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Termination of Your Money Benefits

Burdine & Brown Oct. 24, 2019

There are basically two (2) ways the insurance folks can terminate your benefits in your workers' compensation case. The first is by way of WC-3 Form-Notice of Controvert. This means the claims handler can merely issue a one page form (WC-3) stating that he or she will terminate either your medical treatment, further diagnostic testing or fight your entitlement to weekly disability checks. A reason should be stated but many times that reason is very vague such as “not arising out of and in the course of employment.”

If you are receiving weekly disability benefits called TTD or TPD benefits, the insurer may issue a WC-2 and check the box that states they are going to suspend your further receipt of these benefits. The Form itself has various blanks to check that state the reason for suspension such as “released to go back to work by authorized treating physician with no restrictions.”

Years and years ago the insurer was not allowed by law to unilaterally (on their own) to suspend the worker's entitlement to weekly checks unless the worker agreed. The agreement was contained in a form the adjuster was required to have the worker sign before any suspension took place. I know because I was an adjuster for an insurance company and I had to drive to the workers' home to have them sign this form. That was the toughest part of my job as an adjuster. Now, this process is unnecessary so the insurance adjuster has so much more power over the worker. I call it “cubicle courage.” Right from their desk, armed with a vague and suspect insurance “doc in a box” report, the adjuster issues either a WC-3 or a WC-2 and messes with your benefits.

What do you do next? You better start looking for the right lawyer. Just stay away from the TV lawyers!