Beware of Premature Termination of Workers’ Compensation Benefits

A termination ends your workers’ compensation benefits for the work injury: both your wage-loss checks and your medical treatment. In Pennsylvania, an insurance company generally cannot terminate an accepted claim on its own. It needs your agreement or an order from a Workers’ Compensation Judge, usually after filing a Termination Petition and proving, through medical evidence, that you have fully recovered from the work injury. If your benefits are threatened by premature termination or modification, you should contact an experienced Pennsylvania workers’ compensation attorney today.

The termination of benefits attorneys at Schmidt, Kirifides, Rassias & Rio will help you fight to keep the workers’ comp benefits you are owed. You should not have to wonder how to pay your medical bills or other expenses after being hurt at work.

How an Employer May Modify or Terminate Your Benefits

Insurers use two different kinds of petitions, and the difference matters:

• A Termination Petition claims that you have fully recovered from the work injury. If the judge agrees, both wage-loss and medical benefits for that injury end.
• A Modification or Suspension Petition claims that you can work and earn something. If the judge agrees, your wage-loss checks are reduced or stopped, but medical treatment for the work injury continues and wage-loss benefits can come back later if your situation changes. Learn more about suspension of benefits.

When a Termination Petition is filed with a doctor’s sworn statement that you have fully recovered, the insurer can ask the judge to stop your payments while the case is pending. That request leads to a special supersedeas hearing, often within weeks, so your own medical evidence needs to be ready early. At the end of the case, the insurer carries the burden of proving full recovery, and the judge decides which doctors to believe.

Insurers typically build that evidence using the following tools.

Independent Medical Examination

An independent medical examination (IME) is an exam by a doctor chosen and paid by the workers’ compensation insurance company. You generally must attend when the insurer schedules one at reasonable intervals; refusing without a good reason can lead a judge to suspend your benefits. The doctor sends a report to the insurer, which may use it to argue that you have fully recovered, that you can return to work, or that treatment is no longer related to the accepted work injury. A dispute over whether treatment is reasonable or necessary is handled through Pennsylvania’s Utilization Review process.

The IME report does not stop your benefits by itself. It is evidence the insurer can use in a petition or other formal process, and your treating doctor’s opinion is evidence too. Before an insurer can use a doctor’s release to change your wage-loss benefits, it must also send you a Notice of Ability to Return to Work.

Impairment Rating Evaluation

According to Pennsylvania’s Department of Labor and Industry, an impairment rating evaluation (IRE) measures the degree of permanent impairment caused by the work injury. The insurer can request one after you have received 104 weeks of total disability benefits. If your whole-body impairment is rated below 35%, your benefits can be changed from total to partial disability.

That change is not a termination. Your weekly check stays the same and your medical benefits continue. What changes is the clock: wage-loss benefits become limited to 500 weeks of partial disability. More on how this works is on our wage-loss benefits page.

Impairment rating evaluations were deemed unconstitutional by Pennsylvania’s Supreme Court in 2017. The legislature rewrote the law in 2018 (Act 111), which set the current 35% threshold.

Vocational Counseling

Your employer’s insurance company may try to evaluate your ability to work by requesting a vocational evaluation. This will require you to meet with a vocational expert chosen by the insurance company. The evaluator will review your work history, education and restrictions to identify jobs the insurer says you can do.

Vocational evidence is used to reduce or modify wage-loss benefits based on your earning power. It does not terminate your claim or your medical benefits. The jobs identified must fit your medical restrictions and be available in your usual employment area, but they are not jobs you are guaranteed to be hired for. The expert may point to positions that have little to do with your experience. For example, if you have experience as a nurse, you would not expect to be steered toward work as a security guard. Those opinions can be challenged.

It is important to note that statements you make to a vocational expert may also be used to modify your benefits.

If your employer or insurance carrier asks you to attend any of these exams or meetings, it is likely considering an attempt to modify or terminate your benefits. Before you complete any of these tests or meetings, you should speak with an experienced workers’ comp attorney. Our firm can help you prepare for a vocational meeting or medical examination and even accompany you to ensure that your rights are not violated.

It is also important to note that these are not the only methods an employer may use to cut off your compensation benefits.

We Can Help You Fight the Termination of Benefits

If you have received a Termination Petition, or your insurer has scheduled an IME, you should consult with an experienced Delaware County termination of benefits lawyer right away. At Schmidt, Kirifides, Rassias & Rio, we have represented injured workers since 1994, and our Certified Workers’ Compensation Specialists prepare the medical evidence and testimony needed to answer the insurer’s doctor. Call 610-892-9300, text 610-255-7183, or contact us online.