When Can Workers’ Comp Benefits Be Stopped?

When Can Workers’ Comp Benefits Be Stopped?

If you have suffered a workplace injury in Virginia, workers’ compensation benefits can serve as a critical lifeline during your recovery, helping to cover medical bills, lost wages, and rehabilitation costs. However, injured workers frequently ask, “When can the insurance company start stopping my workers comp benefits?”

Your workers’ compensation benefits can only be terminated or reduced under certain well-defined scenarios established by Virginia law. Understanding these situations can help you advocate for your rights if your employer or their insurer attempts stopping your workers comp benefits prematurely.

Four Common Scenarios

One common excuse insurers will cite to stop benefits is if you have reached Maximum Medical Improvement (MMI), your status could change. MMI is simply a legal and medical designation indicating that your injury-related condition has stabilized and further significant medical improvement or recovery cannot reasonably be anticipated. If you reach MMI and your physician indicates you can return to your regular job, your temporary workers’ compensation benefits typically can be stopped.

On the other hand, your employer might seek to stop your workers comp benefits if you return to work in any capacity—whether with your former employer in a light-duty position or with another employer—with earnings equal to or greater than your pre-injury average weekly wage. Virginia Code Section 65.2-500 describes clearly that once an injured employee has returned to work at their pre-injury wage, temporary total benefits can reasonably be terminated.

Your workers’ compensation benefits may also be stopped if you fail to adhere to prescribed medical treatments or refuse reasonable medical care. According to Virginia Code Section 65.2-603, injured employees have a duty to accept proper medical treatment and cooperate fully in their medical recovery. Failure to cooperate with the recommended treatment, attend scheduled medical appointments, or follow prescribed therapies without good reason could lead your employer or their workers’ compensation insurer to initiate steps aimed at stopping your workers comp benefits.

Another situation when your benefits may end is if you refuse suitable employment—the term “suitable employment” meaning work that matches your physical capabilities as indicated by your treating doctor’s restrictions and abilities. If your employer or insurance carrier offers you an appropriate job that fits within your doctor’s specified work restrictions—a job reasonably close to your residence—and you refuse this offer without adequate reason, your workers’ comp benefits may be lawfully stopped pursuant to Virginia Code Section 65.2-510.

Notice Required

Importantly, insurance companies cannot simply terminate your benefits without appropriate notice.

Virginia law, specifically governed by the Workers’ Compensation Commission and relevant rules, requires the insurance carrier or employer to file an application seeking approval from the Workers’ Compensation Commission before terminating ongoing payments to you, the injured worker (Virginia Code Section 65.2-708).

Typically, employers and insurers issue a form called an Employer’s Application for Hearing if they dispute whether you are entitled to continued benefits due to your recovery status, employment status, or your compliance with medical treatment.

If you disagree with the insurer’s application for termination of your workers’ compensation benefits or believe that your benefits have been unfairly stopped, you have the right to challenge the decision by requesting a formal hearing before the Virginia Workers’ Compensation Commission. As an experienced workers comp lawyer in Roanoke, I can tell you that having legal representation in attending such a hearing greatly improves your chances of adequately protecting your rights and obtaining a favorable outcome.

Appealing Stopped Workers’ Comp Benefits in Virginia

If your benefits have already been improperly terminated, you are entitled to pursue legal recourse under Virginia law. You may file a claim directly with the Virginia Workers’ Compensation Commission, clearly expressing your reasoning for disputing the termination. Understanding how and when to file claims or demands to the Workers’ Compensation Commission can be complex and often requires careful navigation through formal legal proceedings.

As a workers comp lawyer in Roanoke, I routinely assist injured workers in timely filing their appeals, compiling appropriate medical and employment-related evidence, and advocating for reinstatement of unfairly terminated benefits. The Commission will evaluate the dispute, consider the documentary and medical evidence available from both sides, and render an official determination regarding the validity of the termination of your workers’ comp benefits.

Protecting Your Virginia Workers’ Comp Benefits

Understanding precisely what situations lead to stopping your workers comp benefits under Virginia law can significantly benefit your recovery process. Ensure that you understand your medical condition clearly, keep accurate and detailed records of your medical treatment, adhere to medical recommendations, and respond appropriately to applicable and suitable employment opportunities. When in doubt, obtaining professional legal support from a qualified workers comp lawyer in Roanoke can dramatically improve your ability to advocate for fair treatment under Virginia’s complex workers compensation rules.

If you need help, call us today for a free consult