In Pennsylvania Workers’ Compensation; the term “ Suspension” means that the injured worker is still suffering from the work injury but is not entitled to payment of wage loss benefits ( weekly check). Medical bills can still be paid by the Workers’ Compensation Insurance Carrier. A Suspension of Benefits can be reopened by either a signed Supplemental Agreement or the Order of a Workers’ Compensation Judge on a showing that economic circumstances have changed. This should be done within three years of last payment of weekly WC or 500 weeks ( 9.6 years) depending on the circumstances.
There are multiple reasons why WC Payments can be suspended:
- Refusal Of Reasonable Medical Treatment: Insurance Companies threaten this all the time. It can only actually happen if: The WC carrier files a petition, and a Workers’ Compensation Judge rules that objectively speaking, the proposed medical treatment has a reasonable chance of returning the injured worker to the work force. Note that this is an objective standard not a subjective standard. In other words, the refusal must be based on facts and not the Injured Worker’s own opinion or prejudices ( I don’t want surgery because another surgeon cut off my sister’s leg by mistake). Both sides get to present medical evidence to the Judge in a case like this.
- The Injured Worker Has Returned To Work At No Loss Of Wages: There is a 20 day Trial Return To Work period if the Workers’ Compensation Insurance Carrier files the right paperwork once the employee returns to work. If the injured worker files a Challenge to the Return to Work Suspension WITHIN 20 days, Workers’ Compensation benefits are automatically reinstated. If the injured worker goes off work due to the work injury after the work injury; the Claimant has to file a Petition to Reinstate and lifting the Suspension is not automatic.
- Total Disability From A Non Work Related Condition: For example; the injured worker is disabled from doing his/her job due to a hand injury and now has cancer that is totally disabling.
- Failure To Follow Special Rules: 1) Failure to fill out and return Bureau Reporting Forms about income and medical conditions sent by the WC Insurance Company. 2)Failure to comply with an order to attend an IME.
- Incarceration After Conviction: Just what it sounds like, you don’t get Workers’ Compensation if you are a Guest Of The State.
- A Finding By A Wc Judge Of Earning Power After A Vocational Interview, Labor Market Survey And A Petition For Modification Or Suspension Filed By The WC Insurance Company: Prior to pro-employer changes in the law in the 1990’s; Workers’ Compensation Insurance Companies had to prove that an actual job had actually been offered to the injured worker in order to reduce or suspend weekly payments. Now, the Workers’ Compensation Insurance Company can file a Notice of Ability to Return to Work, require a so-called Vocational Interview and then file a Petition to Modify or Suspend WC benefits on the basis of paper jobs which might be available to the injured worker. The Workers’ Compensation Insurance Company does not have to prove that such jobs actually exists or, if they do, that the injured worker would be hired.
- Voluntary Withdrawal From The Workforce: An injured worker should never say: “No way in heck I’m going back to work. No way in heck anyone is going to hire me. I’m done with this rat race, I’m not going back at this point due to my age, limited skills and my work injury”. This may all be true. But if you say it out loud, your weekly WC check can be suspended.
In some circumstances, WC Benefits can be reinstated but there are time limitations. Call Calhoon and Kaminsky P.C., to have your questions answered for FREE! 717-695-4722
