WORK COMP & DENIED TREATMENT
What to do if Workers' Compensation Insurance Stops Treatment
What If the Insurance Company Refuses to Pay?
Whether you sprained your lower back in a frightful construction accident or endured whiplash when a truck hit your company’s van, you’ve been relying on Minnesota workers’ compensation insurance to pay for essential treatments. Rehab can be a grueling process, particularly when it involves “getting over” chronic conditions, like soft tissue injuries. In an ideal world, you’d like to stop going to your thrice-weekly chiropractic or acupuncture appointments, but you know that your pain would return almost instantaneously.
But what happens if the insurance company decides, for whatever reason, to stop paying your rehab and therapy bills?
The Insurance Company's Responsibility to You.
Your insurance may not cover your treatment entirely or in perpetuity. Minnesota workers’ compensation law lays out detailed guidelines for Permanent Partial Disability (PPD) benefits. These rules may seem simple, but insurance companies are adept at confusing patients, and some even intentionally underpay. If your insurer inaccurately calculates your PPD benefits, the court can order the company to pay you, retroactively, for the full amount owed.
Workers' Compensation Insurance Stoppage 101
While the insurance company cannot suddenly stop paying for your wage loss benefits – a judge must order or approve such an action – the company can challenge the validity of your medical treatment. It can present a case that your ongoing medical care is not reasonable or necessary.
What Are My Rights If My Workers’ Compensation Checks Have Stopped?
When the insurance company paying out workers’ comp benefits decides to stop the benefit payments, the insurer is required by law to file a Notice of Intention to Discontinue Benefits (NOID) notice. This form gives you instructions on how to request a conference regarding your benefits.
Usually, the window is limited to ask for a Conference – in some cases for 12 days. It is important to request a Conference, so you have the opportunity to contest the stoppage of your workers’ compensation wage loss benefits. The conference is referred to a .239 Conference. If you do not request a Conference within the required timeframe, you may then have to file an Objection to Discontinuance or a Claim Petition to pursue the reinstatement of your benefits. Once you receive a NOID, it is important to consult with an attorney.
Can Workers’ Comp Stop Paying Without Notice?
Unless you go back to work voluntarily or willingly sign off on a stoppage, the insurer cannot stop sending checks without a judge’s order. If the company does this, the court can respond by issuing substantial penalties.
Notice of Intent to Discontinue Benefits (NOID)
The insurance company may you send a document, known as a Notice of Intent to Discontinue Benefits, or NOID. This is an official “head’s up” that your insurer is seeking to shut down your benefits. Once you receive a NOID, you may have only a brief window of time to respond. The discontinuation is not a fait accompli, though. With the help of a qualified Minnesota workers’ compensation law firm, you can fight back and even penalize the insurer, particularly if your checks have come late or if the company has disregarded the law somehow.
What Age Does Workers’ Compensation Stop?
Just because a benefit is referred to as “permanent,” does not mean the benefit lasts permanently. Under workers’ compensation law, a presumption of retirement exists which causes benefits to cease at age 67.
However, there is a clause in the law that allows you to appeal to a workers’ compensation judge, making the case that you would not have gone into retirement at the age of 67. If you are successful in your appeal, the insurer will be forced to keep paying you benefits. But many are not able to prove such a claim, especially when they have been unable to work on account of their injury.
Getting Help If Workers’ Comp Denied Treatment for Your Injury
To ensure that you get needed care and treatment to manage your injury, long term, please get in touch with the Osterbauer Law Firm today for a free consultation. We understand how insurance companies operate and how to make them treat people fairly. We’d be happy to travel anywhere in the state to meet with you and help you strategize.