The Insurance Company is Trying to ‘Suspend’ your Benefits – What Does This Mean?

May 10, 2021
Stern & Cohen

There may come a time when your employer tries to suspend, or stop, your Workers’ Compensation benefits that you have been receiving as a result of a work injury.  According to the Pennsylvania Workers’ Compensation Act, your employer can suspend your compensation benefits for the following reasons: (1) You returned to work, or there is proof of your ability to return to work, without a loss of earnings; (2) you refused reasonable medical treatment; (3) refusal to comply with an order for an expert examination or interview; (4) incarceration after conviction; (5) failure to complete and return a verification form; (6) voluntary withdrawal from the labor market; (7) total or permanent disability for a non-work-related condition; or (8) employer job offers and earning power assessments. Any suspension does not affect your medical benefits. Your employer is still on the hook and will continue to pay for reasonable and necessary medical care related to your work injury.

Fortunately, your employer cannot just stop paying your benefits without giving you notice. This can occur in several different ways.  If you have returned to work without a loss of earnings compared to what you made before you got hurt, you and the insurance company can sign a “Supplemental Agreement” to suspend your benefits.  This is a mutual agreement that your lost wage checks can stop.  The language in these Agreements can be tricky and it is still worth your while to have a workers’ compensation lawyer review it.  Once signed, your benefits are “suspended.”  As mentioned above, the insurance company still must pay for medical treatment.  One nuance here is that if you stop working again due to your injury, if a Supplemental Agreement was signed, the insurance company does not necessarily have to automatically start wage loss payments again.  If they feel as if you should have been able to continue to work, they can force litigation.  You may have to file a Reinstatement Petition in court in order to begin the payments again.  This is a critical reason why it is imperative that you have a good handle on your situation when you go back to work and make an informed decision before you sign anything.

Furthermore, occasionally, when an injured worker returns to work, rather than seek his/her cooperation in signing an Agreement, the insurance company may just file a “Notification of Suspension.”  This must be filed promptly upon the return to work.  If you receive this form, you want to consult a workers’ compensation lawyer.  If you believe your return to work will be seamless and you do not anticipate any issues, then receipt of this document may not require any action on your part.  However, if you view the return to work as a trial and you are uncertain if you can last; or, if you returned and quickly stopped work again due to pain/discomfort (or even the employer changing their mind about making a job available to you), then you need to take this document to workers’ compensation lawyer quickly.  At Stern & Cohen, we deal with these forms all the time.  You have the right to “Challenge” the form that indicates you have returned to work (even if you did, in fact, return on a brief basis).  By timely filing a Challenge, the case will get in court quickly and a skilled workers’ compensation lawyer will be able to get your wage loss benefits started again very fast.

The insurance company may also seek a “suspension” of benefits even if you have not returned to work.  This is common.  The most frequent scenario here is that while receiving benefits, the employer offers you a job.  This could be after you have attended an independent medical examination and their chosen doctor has concluded you can work; or, perhaps they try to offer a job based on a release from one of your own doctors.  Either way, if the insurance company gets the medical release and learns that a job was offered and you did not return, they may file a Suspension Petition.  Do not panic.  Speak with the lawyers at Stern & Cohen immediately.  You have every right to defend this.  Chances are, there are very good arguments to be made why you did not return to work.  We have defended thousands of cases like these and we know the strategy needed to stop an insurance company from obtaining a suspension of your benefits.

We also like to paint real-life examples, so consider the following:  You hurt your lower back while working as a plumber for ABC Plumbing.  ABC Plumbing accepts your injury and begins paying you Workers’ Compensation benefits and covers your medical bills.  The company sends you for an IME and the doctor says you can return to work in a light-duty capacity doing a sedentary job.  ABC Plumbing offers you a desk job with the same hours and same pay as before your work injury.  Your treating physicians have not released you back to work in any capacity and you know you cannot sit for eight hours a day due to your ongoing back pain, so you do not return.  In response, ABC Plumbing files a Suspension Petition seeking to stop your compensation benefits.  This is a common scenario.  We know the evidence to present in these cases to WIN on your behalf.

If you have received any indication that the insurance company is trying to “suspend” your benefits, reach out to our office and we will guide you through the process.  The call is always FREE.