Most Pennsylvania employers must purchase workers’ compensation insurance. Workers’ compensation ensures that employees receive medical treatment and compensation when they sustain a work-related injury. The law allows employers and workers’ compensation insurance companies to modify, reduce, or terminate workers’ compensation benefits when a worker returns to work or when the disability status of the worker changes.
Returning to Work
An employer may reduce, modify, or terminate an employee’s workers’ compensation benefits under certain circumstances. Under Pennsylvania law, an insurer can modify or suspend an injured employee’s wage-loss benefits if the employee returns to work. This applies even if the employee returns to their former workplace in a modified position or if the employee becomes employed elsewhere.
If an employee is receiving wage-loss benefits, the employer or the insurer can reduce or eliminate those benefits. If the injured employee returns to work but earns less than what they earned prior to the injury, the employee’s wage-loss benefits will be reduced. If the employee returns to work and earns at least the same amount that they did prior to the injury, Pennsylvania law allows the insurer to terminate wage-loss payments.
Change in Disability Status
An employer or insurance company may seek to modify an employee’s benefits if their disability status changes. The employer or insurer can make a request for an impairment rating evaluation (IRE) within 60 days of the 104-week anniversary of the commencement of the employee’s total disability compensation. If the results show that—based on the American Medical Association’s Guidelines—the employee has an impairment rating of less than 50 percent, the employee’s status changes to a partial disability. This means that the employee will receive a maximum of 500 weeks of benefits. The same limitation applies if the workers’ compensation carrier hires a vocational expert that produces a Labor Market survey believed by a judge and the weekly rate can also be reduced based on the earning power demonstrated in the Labor Market Survey. For more information on this topic go to how long do my benefits last.
Termination of Wage-Loss Benefits
When an employee receives temporary wage-loss benefits with a Temporary Notice of Compensation Payable, the insurer or the employer is able to terminate those benefits after providing notice. After 90 days from the date of the accident, Pennsylvania law allows the insurer or the employer to provide notice of termination if the work-related injury claim as being not accepted. An employee can challenge the denial of benefits. If the carrier receives a medical opinion for full recovery, usually from their I.M.E. doctor, they can file a petition to terminate benefits and the Judge will decide whether you have fully recovered or not.