Serious workers compensation injuries are life changing. They affect your ability to work. You need medical treatment to recover from your injury.
Recovering from a serious injury can take a long time. In a perfect world, workers compensation would pay benefits as long as you needed them for your injury. Unfortunately, the laws in Georgia have limits on how long workers compensation must pay you.
Understanding when your benefits should stop and when they should not is very important. You can better prepare for the future when you know this. It also helps you know whether the insurance company has properly stopped your workers compensation benefits or whether they should continue paying them.
What are the reasons that the insurance company can stop my workers compensation benefits?
There are three basic types of Georgia workers compensation benefits:
- Wage loss benefits (temporary total disability or temporary partial disability)
- Medical benefits
- Permanent partial disability benefits
Each of these types of benefits has different rules for when the insurance company can stop paying them to you.
Wage loss benefits
The law has a few different ways that the insurance company can stop paying you benefits for wage loss. One is when you return to work after an injury. Your benefits stop when you return to work because you are earning wages from your employer. If you are making less money than you were before you got hurt, you should probably receive temporary partial disability benefits.
Your wage loss benefits can also stop when your doctor says you can go back to work at full duty without restrictions. The problem is that the doctor may say this when you are not really 100 percent better. When this happens, it can make life extremely difficult because your workers compensation check gets stopped within a few days if the insurance company files the right paperwork.
A third way your check gets stopped is when you reach the limit on how long you can draw wage loss benefits. For temporary total disability benefits, this time limit is 400 weeks (about 7.5 years) from your date of injury in most cases. For temporary partial disability benefits, the time limit is 350 weeks (about 6.5 years) from your date of injury.
While these 350 and 400 week time limits sounds like a long time, serious injuries can often leave you with permanent limitations. Sometimes, these limitations make it difficult for you to return to any type of work which means that these 350 and 400 week time limits become an issue.
There are other reasons that your wage loss benefits can stop as well such as refusing a suitable Form WC-240 light duty job offer or failure to cooperate with medical treatment (after the insurance company follows specific rules that allow them to seek suspension of your benefits). Just know that you should never just accept that the insurance company properly stopped your benefits. You should talk to an attorney to find out if your benefits were stopped properly.
How can the insurance company stop my medical benefits?
Medical benefits include the workers compensation insurance company paying for medical treatment and testing you need for your injury with certain authorized doctors. This medical treatment and testing helps you recover from your injury. If you want to know more about medical treatment, this article has more detail about how medical treatment works under workers compensation.
There are two main ways the insurance company stops your medical benefits. The first is when you reach the 400 week limit on medical treatment. While there are exceptions, this 400 week limit applies in most cases if your injury occurred after July 1, 2013.
This limit means that the insurance company can usually stop paying for medical treatment 400 weeks after your injury occurs. Unfortunately, many people continue to need treatment for their injury more than 400 weeks after their injury.
One other way that the insurance company stops paying for medical benefits is when the workers compensation doctor says you are better. While this is not technically a limit on your medical benefits, it has the same effect by stopping you from getting medical treatment. In this scenario, it is important to know that there are steps you can take to change your doctor or get a second opinion. Doing this can help make sure you get the medical treatment you need.
Permanent partial disability benefits
Permanent partial disability benefits should get stopped when the payment of your permanent partial disability rating is completed. The number of weeks of permanent partial disability you receive depends on the percent disability rating you receive from your workers compensation doctor. This article has more information about permanent partial disability benefits including how the doctor determines your rating.
Why would the insurance company stop my benefits?
Paying you workers compensation benefits costs the insurance company money. Like most business, insurance companies are for profit businesses which means one of their goals is to make money. When the insurance company stops your workers compensation benefits, they save money.
This means that the insurance company will likely take actions to try to stop your workers compensation benefits. This can be very frustrating when you are just trying to get the treatment you need to recover from your injury.
What should I do if the insurance company stops my benefits?
Contact a workers compensation attorney. Anytime the insurance company stops your benefits, you need to make sure they did it properly and determine whether you can fight to get them restarted.
Speaking with an attorney will help you determine a couple of things:
- Can you fight the insurance company stopping your benefits
- If so, what is the best approach to take to try to get your benefits restarted