How Does Suspension of Benefits Work in Pennsylvania Workers’ Comp?

If you already got your Workers’ Comp benefits granted and you are receiving weekly checks and coverage for your medical care, it might feel like your case is done and you are in the clear.  Unfortunately, this usually is not the end, and there are many ways your benefits could end up being suspended – though suspension is not always a bad thing when the alternative is termination.

Employers/insurance carriers can file a Petition for Suspension of Benefits when certain conditions arise.  In some cases, they are trying to stop you from getting benefits you deserve, but in others, they are trying to pause benefits while you can actually go back to work, all without ending the case and foreclosing the possibility of you going back on benefits if your condition gets worse again.  Because of this, it is absolutely vital to have a lawyer review any suspensions or attempts to suspend your benefits.

For help, call Cardamone Law’s Certified Allentown Workers’ Compensation Lawyers at (267) 651-7945.

Grounds for Suspending Workers’ Compensation Benefits in Pennsylvania

There are a few ways that an employer can suspend your benefits and various legal grounds to do so.  The Workers’ Compensation Act’s § 413 is quite general, leaving a judge with the power to suspend benefits when either party petitions them to do so.  Usually, there has to be some disqualification or change in disability that would justify stopping benefits for now.

In any case, remember that suspension means the benefits are stopping temporarily; it does not mean that your benefits are over and gone forever.  There are, generally speaking, ways to get suspensions reversed and get your benefits back.  However, many of these grounds for suspension also double as grounds for termination, so it is important to talk to a Workers’ Compensation lawyer about whether the effect on your benefits is temporary or not.

You Went Back to Work

If you go back to work, then your wage-loss benefits might be suspended.  This can often happen automatically if you return to work under the terms of § 413(d), which allow the employer to give you and the department proper notice of the change and to calculate the changed benefits.

Benefits can typically only be suspended if you go back to work at full capacity; if you return at partial capacity and only make a portion of your previous wages, then you are not back to 100% wages and still need coverage for 2/3 of the difference in old and new wages.  Instead of suspending benefits, your employer would usually try to modify benefits in these cases.

The reason that benefits might be suspended here instead of terminated is that you might have a condition that could still affect you, just not enough to stop you from working right now.  Your doctor might say you can go back to work without restrictions, but they might not make any sort of declaration that you are fully healed or that your condition is gone, leaving room for the possibility that it might get worse again later.  If that does happen, benefits will need to be reinstated, which makes more sense after a suspension than a termination.

You Stopped Complying with Workers’ Comp Rules

To keep getting benefits, you are supposed to keep following the rules that govern your treatment and benefits.  If you stop complying with the terms of Workers’ Comp benefits, then your employer can stop complying as well.  Employers may go straight to filing for termination in some cases, but suspending benefits until you return to full compliance might be a simpler option.

This can happen if you stop going to medical appointments, refuse to get recommended care, deny the existence of part of your diagnosed conditions, or refuse to participate in an IMR, IME, or UR.  Other noncompliance might also lose you your benefits – at least temporarily until we can resolve the dispute and get you back in compliance.

You Leave the Workforce

Work injuries that keep you from working mean that you are not currently acting as a part of the workforce.  However, Workers’ Comp recipients need to be willing to work but not able to do so.  If you voluntarily retire or otherwise leave the workforce, you are technically no longer eligible for Workers’ Compensation.  This means it is important to talk to a lawyer about what you should and should not say about your work injury and your status, given that “retiring” often means losing your benefits entirely.  Instead of suspension, this is often grounds for a Petition to Terminate benefits.

You might also leave the workforce involuntarily, such as by receiving another non-work-related injury that disables you or by being sentenced to jail/prison.  Your benefits might be suspended until such time as you heal from the other disability or leave jail.

Fighting Suspension of Benefits in Pennsylvania

If you receive a notice that your employer has filed a Petition to Suspend Benefits or you receive a notice that benefits have been automatically suspended for another reason, contact a lawyer right away.  You may be able to fight this, but the time to respond is often very short, and your lawyers will need to schedule a hearing right away.  If you lose that hearing, you might also be able to appeal the decision to the Workers’ Compensation Appeals Board for rehearing.

In some cases, the Petition to Suspend also acts as a request to immediately stop payment, so it is important to have a lawyer review any notices you get to see whether your benefits are stopping now or whether they need to go to a hearing first.  In either case, we can still file for a hearing to challenge the decision.

Reinstating Benefits After Suspension in Pennsylvania Workers’ Comp Cases

In some cases, suspension is appropriate because you are actively working or otherwise ineligible for good, positive reasons.  However, if you need those benefits to be reinstated later, our lawyers can help you file the relevant petitions to make that happen.  For example, imagine you go back to work after a broken back, and you work for a week with suspended benefits before your leg goes numb.  If you need surgery and additional recovery time, we can help you get your benefits reactivated during that time.

Call Our Workers’ Comp Lawyers in Pennsylvania Today

For help with your Workers’ Comp case, call the Bucks County Workers’ Compensation attorneys at Cardamone Law at (267) 651-7945.