How and Why Can my Workers’ Compensation Benefits be Terminated?

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Workers’ Compensation insurers must follow certain procedures in order to lawfully terminate or reduce Massachusetts workers’ compensation benefits.  The procedure for modification or termination varies greatly depending on how long the insurance company has been paying benefits.

THE FIRST 180 DAYS AFTER YOUR DISABILITY BEGINS

If the insurer has began to make payment of weekly benefits to you timely, namely within 14 days of notice, the insurer is allowed to stop payments to the employee without obtaining approval of the Department of Industrial Accidents (“DIA”) or the consent of the employee. However the insurer is required to give the employee seven(7) day written notice of their intent to stop benefits. The insurer’s written notice of termination must state their reasons and advise the employee of his or her rights to file a claim for further benefits.  If you return to work at the same rate of pay you were earning prior to your injury, the insurer may terminate benefits effective the last day you were disabled prior to your return to work.  If your own treating doctor clears you to return to your previous job, the insurer may terminate benefits regardless of whether or not your prior job remains available to you.

AFTER 180 DAYS

Once the 180 day period expires the Workers’ Compensation Act makes it much more difficult for the insurer to stop benefits. Basically, they cannot stop benefits on their own. The reason must be specific and be one of the following: 1) The termination was ordered by a judge at the DIA; 2) was assented to in writing by the employee; 3) the employee returned to work with no wage loss; 4) the insurer has a medical report from the attending physician indicating that the employee is capable of returning to work with a certification that the attending doctor has reviewed a written job description of the employee’s job and the insurer has a letter from the employer indicating that said job is open and ready; 5) where the employee has exhausted the maximum period of benefits; 6) were terminated because the employee failed to provide the insurer with a written request for earning records and; 7) several other technical and specific reasons that are beyond the scope of this brochure. The important thing to remember, however, is that after 180 days of payment, the insurer cannot stop compensation on their own whim, whereas they can basically do that prior to the 180th day.

WHAT IS THE AGREEMENT TO EXTEND THE 180 DAY PAYMENT WITHOUT PREJUDICE (FORM 105)?

Signing the Agreement to Extend 180 Day Payment Without Prejudice Period form sent to you by the workers’ compensation insurer can have an extremely negative impact on your claim. Insurance companies will send you this form under the guise that they are doing you a favor and agreeing to pay you for another 180 days, however by signing this form you are giving up legal rights and you may expose yourself to allowing the insurer to legally terminate benefits and put you in the position where you could go many months with no benefits while you fight the insurance company in court. If you have received an Agreement to Extend 180 Day Payment Without Prejudice Period (Form 105) by your employer’s workers’ compensation insurance company, you should immediately contact one of our Boston workers’ compensation attorneys immediately.

If a workers’ compensation insurer has terminated your benefits, you should immediately contact one of our workers’ compensation attorneys to discuss how we can help you get your benefits reinstated. There are many laws that an insurance company must follow when attempting to terminate your benefits.  It is wise to have an attorney review all documents related to your claim to determine whether the insurer has lawfully terminated benefits.  In some instances, an unlawful termination of benefits can result in an immediate reinstatement of benefits once an attorney files a claim for you.