Workers’ Compensation benefits can end for many reasons. Sometimes, those benefits may be able to be resumed. Other times, those benefits may have ended and cannot be resumed. It is recommended that you seek legal advise to see if benefits can be pursued.
The following are various reasons why Workers’ Compensation benefits end.
Compromise and Release
If you enter into a settlement agreement called a Compromise and Release, you may have terminated your benefits by agreeing to that lump sum payment or structured settlement. Sometimes, however, some Compromise and Release settlements provide for open medical care. Review your document carefully to see what has been resolved via your agreement.
Determinations of a Physician
Benefits can end if a Treating Physician, Qualified Medical Evaluator or an Agreed Medical Evaluator makes a finding on your case. A Physician may find that you are no longer totally temporarily disabled and TTD benefits can be cut-off. A Physician may find no permanent disability and on that basis, PD benefits can be cut-off. A Physician may find no work-related injury to the body part(s) evaluated and upon that basis the claim can be denied and benefits would accordingly be cut-off.
Determination of the Insurance Company
An insurance company can terminate benefits for a variety of reasons. Mostly, they deny benefits based upon a failure to receive documentation to support payments of benefits. They can terminate benefits based upon a failure of the injured worker to attend evaluations and obtain disability reports. They can terminate benefits if the your treating doctor does not submit proper paperwork. They can terminate medical care if your treating physician does not submit proper paperwork for authorization of treatment.
Determination of the Workers’ Compensation Appeals Board
The WCAB can suspend benefits for failure to attend evaluations. The WCAB can dismiss a case if there is a failure to prosecute the case. Further, the WCAB in approving Compromise and Releases or Stipulated Awards, can terminate benefits or limit them. Finally, the WCAB can terminate benefits as part of a court decision which is called a Findings and Award.
The Labor Code may limit your benefits
For injuries on or after 4/19/2004, total temporary disability benefits are limited to 104 weeks in some cases. In other cases, 240 weeks apply. This is in cases of (A) Acute and chronic hepatitis B, (B) Acute and chronic hepatitis C, (C) Amputations, (D) Severe burns, (E) Human immunodeficiency virus (HIV), (F) High-velocity eye injuries, (G) Chemical burns to the eyes, (H) Pulmonary fibrosis and (I) Chronic lung disease. Once the limits have reached, benefits will be cut-off.
Some modalities of treatment are also limited. Namely, there is a Labor Code Section which indicates that you shall be entitled to no more than 24 chiropractic, 24 occupational therapy, and 24 physical therapy visits per industrial injury. There may be some ways to get around this limit based upon certain circumstances.
Law Office of Edward J. Singer
Contact the Law Office of Edward J. Singer if you have any questions concerning Worker’s Compensation and the benefits to which you may be entitled. He has over 23 years of experience handling these types of cases and will aggressively protect your rights, getting you the compensation you deserve and the peace of mind you need.