What to Do if Your California Workers' Compensation Benefits are Terminated or Reduced

California workers' compensation benefits are an essential safety net for employees who get injured or become ill while on the job. These benefits can provide financial assistance for medical expenses, lost wages, and other related costs. Unfortunately, in some cases, the benefits may be terminated or reduced, leaving the employee in a difficult situation.

In this blog, we will provide information on what to do if your California workers' compensation benefits are terminated or reduced. We will explore the reasons why benefits may be terminated or reduced, the steps to take if this happens, and how to appeal the decision as well as discuss when it may be necessary to get legal help and how to find a qualified attorney. 

Reasons for Terminating or Reducing Workers' Compensation Benefits

There are several reasons why workers' compensation benefits in California may be terminated or reduced. Some of the most common reasons include:

Medical Improvement: If a doctor determines that you have recovered from your injury or illness and are able to return to work, your benefits may be terminated. This is because the purpose of workers' compensation benefits is to provide financial assistance while you are unable to work.

Refusal to Participate in Treatment: If you refuse to participate in medical treatment that your doctor recommends, your benefits may be terminated. This is because the treatment is necessary for your recovery, and without it, you may not be able to return to work.

Failure to Attend Medical Appointments: If you fail to attend scheduled medical appointments, your benefits may be terminated. This is because attending medical appointments is necessary to monitor your recovery and ensure that you are receiving appropriate treatment.

Resumption of Work: If you return to work, your benefits may be terminated or reduced. The amount of your benefits will depend on your earnings and how much you are able to work.

Non-Work-Related Reasons: If it is determined that your injury or illness is not work-related, your benefits may be terminated. This may occur if it is found that your injury or illness was caused by a pre-existing condition or an activity that was not related to your job.

It is important to note that these reasons are not exhaustive, and there may be other reasons why your benefits are terminated or reduced. If you are unsure why your benefits have been affected, it is important to seek legal advice.

Steps to Take if Your Benefits are Terminated or Reduced

If your California workers' compensation benefits are terminated or reduced, there are several steps you can take to protect your rights and ensure that you receive the benefits you are entitled to. Here are some of the steps you should take:

Review the Decision: Carefully review the decision to terminate or reduce your benefits. Understand the reason given and determine whether you agree with it or not.

Contact Your Employer or Insurance Company: If you disagree with the decision to terminate or reduce your benefits, contact your employer or the insurance company that provides your workers' compensation coverage. Ask for an explanation of the decision and provide any information or documentation that may support your claim.

Request a Re-Evaluation: If you believe that the decision to terminate or reduce your benefits was based on incomplete or incorrect information, you may request a re-evaluation. This may involve submitting additional medical evidence or requesting a second opinion from another doctor.

File an Appeal: If your benefits are still terminated or reduced after a re-evaluation, you may file an appeal. You will need to follow the formal appeals process, which involves submitting a written request for review and attending a hearing before an administrative law judge.

Get Legal Help: If you are having difficulty navigating the appeals process or believe that your rights are being violated, it may be necessary to seek legal help. A workers' compensation attorney can provide advice and guidance on your options and represent you during the appeals process.

Remember, it is important to take action as soon as possible if your benefits are terminated or reduced. The longer you wait, the more difficult it may be to reverse the decision or receive the benefits you are entitled to.

Appealing the Decision

If your California workers' compensation benefits are terminated or reduced and you disagree with the decision, you have the right to appeal. The appeals process involves several steps, which are outlined below:

File a Petition for Reconsideration: The first step in the appeals process is to file a Petition for Reconsideration with the Workers' Compensation Appeals Board (WCAB). The petition should include a statement explaining why you disagree with the decision to terminate or reduce your benefits.

Attend a Mandatory Settlement Conference: After you file your petition, you will be required to attend a Mandatory Settlement Conference (MSC). The purpose of the MSC is to discuss the issues in dispute and attempt to reach a settlement agreement.

Attend a Hearing: If a settlement agreement cannot be reached at the MSC, the next step is to attend a hearing before an administrative law judge (ALJ). At the hearing, both sides will present evidence and arguments, and the ALJ will issue a written decision.

Request Reconsideration: If you are dissatisfied with the ALJ's decision, you may request reconsideration by the WCAB. The request must be made in writing within 20 days of the ALJ's decision and must include a statement explaining why you believe the decision was incorrect.

Appeal to the California Court of Appeal: If you are still dissatisfied with the decision after reconsideration by the WCAB, you may appeal to the California Court of Appeal. This involves filing a formal appeal with the court and presenting arguments and evidence to a panel of judges.

It is important to note that the appeals process can be lengthy and complex.

Getting Legal Help

If your California workers' compensation benefits have been terminated or reduced and you are having difficulty navigating the appeals process, it may be necessary to seek legal help. Here are some of the ways a workers' compensation attorney can assist you:

Provide Advice and Guidance: A workers' compensation attorney can review your case, explain the law, and advise you on your rights and options. They can help you understand the appeals process and guide you through each step.

Gather Evidence: To build a strong case, it may be necessary to gather evidence, such as medical records, witness statements, and expert opinions. An attorney can assist in collecting this evidence and ensuring it is properly presented.

Represent You at Hearings and Appeals: An attorney can represent you at mandatory settlement conferences, hearings, and appeals. They can argue on your behalf, present evidence, and cross-examine witnesses.

Negotiate Settlements: In some cases, it may be possible to reach a settlement agreement without going through the appeals process. An attorney can negotiate with the insurance company to reach a fair settlement that meets your needs.

Protect Your Rights: Workers' compensation laws can be complex, and it can be challenging to navigate the system on your own. An attorney can help ensure that your rights are protected and that you receive the benefits you are entitled to.

Remember, workers' compensation attorneys typically work on a contingency fee basis, which means they only get paid if you receive a settlement or award. This can provide peace of mind knowing that you can get legal help without worrying about upfront costs.
In conclusion, if your California workers' compensation benefits have been terminated or reduced, it is important to take action as soon as possible. By understanding your options and taking proactive steps, you can increase your chances of a successful outcome. If you have any questions, please contact us today.

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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.