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Termination Or Cessation Of Workers’ Compensation Benefits

Termination Forms

Workers’ compensation insurance provides benefits crucial for injured workers. Circumstances can arise where these benefits may cease or terminate. Knowing the processes and reasons around the termination of benefits can help injured workers with their workers’ compensation case.

Pre-Litigation Forms

Agreement To Stop Weekly Workers’ Compensation Benefits (Final Receipt) – LIBC-340

Also called a “Final Receipt.” The worker signs this form in agreement to stop receiving workers’ comp benefits. By signing this form, the worker may terminate benefits. But, the insurance company may still cover medical expenses related to the work injury.

Supplemental Agreement For Compensation – LIBC-337

Known as the “Supplemental Agreement.” The worker and employer use this form to agree to adjust the benefits. If the worker’s disability has ceased, this form could terminate both indemnity and medical benefits.

Litigation Forms

Petition To Terminate Compensation Benefits – LIBC-378

Employers use this form to request the termination of benefits. A workers’ compensation judge decides this petition.

Physician’s Affidavit of Recovery – LIBC-497

A doctor completes this affidavit to declare an injured worker fully recovered and no longer in need of benefits. 

Injured worker celebrating full recovery, standing confidently with a cast and crutches in a workplace environment, with a sunny sky symbolizing a positive and bright future.
While employers try to stop benefits, injured workers have options.

What Causes Workers’ Comp Benefits To Terminate?

Full Recovery

Benefits terminate when an injured worker reaches full recovery. Substantial medical evidence must show the full recovery. An independent medical examination (IME) often provides support for this conclusion. This typically requires a physician’s affidavit or the worker’s signed final receipt.

Specific Scenarios For Fatal Claims

Meretricious Relationship or Prostitution:

Benefits can terminate if the dependent engages in a meretricious relationship or lives a life of prostitution.

Remarriage or Change in Dependency Status:

Death benefits for dependents may stop upon remarriage, death, or a change in the dependency status. For example, a widower who remarries can lose their benefits.

What Causes Workers’ Comp Benefits To Cease?

Death From Unrelated Causes

If an injured worker dies from causes unrelated to the workplace injury, the obligation to pay benefits typically ends. However, specific loss benefits may still apply.

Running Of The Statutory Period For Partial Disability

Workers’ compensation benefits for partial disability have a maximum statutory period of 500 weeks. Once this period ends, the benefits will cease by law.

Pre-Litigation Procedures

Final Receipt

A final receipt refers to a signed agreement in which the employee agrees to stop receiving benefits. Even after signing a final receipt, the insurance carrier may still pay reasonable and necessary medical expenses.

Supplemental Agreement

Both parties can agree to terminate benefits through a supplemental agreement. It must include a statement that the worker’s disability has ended.

Agreement For Compensation

Both the worker and employer sign this type of agreement. It can include terms that terminate benefits if it clearly states the end of disability.

Two people shaking hands over a table with documents and a pen, symbolizing a successful workers' comp agreement in a professional office setting.
Sometimes workers’ compensation claims resolve with an agreement

Litigation Process For Terminating Benefits

Burden Of Proof

In litigation, the insurance company bears the burden of proof to show that the worker’s disability has ended. This requires medical evidence. It must show a full recovery and the ability to return to work without restrictions.

Key Points In Proving Full Recovery

  • Medical Opinions: The insurance carrier must present medical opinions that unequivocally state the worker has fully recovered.
  • Employee’s Condition: The employer must prove that any current disability does not relate to the work injury.

Termination Of Lifetime Benefits

Full Recovery

An injured worker no longer has entitlement to benefits once fully recovered. Employers must obtain a final receipt or file a petition for termination to formalize this.

Partial Recovery

Even if an employee has partially recovered, benefits may still terminate. This may happen if proven that the employee’s current condition does not relate to the work injury.

Termination Not Proper

Benefits cannot terminate solely based on the worker’s ability to return to work. The evidence must show that all disability related to the work injury has ceased.

Workers’ Comp Lawyer

Injured workers should know their rights and the evidence needed to challenge or accept the termination of their benefits. If you receive a termination, you need to speak with a Pennsylvania workers’ compensation lawyer. They can help in dealing with the insurance company, filing forms, and representing you before a workers’ compensation judge.

A knowledgeable lawyer can help you handle your workers’ compensation claim, ensuring you receive the benefits you deserve. For personalized help, reach out to our offices 24/7 for a free consultation  (215) 609-4183.

Independent Medical Examinations & Impairment Ratings

Injured workers in PA should know some of the procedures they may face during their claim. Certain procedures can determine the extent of the injury, the ability to work, and the compensation received. Here, we will cover Independent Medical Examinations (IMEs), expert interviews, and Impairment Rating Evaluations (IREs).

What Does Independent Medical Examination (IME) Mean?

An Independent Medical Examination (IME) refers to a medical evaluation performed by a doctor chosen by your employer or their insurance company. An IME aims to obtain an objective assessment of the medical condition following a work-related injury. Research shows these exams tend to favor the employer much more than a treating physician.

Many stakeholders report these examinations as barely an exam and not independent. But, employers have the right to request that injured workers undergo an IME at a reasonable time and place. This exam may allow the employer to dispute the extent of the injury and any ongoing medical treatment. It also allows them to challenge the worker’s medical restrictions.

@thwesq Replying to @laurencepatterso8 unfortunately, the financial incentive for these doctors seems too far out weigh any moral compass they may have had. Independent medical exams are not independent, and they are barely a medical exam. #workersrights #workerscomp #lawyer #workinjurylawyer #workinjury ♬ original sound – Tom Wing | Workers Comp Lawyer

Why Does An Employer Request An IME?

Employers often request an IME to gather a second opinion about the medical condition from a friendly party. An IME can provide evidence on the diagnosis, the current treatments, and the prognosis for returning to work. This can save the employer money on claims. IMEs help employers to challenge parts of an employee’s claim.

What If I Refuse To Attend An IME?

Refusing to comply with an order for an IME can lead to serious consequences. The Pennsylvania Workers’ Compensation Act addresses this. If you miss an IME without reasonable cause, you risk losing your benefits during this period. This means they could suspend wage loss and medical benefits.

How Often Can My Employer Request An IME?

The frequency of IMEs can vary. Typically, employers may request an IME every six months. This can depend on the circumstances of the case and the discretion of the Workers’ Compensation Judge (WCJ).

May I have My Own Doctor Present During An IME?

Yes, you have the right to have your own healthcare provider there during the IME. However, your doctor’s role remains limited to observing the exam. They cannot interfere, videotape or audiotape, question the examiner, or help you in responding to questions. Your lawyer may hire a nurse to attend the exam as well.

Independent Medical Examination (IME) scene showing a patient being examined by a doctor in a medical office, with medical instruments, records, and anatomical charts visible in the background, representing the detailed assessment process for workers' compensation claims.
A patient examined by a doctor for a workers’ compensation claim.

Understanding Expert Interviews

What Happens At A Vocational Expert Interview?

Vocational expert interviews assess the injured worker’s earning power when receiving workers’ comp. They look at their ability to return to work. They also determine the type of work they can perform, given the injury. The insurer can require the worker to submit to an interview with a vocational expert.

Why Conduct Vocational Expert Interviews?

The main purpose of a vocational expert interview involves assessing the worker’s earning capacity. They consider the worker’s education, work experience, skills, and current labor market conditions. Then, they will determine the types of jobs that might suit the injured worker.

The findings from the vocational interview can impact the continuation or modification of workers’ comp benefits.

What Qualifications Does A Vocational Expert Have?

Vocational experts must adhere to the criteria set forth by the Bureau of Workers’ Compensation. They must have a Commission on Rehabilitation Counselor Certification and one year of experience analyzing labor market conditions. Or, a bachelor’s degree and work under the direct supervision of someone with these qualifications.  

What If I Refuse To Attend A Vocational Expert Interview?

Refusing to attend a vocational expert interview can result in the suspension of benefits. The WCJ has the authority to enforce attendance at these interviews. They can also suspend benefits for failure to comply without reasonable cause.

Impairment Rating Evaluations (IREs)

What Does IRE Mean?

An IRE refers to a medical assessment used to determine the extent of permanent impairment from a work injury. An IRE aims to establish the degree of the body impairment and classify the disability status.

IREs must use the sixth edition of the American Medical Association Guides to the Evaluation of Permanent Impairment. The results of an IRE can impact the duration and amount of workers’ comp benefits.

How Does An IRE Affect Disability Status?

The IRE’s outcome determines whether the disability status remains classified as totally disabled or changes to partial disability. If the impairment rating hits 35% or higher, total disability benefits will continue.

If the impairment rating is less than 35%, the status will change to partial disability. This change means receiving partial disability benefits. While the name of the benefit changes, the amount of the benefit stays the same. However, an injured worker can only receive partial disability benefits for a maximum of 500 weeks.

What If I Disagree With The IRE Results?

If you disagree with the results of an IRE, you may be able to appeal the decision. This would involve filing a petition for review with the Bureau of Workers’ Compensation or hiring your own expert.

Patient reaching Maximum Medical Improvement (MMI) in a medical office, with a doctor explaining the stabilized condition using medical charts and x-rays. The patient looks relieved and hopeful, highlighting the recovery progress and thorough discussion about the condition.
Patient reaching Maximum Medical Improvement (MMI) in a medical office.

Reaching Maximum Medical Improvement (MMI)

What Does MMI Mean?

Maximum medical improvement (MMI) refers to a vital point in the recovery. It means the medical condition has stabilized and will likely not improve that much with further treatment.

An injured worker must reach MMI before an impairment evaluation. It can also impact decisions regarding your workers’ compensation claims.

Understanding the Editions of the Guides

The American Medical Association Guides to the Evaluation of Permanent Impairment, often referred to simply as the “Guides.” They serve to assess the extent of an injured worker’s permanent impairment.

Different editions of the Guides appear over time, each incorporating updated medical knowledge and assessment techniques. The sixth edition, currently used for IREs in PA, includes comprehensive criteria for evaluating various types of impairments and determining the overall impairment rating.

Wrap Up

Know your rights. For help with your workers’ comp case, consult with a workers’ compensation lawyer. An experienced lawyer can help secure the benefits you need to support your recovery and future well-being. For a free consultation, reach out to our offices 24/7 at (215) 609-4183.

How Does Workers’ Comp Work in PA?

Workers’ compensation ensures employees receive financial support and medical care in cases of work-related injuries or illnesses. This blog post aims to explain how workers’ comp works under the Pennsylvania Workers’ Compensation Act. We will only focus on PA workers’ compensation laws here.

Understanding Workers’ Compensation in Pennsylvania

What is Workers’ Compensation?

Workers’ comp is a state-mandated insurance program, designed to protect employees. These protections cover employees with injuries and illness caused by their work.

In PA, the Pennsylvania Bureau of Labor and Industry administers workers’ comp. This program helps employees get compensation for their medical expenses and lost wages. It also protects employers from lawsuits related to workplace injuries.

Am I Covered?

PA requires nearly all employers to provide workers’ comp coverage to their employees. This includes both private and public sector employers. However, some exceptions exist, such as sole proprietors and certain agricultural workers.

Types of Injuries Covered

PA workers’ compensation covers a broad range of work-related injuries and illnesses. This includes accidents like slips and falls. It also covers conditions that develop over time, such as repetitive stress injuries or occupational diseases.

The Workers’ Compensation Claim Process

Reporting an Injury

When an employee suffers an injury or work-related illness, they should promptly report the injury to their employer.

Reporting must occur within 21 days of the injury or diagnosis to qualify for retroactive back pay. If the employee fails to report the injury within 120 days, they lose all entitlement.

This means the end of the workers’ comp claim and the employee will not qualify for any workers’ comp benefits. Reporting ensures that the claims process can begin in a timely manner.

Seeking Medical Treatment

Workers’ comp covers all reasonable and necessary medical expenses related to the work-related injury or illness. Employees have the right to choose their own healthcare provider.

But, there can be limitations within the first 90 days of a claim. Often, that would necessitate an employee to receive medical treatment through an employer’s approved panel of doctors. The panel may allow the injured worker to seek medical treatment without delay.

Filing a Claim

When loss of work from an injury exceeds/expects to exceed more than 7 days, the employer must file a formal workers’ compensation claim. The Pennsylvania Bureau of Workers’ Compensation receives this notification. The employee receives notification and the claims process begins.

Investigation

Once filed, the employer or its insurance company will investigate the claim and the circumstances surrounding the injury. Interviews of both the employer and the injured employee may happen during this process.

With an accepted claim, the injured employee will receive compensation and notice in the mail. With a denied claim, the injured worker would need to file the appropriate petition.

Benefits

Workers’ comp benefits include medical benefits, wage loss benefits, and specific loss benefits.

Medical benefits cover all reasonable and necessary medical expenses related to the injury or illness. Wage loss benefits provide compensation for lost wages during the recovery period. Temporary Total Disability (TTD) benefits also refer to wage loss benefits.

When an injured worker has wage loss, while continuing to work, Temporary Partial Disability (PTD) benefits would apply. Specific loss benefits provide for permanent disfigurement or loss of use or loss of a body part.

Legal Aspects of Workers’ Comp in PA

Employer Responsibilities

Employers have several responsibilities in workers’ compensation.

They must carry proper insurance coverage. They must post notices about workers’ comp in an obvious location.

They must accept or deny liability within 21 days of the injury. They must send written notice of the claim’s acceptance or denial to the injured worker.

Injured employees should not fear reporting their injuries. Employers also cannot retaliate against employees for filing a workers’ compensation claim.

Employee Rights

Employees have certain rights in workers’ compensation in PA.

They have the right to receive medical treatment for their work-related injuries. They have the right to receive wage loss benefits if they are unable to work or are working at a wage loss. They have the right to appeal decisions on denied claims.

Employees should understand their rights and exercise these rights to protect their interests.

Dispute Resolution

Disagreements can arise during the workers’ comp process. With a denied claim, an employee can request a hearing before a workers’ compensation judge. This allows both parties to present evidence and arguments, and the judge will make a decision.

The Workers’ Compensation Appeal Board and the Commonwealth Court, if necessary, hear appeals.

Denied Workers' Compensation Claim Process Diagram - Detailed visual guide illustrating the step-by-step appeal process for denied workers' comp claims in Pennsylvania, featuring the initial denial notice, Workers' Compensation Judge review, Workers' Compensation Appeal Board examination, Commonwealth Court appeal, and potential PA Supreme Court review. Ideal for individuals navigating the complexities of workers' compensation denials.
How the court process works for Workers’ Comp

Attorney Involvement

An attorney, though not required, can add serious benefit. When complex cases and claim disputes arise, a workers’ comp attorney knows what to do.

Lawyers can provide legal guidance and protect the rights of the injured worker. They can calculate the average weekly wage, making sure injured workers receive the compensation they deserve.

Attorneys can protect the injured workers, making sure they do not return to work until medically able. They can make sure the notice of compensation payable lists all injuries include.  Lawyers can also make sure your medical bills do not end up on your credit report.

Questions and Concerns

Will My Employer Fire Me for Filing a Workers’ Comp Claim?

PA law prohibits employers from firing or retaliating against employees for filing workers’ compensation claims. If an employee faces such retaliation, they have the right to take legal action.

How Long Can Workers’ Comp Benefits Last?

The duration of workers’ compensation benefits in PA varies depending on the circumstances of the injury or illness. Temporary Total Disability (TTD) benefits may be available as long as the employee remains unable to work. Other benefits may have different durations.

Can I Choose My Doctor?

Employees have the right to choose their own healthcare provider, from the list of approved providers, within the first 90 days of a claim. However, the employer must follow all its obligations for this to apply. After the initial 90 days an employee can treat with any medical provider. This allows injured workers to receive treatment from a trusted medical professional.

Will Workers’ Comp Offer a Settlement?

Many workers’ comp cases settle for a lump sum. A lawyer can often help to negotiate a higher settlement. Use our free settlement calculator to estimate the value of your case online.

@thwesq Will workers comp offer a settlement without a lawyer? #theymight #lawyer #pennsylvania #getpaid #workinjury ♬ Breaking News Background Music (Basic A)(1001538) – LEOPARD

Conclusion

Workers’ comp helps employees receive financial support and medical care after an injury or illness caused by their work.

Understanding how workers’ comp works in PA is essential for both employers and employees. This upholds everyone’s rights and responsibilities under the program.

Talk to a workers’ comp lawyer today for a free case evaluation. Let us answer your questions about your rights in your workers’ compensation claim.