Can Workers’ Compensation Benefits Be Stopped Without Warning?

Workers’ compensation benefits are vital for employees who suffer work-related injuries or illnesses, providing necessary financial and medical benefits. However, these benefits can sometimes be terminated unexpectedly, leaving workers vulnerable. This article explores the conditions under which workers’ compensation benefits might be stopped without warning and the legal rights and remedies available to employees in such situations.

Understanding Workers’ Compensation Benefits

Workers’ compensation is a system established to protect workers and employers in the event of a workplace injury or illness. Benefits typically include coverage for medical expenses, disability payments, vocational rehabilitation, and death benefits for dependents. In New Jersey, employers must provide workers’ compensation insurance to ensure employees receive appropriate benefits after work-related incidents.

Eligibility for Workers’ Compensation in New Jersey

To qualify for workers’ compensation benefits in New Jersey, an employee’s injury or illness must have occurred while performing work-related duties, and must be reported to the employer within 90 days. The injury or illness must be directly related to job activities, and the employee must seek medical treatment from a physician authorized by their employer or the workers’ compensation insurance carrier.

How Long Do Workers’ Compensation Benefits Last?

Workers’ compensation benefits in New Jersey can be provided on a temporary or permanent basis, depending on the severity and long-term effects of the injury or illness. Temporary disability benefits cover the recovery period until the employee can return to work and are calculated at 70% of the worker’s average weekly wage, up to a maximum amount set by law. Permanent disability benefits are provided if the injury or illness results in a permanent disability and are classified as either partial or total, depending on the extent of the impairment.

When Can Workers’ Compensation Benefits Be Stopped?

While workers’ compensation benefits are generally meant to continue until the injured employee has recovered or reached maximum medical improvement (MMI), there are situations where the benefits may be terminated, such as:

Maximum Medical Improvement (MMI)

When a worker has recovered as much as possible or their condition has stabilized, benefits may be adjusted or terminated based on the treating physician’s assessment. This does not necessarily mean all benefits will end, but they may be modified. In New Jersey, the worker may receive a partial permanent disability award if they have any lasting impairments.

Return to Work

If an employee is deemed capable of returning to work after an injury, either in their previous role or in a modified position, workers’ compensation benefits may be adjusted or stopped. However, the employer must provide reasonable accommodations, if necessary, to support the employee’s return to work. The worker might transition to permanent partial disability benefits if they cannot earn as much as before their injury.

Failure to Comply with Medical Treatment

In some cases, workers’ compensation benefits can be terminated if the injured worker fails to comply with medical treatment recommended by the authorized healthcare provider or if they engage in activities that are inconsistent with their claimed disability. It is important for employees to follow medical advice and cooperate with treatment plans to maintain their benefit eligibility.

Fraudulent Claims

Engaging in fraudulent activities, such as misrepresenting the extent of injuries or concealing information, can lead to the termination of workers’ compensation benefits. Employers and insurance companies have mechanisms in place to detect and investigate fraudulent claims. Penalties for fraud can include fines, imprisonment, and repayment of benefits.

Settlement or Agreement

Benefits may end if the involved parties reach a settlement or agreement. In New Jersey, settlements can take the form of a Section 20 settlement (a lump-sum payment with no future benefits) or a Section 22 settlement (which allows for periodic payments and possible reopening of the case under certain conditions).

Legal Protections for Injured Workers

Workers’ compensation laws are designed to safeguard the rights of injured workers. In New Jersey, employees are entitled to certain protections, including:

Notice of Benefit Termination

Employers or insurance carriers must provide written notice to employees when terminating or reducing workers’ compensation benefits. This notice should outline the reasons for the decision and the worker’s rights to contest it.

Appealing Benefit Terminations

If an employee believes their workers’ compensation benefits were unjustly terminated, they have the right to appeal the decision. In New Jersey, the appeals process involves filing a claim petition with the Division of Workers’ Compensation, which will initiate a formal hearing to review the case. The worker has up to two years from the date of injury or last payment to file a claim.

Legal Representation

Injured workers have the right to seek legal representation to ensure their rights are protected throughout the workers’ compensation process. Attorneys experienced in workers’ compensation law can provide guidance, assist with appeals, and advocate for fair treatment.

Contact Rudnick, Addonizio, Pappa & Casazza PC Today

If you find yourself in a situation where your workers’ compensation benefits have been stopped without warning, seeking professional legal assistance is essential. Rudnick, Addonizio, Pappa & Casazza PC is the law firm you can trust to protect your rights and fight for the benefits you deserve.

Our skilled personal injury attorneys specialize in workers’ compensation cases. Rudnick, Addonizio, Pappa & Casazza PC has built a reputation for providing exceptional legal guidance and representation to injured workers throughout New Jersey. We understand the complexities of the workers’ compensation system and are dedicated to ensuring that their clients receive fair treatment and the benefits they are entitled to.

When you choose Rudnick, Addonizio, Pappa & Casazza PC as your legal advocates, you gain access to a team that will meticulously review your case, gather evidence, and develop a strategic approach tailored to your unique circumstances. We will fight tirelessly on your behalf, negotiating with insurance companies and, if necessary, taking legal action to protect your rights.

Don’t let the sudden termination of your workers’ compensation benefits leave you feeling helpless and uncertain about your future. Contact us today for the guidance and representation you need.