6 Ways Your Workers Compensation Benefits Can Be Stopped – Even If You Have an Award
Some folks assume that once they receive that magical Award from the Virginia Workers Compensation Commission, they are completely safe and have nothing to worry about. Not true! Yes, the Award is to protect benefits; however, if the insurance company can find a legitimate reason, they can still terminate (or attempt to terminate) your benefits. Watch out for these:
1) The private investigator
Insurance companies will sometimes hire a private investigator to observe an injured worker while they are under the physical restrictions of a doctor. If the private investigator’s video that he captures shows the injured worker doing more than he or she claims that they can, or if the injured worker is doing things that would violate the restrictions of the workers compensation doctor, the injured worker’s benefits can be terminated. ALWAYS follow your doctor’s restrictions, at home, work, and anywhere in between!
2) Refusing light duty work
Lost wage benefits only: If the employer provided light duty work for an injured worker, the injured worker must accept this light duty assignment so long as it is in line with the doctor’s work restrictions. If the employer offers the injured worker tasks that are in compliance with the doctor’s work restrictions and the injured worker does not return to work, workers compensation insurance does not have to pay the injured worker lost wages.
3) The Independent Medical Exam
Insurance companies will often send an injured worker for an “Independent” Medical Exam (or IME). The IME doctor is a doctor hand picked by the insurance company to read the injured worker’s medical reports, examine the injured worker, and then report his or her findings to the insurance company about the claimant’s abilities and current course of treatment. If the injured worker does not attend this exam, the insurance company can cut off lost wage benefits for not cooperating. However, if the IME doctor says you can return to work, the insurance company may use this as a way to attempt to stop the injured worker’s benefits (Call a workers’ compensation attorney right away!!!).
4) The Functional Capacity Exam
Injured workers are often sent for a Functional Capacity Exam (or FCE) when the doctor believes their limitations have reached a level of permanency. The FCE is an exam where the examiner (usually a Physical Therapist) will have the injured worker do several movements and lift set amounts of weight in order to gauge the injured worker’s strength and physical abilities. The injured worker must cooperate with this exam and give full effort. If the Functional Capacity Examiner reports that the injured worker would not cooperate or he/she believes the injured worker was exaggerating their pain or diminished abilities, the insurance company can use this as a reason to stop benefits.
Lost wage benefits only: If the injured worker quits their job while they are off of work due to an injury or on a limited duty status, the insurance company does not have to pay lost wages to the injured worker once they have quit their job.
6) Gaps in medical treatment
If an injured worker has an Award of lifetime medical benefits but does not use them for a long period of time and then returns to the doctor for treatment, the doctor has to be able to say if the current symptoms the injured worker is experiencing are a result of the work place accident. If the doctor can’t make this connection (because he/she has not seen you in several years) workers compensation may not cover the treatment the doctor is recommending.