows for penalties. Penalties can be for up to 50% of the amount in controversy (the overdue compensation to you) and/or your counsel can be awarded legal fees for having to prosecute the penalties wherein your attorney can be paid on an hourly basis for going after the insurance company. So the insurance company has a good incentive not to just unilaterally stop your benefits. Obviously if you need more advice and wish a consultation on this please do not hesitate to contact my office. All of our consultations are free and we can hopefully reduce any anxiety or concerns you have regarding this issue or other issues regarding your rights under the Workers’ Compensation Act.