Your workers’ compensation benefits should continue so long as you are dealing with your injury. Your medical bills would be paid so long as you need treatment for your job-related illness or injury. You should keep receiving lost wages while you are unable to work or earn what you were able to before the injury.
However, the insurance company may come to believe at some point that you no longer deserve benefits. While workers’ comp may stop paying you, they cannot do so without notice.
You could then appeal the termination of your benefits. If your workers’ compensation benefits have been wrongfully terminated, call the aggressive Wilmington workers’ comp lawyers at Horton & Mendez today. We can help you fight back.
Why Insurance Companies Stop Paying Your Workers’ Comp Benefits
There are many reasons why an insurance company may cut off your benefits. The main requirement to maintain your benefits is that you are suffering from a work-related injury that leaves you unable to work, either in whole or in part.
The main reason why an insurance company would stop payments is they believe that you are no longer disabled.
At some point, they would direct you to attend an independent medical examination (IME). The IME is not optional. You must show up to the appointment and submit to the process. Even though the IME is fraught with danger for you as a claimant, the insurance company still has the right to ask for one.
First, the failure to attend the IME is grounds alone to cut off your benefits. If you did not cooperate in the process, the insurance company could stop paying your claim. They would not even be able to verify your current condition because their doctor cannot examine you.
If you have received a notice that you are to attend an IME, you should cooperate. You may benefit consulting with a workers’ compensation attorney before the exam.
The Insurance Company May Believe that You Can Work
The IME may not reach the results that you wanted. The insurance company is the one who is paying the doctor. Thus, the physician may not want to get crosswise with the insurance company by finding that too many patients are permanently disabled.
One common result of the IME is that the insurance company may say that you are able to perform light-duty work at the office. If you previously performed some sort of physical labor, you could be asked to work at a desk job without the strain. If you are asked to perform light-duty work, you have to do it if you are able. If you refuse light-duty work when you have the capacity to perform it, your benefits may be ended.
Of course, the doctor could wrongfully believe that you are able to return to work in some capacity. It is nothing to the insurance company if you prematurely go back to work and struggle.
When you are receiving workers’ compensation benefits, you have certain obligations of your own. You must keep up with your doctor’s appointments and follow the medical provider’s recommendations. If the doctor prescribes medication, you must take it. Similarly, you must attend therapy and rehabilitation appointments. If you have the capacity to attend vocational rehabilitation, you must also do it.
You can expect that the insurance company will review your medical records to see what you are doing. If they believe that you are not being diligent about your recovery and treatment, they may try to cut benefits.
There are other reasons why your insurance company may end your benefits, including:
- You quit your job (do not do this when you are receiving workers’ comp benefits)
- The insurance company believes that they have evidence you are malingering
- A capacity exam reveals that you can go back to work
You Can Appeal When Your Workers’ Comp Benefits Have Been Terminated
You may have received notice that your benefits are being stopped. When that happens, the insurance company does not get the final word. Just like when the insurance company denies your initial claim, you also have the right to appeal. The last say is taken out of the insurance company’s hands. Whatever conclusion that they have reached to cut off your benefits may be wrong. An objective and impartial Administrative Law Judge would review the evidence in a hearing and make their own ruling.
When you file an appeal, your attorney may present medical evidence that could show why you still deserve benefits, such as:
- Testimony from your own treating doctor who disagrees with the opinion expressed in the IME.
- Evidence that shows that you followed all medical recommendations.
- Arguments why you are still not able to perform the light duty work that you were offered.
- Medical records and test results that show your condition.
The Insurance Company Could Be Penalized for Cutting Your Benefits Without Notice
The insurance company needs to be careful about wrongfully cutting off your benefits. If they stop paying your benefits, they may have their own financial risk.
In North Carolina, there is a 10% penalty payment if your workers’ compensation check is more than 14 days late. They cannot simply stop paying you with no notice or explanation. If the insurance company just stops paying your checks, you could consider your payment late.
While there is a late penalty attached, it is a small compensation for the stress that you have had to go through because of the insurance company. You may have to take legal action to get the money you deserve.
Contact a Workers’ Compensation Attorney in Wilmington, NC Today
If you have any difficulties getting paid for the benefits you’re owed during the workers’ compensation process, the attorneys at Horton & Mendez are here to help. We can review your case and explain how you may be able to take on the insurance company. If your benefits have been cut, you have a limited amount of time to take action. To speak with an attorney, you can send us a message online, or you can call us today at 910-405-7751.