Suspension of Workers’ Comp Benefits: Make Sure It Doesn’t Become a Termination

A suspension stops your workers’ compensation wage-loss checks without ending your claim. In Pennsylvania, benefits are most often suspended because you went back to work earning as much as, or more than, you earned before the injury. While the suspension is in place, your employer’s insurer remains responsible for reasonable and necessary medical treatment of the work injury, and your wage-loss benefits can be reinstated if the injury later cuts your earnings again, generally at any time within 500 weeks of the suspension.

A termination is very different. A termination ends your right to benefits for that injury, including medical treatment, because a judge found, or you agreed, that you have fully recovered. That is why the paperwork you receive or sign when you go back to work matters so much. The workers’ compensation attorneys at Schmidt, Kirifides, Rassias & Rio review these documents every day, and we can make sure a return to work doesn’t quietly cost you your future benefits.

Suspension, Modification and Termination at a Glance

How Workers’ Comp Benefits Get Suspended

There are several different routes to a suspension, and each has its own rules and deadlines.

Notification of Suspension or Modification. When you return to work at your prior or higher earnings, the insurer can suspend your benefits without going to a judge by sending you, and the Bureau of Workers’ Compensation, a Notification of Suspension or Modification within seven days of suspending your checks. If the notice is wrong, for example because you never actually went back or you are earning less than it says, you have 20 days from receiving it to challenge it. A special supersedeas hearing is then held within 21 days. If you do not challenge the notice within 20 days, it is treated as if you had signed an agreement to the suspension.

Supplemental Agreement. The insurer may ask you to sign a Supplemental Agreement suspending your benefits. It is a legally binding document. Read it carefully, and have a lawyer review it, before you sign.

Suspension Petition. In other situations, such as when the insurer claims you turned down a suitable job or voluntarily left the workforce, it must file a Suspension Petition and prove its case to a Workers’ Compensation Judge. Before an insurer can seek to change your benefits based on a doctor’s release to work, it must also send you a Notice of Ability to Return to Work.

Refusing a required medical exam. A judge can suspend benefits if you refuse, without a reasonable excuse, to attend an examination the insurer is entitled to schedule.

Challenging a Suspension

Representation by a workers’ compensation attorney, such as the workplace injury attorneys at Schmidt, Kirifides, Rassias & Rio, is especially valuable at the supersedeas stage. At a special supersedeas hearing on a challenged notice, the judge looks at a narrow question: whether you actually returned to work at the wages the notice claims. When the insurer files a petition, the judge may also decide whether to stop your payments temporarily while the case goes forward.

A supersedeas ruling is temporary. It generally cannot be appealed right away, which is why preparation for that first hearing matters. The judge’s final decision on the petition can be appealed to the Workers’ Compensation Appeal Board, generally within 20 days. Our experienced attorneys can gather the pay records and medical evidence needed at each stage, although no lawyer can guarantee the outcome of a hearing.

Returning to Work After a Suspension of Benefits

Once your wage-loss benefits are suspended, keep treating for your work injury and keep your records: medical visits, physical therapy, work restrictions and pay stubs. If the injury flares up, your hours are cut or you can no longer do the job, those records are the foundation for getting your benefits back.

Be careful with any document you are asked to sign. Some employers and insurers present a Final Receipt, which states that your disability has ended. Signing one when you have not fully recovered can jeopardize your benefits. If this has already happened, a petition to set aside the Final Receipt generally must be filed within three years of your last payment.

Getting Suspended Benefits Reinstated

Under Section 413 of the Pennsylvania Workers’ Compensation Act, suspended benefits can be reinstated when your work injury again causes a loss of earnings. This is usually done with a Petition to Reinstate. After a suspension based on your return to work, the petition generally must be filed within 500 weeks of the suspension. The insurer may argue that your lost earnings have nothing to do with the injury, for example because you were fired for misconduct, so the facts surrounding any job loss matter.

How Can Specific Loss Benefits Help?

A suspension of your wage-loss benefits does not cancel every benefit you may be owed. If your injury caused the permanent loss of use of a hand, arm, leg, foot, finger, toe or your eyesight, caused qualifying permanent hearing loss, or left you with serious and permanent scarring of the head, neck or face, you may qualify for specific loss benefits even after you are back at work. Each type of loss has its own legal test.

Our Legal Team Can Protect Your Rights

If you are planning to return to work, or you have already received a suspension notice or agreement, talk to us before a deadline passes. Our firm has represented injured workers since 1994, and our Certified Workers’ Compensation Specialists know how suspensions, supersedeas hearings and reinstatement petitions actually play out in front of Pennsylvania judges.

Whether you are reviewing a Supplemental Agreement, challenging a notice or asking a judge to reinstate your benefits, we can help. Call 610-892-9300, text 610-255-7183, or contact us online for a free consultation.