Boston Workers Compensation Lawyer Blog
Few moments are more unsettling for an injured worker than discovering that workers’ compensation benefits have stopped or been reduced. For many families, weekly checks are the primary source of income while an injury heals. When those payments change suddenly, the financial impact can be immediate.
Two things are critical at the outset: (1) workers’ compensation benefits can be reduced or terminated only for specific reasons, and (2) the insurer’s ability to do that depends heavily on whether you are still within the first 180 days of payments. This post explains common cutoff scenarios in Massachusetts, how the 180-day “payment without prejudice” period works, and what to do if your checks stop.
The 180-Day “Payment Without Prejudice” Period
Massachusetts workers’ compensation insurers can start paying weekly benefits “without prejudice” for up to 180 days. In plain English, the insurer can pay benefits without admitting the claim and still preserve the right to later deny liability or stop paying—as long as it takes the required action within that 180-day window.
This is why injured workers are often surprised. Checks arrive for months and treatment continues, but the insurer may still be investigating, reviewing prior records, and scheduling an IME—while continuing to pay “without prejudice.”
What the insurer can do during the first 180 days
During this period, the insurer typically has more flexibility to:
- stop weekly checks;
- reduce the weekly rate (for example, by disputing wage calculation or claiming an earning capacity);
- change the type of benefit being paid; and/or
- dispute causal relationship or extent of disability.
In many cases, the insurer can take these actions without first obtaining a judge’s order, so the injured worker may need to move quickly at the Department of Industrial Accidents (DIA).
Why insurers often “push” before day 180
Once the insurer pays beyond 180 days, the ground shifts: the insurer generally must use the DIA process to attempt a reduction or termination. That is why you will often see IMEs scheduled close to day 180 and increased return-to-work pressure as the deadline approaches.
After Day 180: What Must Happen Before Benefits Can Be Reduced or Stopped
If the insurer makes weekly payments past the 180-day period, benefits are no longer “without prejudice.” From that point forward, the insurer generally must take formal steps to try to reduce or terminate benefits, and it must prove its position through the DIA process.
The typical framework looks like this:
- The insurer files a complaint at the DIA seeking modification (reduction) or termination of benefits.
- The dispute is scheduled for a conference before an administrative judge.
- If the case is not resolved, it may proceed to a hearing where evidence is presented more fully.
- The insurer must support its position with credible evidence—often medical, and sometimes vocational—rather than simply asserting “you can work.”
What “payment beyond 180 days” looks like in real life
If the insurer keeps paying checks past day 180, it generally cannot later decide to stop payments by simply sending a letter. Instead, it must affirmatively go to the DIA and seek permission to change benefits. That usually means a filed complaint, a scheduled conference, and a judge’s order before benefits can be reduced or terminated.
Common examples we see include:
- the insurer continues paying while it “waits for the IME report,” then tries to stop checks after the report comes in;
- the insurer pays past 180 days and then claims you have an earning capacity based on a light-duty job that was never realistically available; or
- the insurer pays for months, then argues your ongoing symptoms are “pre-existing” after reviewing old medical records.
In these situations, the procedural posture matters. If payments extended beyond 180 days, the insurer typically must prove its case through the DIA process, and the worker’s response should focus on (1) enforcing the correct procedure and (2) building strong medical documentation of ongoing restrictions.
What not to do after a cutoff notice
Do not ignore the mail, stop treatment, or assume the insurer “must be right.” And avoid trying to fix the case by returning to work against restrictions. If you attempt work you cannot sustain, document it and speak to counsel—failed return-to-work attempts can be powerful evidence when presented correctly.
Common Reasons Insurers Try to Cut Off Benefits (And What They’re Really Arguing)
Insurers usually reduce or terminate benefits for one of a few recurring reasons. The stated reason on paper may be brief, but the real dispute tends to fall into one of these buckets.
1) “You’re no longer disabled.”
This is the most common. The insurer claims you have recovered enough to return to work, or that restrictions are no longer supported. Often this argument is based on:
- an IME report,
- a note suggesting you are “improving,” or
- a single exam where you appeared to be moving better.
How to respond: treat consistently and make sure your providers document functional limits (standing, walking, lifting, reaching, sitting tolerance, and endurance). Disability in workers’ comp is about earning capacity, not whether you can do a few tasks on a good day.
2) An IME is used as the justification.
Insurers frequently require Independent Medical Exams (IMEs). Despite the name, the exam is arranged and paid for by the insurer. Many IME doctors see the worker once and issue opinions that minimize symptoms or attribute them to pre-existing conditions.
How to respond: attend the IME (missing it can create a separate problem), be accurate and calm, and then continue treating. If the IME report is used to cut off benefits, the dispute often becomes a “treating doctor vs. IME” evidence battle at the DIA.
3) “You have an earning capacity” or “light duty is available.”
Insurers may reduce benefits by assigning an earning capacity, even when you have not actually secured work. This can happen if:
- the employer offers a light-duty job that does not meet restrictions, or
- the insurer claims suitable jobs exist in the labor market.
How to respond: document restrictions and job demands, keep copies of any job offer, and record what happened if a return-to-work attempt fails. The key issue is whether suitable work is realistically available given medical limits, training, education, and work history.
4) “You failed to cooperate.”
Sometimes the insurer argues benefits should stop because you missed an IME, did not provide requested information, or did not participate in vocational efforts. In other cases, notices were unclear or sent to the wrong address.
How to respond: keep copies of everything, confirm appointments in writing when possible, and do not ignore DIA notices. If something is missed, address it immediately.
5) Surveillance or social media is misused.
Insurers may hire investigators. Short clips or photos can be taken out of context to suggest you are more capable than claimed.
How to respond: assume you may be watched, keep social media private, and make sure restrictions and symptoms are well documented in medical records. Strong, consistent medical evidence is the best answer to selective surveillance.
What To Do Immediately If Your Checks Stop or Drop
If your weekly checks are reduced or terminated, act deliberately and quickly.
Step 1: Identify where you are in the 180-day timeline
Ask: Were benefits paid only within the first 180 days, or did payments extend beyond 180 days? That fact often determines what the insurer was allowed to do and what procedures it must follow.
Step 2: Read the insurer’s notice and track deadlines
Look for:
- the stated reason for the change,
- any scheduled conference/hearing date,
- whether a complaint has been filed, and
- any deadline to respond.
Step 3: Keep treating and avoid gaps
Gaps in treatment are one of the easiest ways for insurers to argue you must be “better.” Continue care and follow recommendations unless your doctor advises otherwise.
Step 4: Preserve evidence
Keep a file with insurer correspondence, benefit payment records, and current work restrictions. If you can, keep a simple symptom log that matches what you tell your doctors.
Step 5: Talk to an experienced workers’ comp attorney
Benefit cutoffs are often winnable, but they are also procedural. An attorney can evaluate whether the insurer followed the post-180-day rules (if applicable), build the right medical and vocational record, and move quickly at the DIA to seek reinstatement and back pay when appropriate.
Bottom Line: A Cutoff Is Not a Final Decision
A benefit reduction or termination is usually an insurer position—not a final ruling. Many workers have benefits reinstated after a conference, hearing, or additional medical evidence. The key is understanding the 180-day timeline, enforcing the procedural rules, and presenting credible proof of ongoing disability.
At Carney, Rezendes & Crowley, we represent injured workers across Massachusetts in disputes involving benefit reductions, IMEs, return-to-work pressure, and post-180-day termination attempts. If your checks were cut off or reduced—or you are worried they will be—getting advice early can protect your income, your medical care, and your future.
