During the first 180 days of receiving benefits, your payments are made “without prejudice,” meaning that even though the company is paying you weekly, they do not admit responsibility for your injury or illness. During this period, the insurer may discontinue your payments at any time by giving you 7 days notice and explaining the reasoning behind their decision. In this situation, you may appeal the insurer’s decision to the Department of Industrial Accidents.
If you have been receiving compensation for more than 180 days, or if your payments are the direct result of a decision by the Industrial Accident Board, then your claim is considered “accepted.” In this situation, payments can only be discontinued in the following situations:
- You sign a Discontinuance Agreement, which allows the company to cease payment.
- A Department of Industrial Accidents judge determines that your benefits should be modified or discontinued (following a conference).
- Your return to work
- Your doctor or an impartial physician reports that you are able to return to work at your former job or a new job, and your employer verifies that such work is available.
- You have received the maximum amount of compensation for your claim.
Additionally, compensation benefits may be suspended at any time if you are incarcerated, if you don’t submit to a required examination by the insurer’s chosen physician, or if you don’t provide the necessary earning reports. If the insurer stops payment for any other reasons, it is considered illegal discontinuance, and they would be penalized under the law.
Even if your weekly payments have been discontinued, the insurer is still responsible for your medical expenses as long as the treatment is deemed necessary and causally related to your on-the-job injury or illness.
Receiving social security payments does not affect your right to continued compensation if you are permanently and totally disabled. If you are receiving temporary total disability compensation, have been receiving payments for two or more years, and would like to continue receiving payments past the age of 65, you must prove—with hard facts and evidence—to the Industrial Accident Board that you would have continued to work past 65 if you had not been injured on the job.