The Insurance Company is Trying to ‘Suspend’ your Benefits – What Does This Mean?
A workers’ compensation suspension occurs when an employer or insurance company seeks to stop an injured worker’s wage loss benefits, often because the worker has returned to work, been offered suitable employment, or is otherwise no longer considered disabled under Pennsylvania law. While a suspension can affect wage loss benefits, it generally does not impact medical benefits related to the work injury
Understanding a Workers’ Compensation Suspension
Receiving notice that the insurance company is trying to suspend your benefits can be alarming. Fortunately, a suspension does not automatically mean you lose your workers’ compensation case.
In Pennsylvania, a suspension typically affects only wage-loss benefits. The insurance company generally remains responsible for reasonable and necessary medical treatment related to your accepted work injury.
Insurance companies commonly seek a suspension when they believe:
- You returned to work without a loss of earnings
- You are capable of returning to work
- You refused suitable employment
- You voluntarily left the workforce
- You failed to return required forms or information
Every situation is different, and many suspension requests can be challenged.
Returning to Work and Supplemental Agreements
One of the most common reasons for a suspension is a return to work. If you return to work earning the same wages you earned before your injury, the insurance company may ask you to sign a Supplemental Agreement suspending your wage-loss benefits.
Before signing any workers’ compensation paperwork, it is important to understand the consequences. If your symptoms worsen and you later stop working because of your injury, the insurance company may not automatically restart your benefits. In some situations, you may need to file a Reinstatement Petition to have wage-loss benefits restored.
Notifications of Suspension
Sometimes the insurance company files a Notification of Suspension instead of asking you to sign an agreement. This commonly occurs after an injured worker returns to work.
While some employees successfully return to work without further issues, others discover that the job is too physically demanding or that the employer cannot continue accommodating their restrictions.
If your return to work was unsuccessful, you may have the right to challenge the suspension and pursue reinstatement of your benefits.
Job Offers and Suspension Petitions
A suspension can also be requested even if you have not returned to work.
This often happens after:
- An Independent Medical Examination (IME)
- A release to light-duty work
- A modified-duty job offer from the employer
If the insurance company believes suitable work is available and you do not return, it may file a Suspension Petition.
Receiving a Suspension Petition does not mean the insurance company automatically wins. You have the right to present evidence explaining why you could not perform the job or why the offered position was not appropriate.
Example of a Workers’ Compensation Suspension
Imagine you suffer a serious back injury while working as a plumber.
The insurance company sends you to an IME doctor who concludes that you can perform sedentary work. Based on that opinion, your employer offers you a desk job with the same pay and hours you worked before your injury.
However, your treating doctor has not released you to return to work, and your ongoing pain prevents you from sitting for extended periods.
If you decline the position, the insurance company may file a Suspension Petition seeking to stop your benefits.
In a situation like this, medical evidence and testimony often become critical to determining whether the suspension should be granted.
What to Do If the Insurance Company Is Trying to Suspend Your Benefits
If you receive any notice that the insurance company is attempting to suspend your workers’ compensation benefits:
- Do not ignore the paperwork
- Do not assume your benefits must stop
- Keep copies of all documents you receive
- Continue treating with your doctors
- Speak with an experienced workers’ compensation attorney as soon as possible
The sooner you understand your rights, the better positioned you may be to protect your benefits.
Talk to a Pennsylvania Workers’ Compensation Lawyer
A suspension of benefits does not necessarily mean the insurance company is entitled to stop paying wage-loss benefits. Many suspension cases involve disputes over medical restrictions, job offers, and a worker’s ability to return to employment.
At Stern & Cohen, we help injured workers throughout Pennsylvania defend against Suspension Petitions, challenge improper benefit suspensions, and protect their right to workers’ compensation benefits.
Contact Stern & Cohen today for a free consultation.
FAQs
What is a workers' compensation suspension in Pennsylvania?
A suspension is an attempt to stop wage-loss benefits while generally leaving medical benefits in place.
Does a suspension stop my medical benefits?
Usually no. In most cases, medical benefits related to the accepted work injury remain available.
Can the insurance company suspend my benefits if I return to work?
Yes. If you return to work without a loss of earnings, the insurance company may seek to suspend wage-loss benefits.
Can I challenge a workers' compensation suspension?
Yes. Injured workers have the right to challenge suspensions and present evidence supporting continued entitlement to benefits.