When can the insurance company stop my benefits?

Because this question is asked so many times it bears repeating the circumstances under which a workers’ compensation insurance company can stop your benefits.  First of all it is important to separate the benefits.  There are disability benefits also known as wage loss benefits and hereinafter referred to as wage loss benefits, and there are medical benefits.

Let’s deal with the wage loss benefits in this article since this is what usually occurs first.  A workers’ compensation insurance company cannot legally stop your benefits without one of the following:

  1. Your signing an agreement that you allow them to stop your benefits.
  2. A Judge’s Order allowing or directing the insurance company to stop paying your benefits.
  3. You actually do return to work with some wages that you are earning whether it be with your time of injury employer or another employer and the insurance company sends you a Notice of

Stopping or Modifying your compensation.

  1. Or your settle your case
  2. You die.

Putting aside the morbidity of the last circumstance taking note that disability payments due end on your death while other types of benefits can be payable to your estate such as benefits for a specific loss if you lost an arm or a leg, had a facial or head or neck disfigurement, etc.

If the insurance company unilaterally stops your benefits or changes them without your written agreement or without a Judge’s Order it is imperative that you seek counsel immediately because where the workers’ compensation insurance company has violated the Workers’ Compensation Act then you may be entitled to penalties which can include one or more of the following:

  1. Up to 50% of the amount in controversy.
  2. Your attorney can seek counsel fees at an hourly rate although it has to be approved by a Judge and if successful the Judge may or may not order that your counsel not be paid the normal percentage counsel fees until the hourly award has been used up. Not to be confusing to you but in essence it is a severe penalty if the workers’ compensation company violates the Act. You should be aware however that the filing of a petition by your lawyer to hold the insurance company accountable until it goes through the final decision making process can be a long process so there is no immediate remedy for a violation of the Act other than the threat of the penalties outlined above.