What to Do if Your Workers’ Compensation Payments Stop in Pennsylvania
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If your workers’ compensation payments stop before you’re ready to return to work, you’re not alone, and you’re not powerless. In Pennsylvania, an insurance company generally cannot stop paying an accepted claim on its own say-so. It needs your agreement, a judge’s order or a specific notice the law allows. Why your checks stopped decides what you need to do next, and some of the deadlines are very short.
Here’s how to figure out what happened and how to protect your benefits.
Step 1: Contact Your Employer and the Insurance Company
Start by reaching out to:
- Your employer’s HR department
- The workers’ compensation insurance adjuster
Ask for:
- An explanation of why payments were stopped
- Any forms or letters they’ve mailed
- Copies of any medical reviews they used
Then check your mail for the document that came with or before the last check. A Notice Stopping Temporary Compensation, a Notification of Suspension or Modification, a Supplemental Agreement, a Final Receipt or a judge’s order each means something different. Sometimes the problem is a clerical error. If not, that document is what you and your lawyer will work from.
Step 2: Get a Medical Re-Evaluation
If a medical report was used to justify ending your benefits — and you’re still unable to work — ask your treating doctor to:
- Provide updated medical records
- Write a letter confirming your ongoing disability
- Refer you for a second opinion if necessary
This evidence may help support your workers’ comp claim and strengthen your case for medical benefit coverage.
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Step 3: File the Right Petition Before the Deadline
There is no single petition that fits every stopped check. The right response depends on why the payments stopped:
- Temporary payments stopped and the claim was denied. If the insurer paid under a Notice of Temporary Compensation Payable and then sent a Notice Stopping Temporary Compensation and a denial, the usual next step is a Claim Petition, generally within three years of the injury.
- You received a Notification of Suspension or Modification. Insurers send this form when they say you went back to work. If you disagree, for example because you never returned or you returned at lower pay, you have only 20 days from receiving it to file a challenge. A special supersedeas hearing is then held within 21 days. Learn more about suspension of benefits.
- Your benefits were suspended and your condition got worse. A Petition to Reinstate may restore your wage-loss benefits. After a suspension based on your return to work, it generally must be filed within 500 weeks of the suspension.
- A judge granted the insurer’s petition. A judge’s final decision can be appealed to the Workers’ Compensation Appeal Board, generally within 20 days. If the judge only granted a supersedeas, a temporary stop while the case continues, the case goes on before the same judge. Learn more about termination of benefits.
- The insurer stopped paying without any notice, agreement or order. On an accepted claim, that is generally a violation of the Workers’ Compensation Act. A Penalty Petition asks the judge to order payment and can add a penalty.
- You signed a Final Receipt. If your disability had not actually ended, a petition to set the Final Receipt aside generally must be filed within three years of the last payment.
- You reached the 500-week limit on partial disability. Wage-loss benefits end by law at that point, but medical treatment for the work injury can continue.
Petitions are filed with the Pennsylvania Workers’ Compensation Office of Adjudication and decided by a Workers’ Compensation Judge.
You’ll need:
- Medical records
- The notice, agreement or order you received
- Any correspondence with the insurer
- Your payment history
If you wait too long, you may lose your right to collect back pay, or the right to pursue the claim at all.
See: How to file a Claim Petition for a denied or disputed claim
Learn about denied claims and reinstatement petitions
Know Your Rights Under Pennsylvania Law
Key laws that protect injured workers include:
- Section 306(a) and (b) — Wage-loss benefits when you’re unable to work or can only earn less
- Section 306(f.1) — Payment for reasonable and necessary medical treatment
- Section 413 — The rules for modifying, suspending, terminating or reinstating benefits when your condition or earnings change
- Section 435 — Penalties when an insurer violates the Act, including by failing to pay benefits it owes
If your benefits were stopped improperly, you may be entitled to back pay, reinstated benefits and, in some cases, penalties against the insurer.
Also read: Can your employer deny your workers’ comp claim?
Talk to Our Workers’ Compensation Lawyers
When your payments stop suddenly, time is critical. At Schmidt, Kirifides, Rassias & Rio, our Certified Workers’ Compensation Specialists know how to fight back, and our firm has helped more than 5,000 injured workers and families, including many in Delaware County and Media, protect their benefits.
Let us help you act fast, file the right petition, and build a strong case to get your benefits restored.
Call 610-892-9300, text 610-255-7183 or request a free consultation online.