Suspension Of Benefits In PA Workers’ Comp
What Can Suspend My Benefits?
Return To Work With Residual Impairment
Benefits may stop if a worker returns to work with some impairment, but without the loss of earnings or earning power. The Pennsylvania Workers’ Compensation Act addresses this. It states if a worker can do their job without a significant loss of income, they may not qualify for more benefits. This applies even if the worker has not fully recovered from their work-related injury.
Refusing Reasonable Medical Treatment
Benefits can face suspension if a worker refuses reasonable medical treatment. The Act states employees must comply with the recommended medical services. This covers things like: surgical, medical, and hospital services, treatment, medicine, and supplies. Refusal to do so can result in forfeiture of compensation for any injury or increased incapacity.
Refusal To Comply With Exam Or Interview Order
If a worker refuses a medical exam or interview related to their claim, their benefits can face suspension.
Incarceration After Conviction
If incarcerated after the conviction of a crime, the worker’s benefits will face suspension. The incarceration has removed that individual from the workforce, making them ineligible for benefits.
Failure To Complete And Return Employee Verification Form
Workers must complete and return their verification forms to confirm ongoing eligibility for benefits. Failure to do so may cause the suspension of benefits until compliance.
Voluntary Withdrawal From The Labor Market
If a worker chooses to leave the workforce, benefits can face suspension. For example, retirement or choosing not to seek employment.
Total And Permanent Disability From A Non-Work-Related Condition
When a worker becomes totally and permanently disabled from a condition unrelated to work, the employer can suspend benefits. This may occur because the non-work-related condition hinders any chance of the worker’s return to work. *This refers only to workers’ comp and not to total disability benefits.
Employer Job Offers And Earning Power Assessments
Employers can offer jobs that meet the worker’s capability post-injury. If a worker turns down such an offer without justifiable reason, their benefits may face suspension.
The Act requires employers to assess the earning power of the employee. This helps to ensure an appropriate and fair offered position.
Pre-Litigation Procedures For Suspension
Notification And Forms
Employers must follow specific procedures to suspend benefits. This includes notifying the employee in writing and using the designated forms. For instance, LIBC-751 (Notification of Suspension or Modification) and LIBC-762 (Notice of Suspension for Failure to Return LIBC-760).
Cessation Of Compensation
The cessation of benefits typically happens in one of the following ways. Compensation can stop through a final receipt, supplemental agreement signed by the employee, or notification of suspension or modification. If the worker disputes the suspension within 20 days, a supersedeas hearing will occur to address the matter.
What Happens During Litigation?
Burden Of Proof
The employer bears the burden of proof in litigation when it comes to the suspension of benefits. They must meet certain conditions. For example, proving the worker’s ability to return to work or the refusal to follow medical treatment.
Special Cases
Several notable cases that illustrate various aspects of the suspension of benefits:
- Landmark Constructors, Inc. v. WCAB:
Employers must demonstrate job availability if the employee can return to work without restrictions.
- Brandywine Mazda Suzuki v. WCAB:
Misconduct by an employee prior to the injury does not remove the employer’s obligation to prove job availability.
- Crowell v. WCAB:
The employer cannot suspend benefits if the employee cannot perform the pre-injury job without significant pain.
How Does Refusal Of Medical Treatment Affect Benefits?
Forfeiture vs. Suspension
The refusal of medical treatment can lead to the forfeiture or the suspension of benefits. Forfeiture removes the worker’s right to benefits during the refusal period. Suspension pauses the benefits until the worker complies with the treatment.
This distinction matters. For instance, cases where the worker’s medical condition depends on doing the recommended medical procedures. Also, in situations where the worker’s ability to return to work depends on undergoing the medical treatment.
Employer’s Burden
The employer must prove the reasonableness of the medical treatment and that the worker unjustifiably refuses it. If treatment involves minimal risk and a high likelihood of success, refusal can lead to the suspension of benefits. The employer must show that the refusal directly impacts the worker’s recovery and ability to return to work.
Impact Of Incarceration On Benefits
Automatic Suspension
Benefits automatically suspend upon an worker’s incarceration after a conviction. This self-executing suspension does not require a petition. The incarceration significantly changes the worker’s status and ability to work, justifying the suspension of wage loss benefits.
Scope Of Incarceration
Suspension applies to all forms of incarceration, including detention in alcohol recovery facilities and halfway houses. House arrest also qualifies as constructive custody, leading to suspension of benefits. The goal aims to ensure benefits only cover those working or recovering from a work injury.
Voluntary Withdrawal From The Labor Market
Retirement And Benefits
The suspension of benefits takes places when a worker voluntarily retires and has no intention of seeking further employment. But, if the retirement results from the work-related injury, the employee may still receive benefits.
Proving Retirement
The employer must prove the worker’s voluntary retirement through evidence. For example, the acceptance of a retirement pension and the refusal of suitable employment offers. The evidence must show that the worker has decided not to return to the workforce.
Other Reasons For Withdrawal
Workers who move out of the country or fail to seek employment in good faith may have their benefits suspended.
Decisions that lead to withdrawal from the workforce, unrelated to the work injury, can justify the suspension of benefits. This includes situations in which the worker’s substandard job performance occurred prior to the injury. This can impact their eligibility for benefits.
Conclusion
Suspension of benefits in Pennsylvania workers’ compensation involves various factors, including return to work, medical treatment compliance, and voluntary withdrawal from the workforce. Employers must follow specific procedures and prove the basis for suspension. Workers have ways to challenge suspensions through hearings and litigation.
All workers should know their rights to avoid problems down the road. Knowing your rights helps ensure a fair process, supported by substantial evidence. Many situations arise where your benefits could face suspension. Knowing these situations and preparing for them, can help ensure you do not go without the compensation you deserve.
If you face suspension of your benefits, you need an experienced workers’ compensation lawyer to assist you. When a work injury has occurred, you need someone to protect your rights. The insurance company has a lawyer on their side and so should you.
We can help, don’t go it alone. Reach out to our offices 24/7 for a free consultation at (215) 609-4183.
