5 Reasons Workers' Comp. Benefits May End

If you are receiving workers’ compensation benefits due to a workplace injury or illness, you likely depend on these monthly payments to make up for lost wages. If you receive permanent disability benefits, it’s especially important to keep in mind that these benefits may end at some point. Knowing when and why permanent disability benefits may stop being paid can help you better prepare for what comes after that. Here are five common reasons why your workers’ compensation benefits could stop being paid.

1. Settlement

Benefits are usually paid in ongoing payments or recurring coverage for your medical expenses. However, if you enter into a settlement agreement called a Compromise and Release, you are effectively terminating your benefits by agreeing to that lump sum payment or structured settlement. Some Compromise and Release settlements do still provide for open medical care. Review your proposed settlement documents carefully with an attorney before accepting any agreement.

2. Physician Determination

Benefits can end if a Treating Physician, Qualified Medical Evaluator or an Agreed Medical Evaluator determines that you are no longer in accordance with an already-assigned level of disability. For example, your physician could lower your level of permanent disability after treatment, in which case you would be entitled to less weeks of permanent disability payments. 

3. Insurance Company Determination

Your employer’s insurance company can terminate benefits for a number of reasons. Oftentimes, they deny benefits due to a failure to receive documentation to support payments of benefits. They can also terminate benefits if you fail to attend an evaluation or your evaluating doctor doesn’t submit the proper paperwork. Luckily, you may be able to appeal this decision and reinstate the benefits if the discontinuation is the result of a mistake.

4. Appeals Board Determination

The Workers’ Compensation Appeals Board (WCAB) maintains a high level of authority in workers’ comp. Cases. They can suspend benefits for failure to attend evaluations. They can terminate your benefits if you fail to attend hearings, prosecute your case, or submit paperwork. The WCAB can even terminate benefits as part of a compromise and release agreement or in line with a court decision.

5. Labor Code Limitations

California’s labor code institutes a number of limitations on how long a worker can receive benefits. In some cases, benefits are limited to 104 weeks. In other cases, 240 weeks apply. Some modalities of treatment are also limited. Talk to an attorney to see if you are bound by any of these limitations.

Whether you are currently receiving workers’ comp. Benefits, or you are in the initial stages of filing a claim, seeking advice from a Certified Workers’ Compensation Specialist in Fresno, CA can help ensure your benefits don’t suddenly stop being paid.

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Cole, Fisher, Cole, O’Keefe + Mahoney is Central California’s leading workers’ compensation and social security disability law firm. With over 30 years of successful experience, we are committed to securing maximum benefits for our clients in the Fresno, California area. Schedule a free consultation today.