Petition to Terminate vs. Petitions to Suspend Workers’ Compensation Benefits
For those who have been injured on the job, workers’ compensation benefits are essential. If an injury prevents you from earning your wages, your family still needs to be fed, and bill collectors still need to be paid.
Sadly, workplace injuries occur regularly here in the Commonwealth of Pennsylvania. According to the annual report on Pennsylvania Workers’ Compensation and Workplace Safety, the Bureau of Workers’ Compensation received 166,102 workplace injuries and illnesses reports in 2015 alone. These reports were received from a wide range of industries and economic sectors, including agriculture, manufacturing, mining, construction, service industries, education and health services, professional services and public administration.
Unfortunately, employers are incentivized to find ways to stop providing you with your workers’ compensation benefits. Ideally, the benefits will last as long as you need them to, allowing you to be financially secure while you recover from injuries that you suffered while working in the first place. However, in some cases, employers will either try to suspend or terminate your benefits, even if you have not yet fully recovered from your injuries.
In these instances, it is imperative that you understand the difference between a petition to suspend workers’ compensation and a petition to terminate workers’ compensation. Despite being similarly titled, these two types of petitions can have drastically different impacts on an injured person’s physical and financial well-being.
To help you navigate these differences easier, we have put together this guide comparing the two petitions, paying special attention to how each can impact an injured Pennsylvania worker’s benefits.
Petition to Terminate Workers’ Compensation
Because workers’ compensation benefits are defined differently state by state, we are going to focus on the Pennsylvania-based petitions to terminate workers’ compensation claims specifically.
Who Files a Termination Petition?
A termination petition is filed when an employer or the insurance company providing compensation feels that they have satisfactorily fulfilled their obligation because the injured employee has fully recovered from their injuries. They file the petition to the Bureau of Workers’ Compensation to demonstrate that they no longer need to provide benefits and will not need to do so again in the future, assuming that a new injury is not suffered. The Bureau will then assign a workers’ compensation judge to make the final determination on the validity of the petition.
Who Has to Prove That the Employee Has Fully Recovered?
The burden of proof in these cases falls on the employer. That means that they are responsible for collecting and presenting evidence that demonstrates the employee is no longer injured or that the injury the employee suffered did not occur in the workplace.
What Should an Employee Do When Receiving Notice of a Termination Petition?
Even though the burden of proof falls on the employer, an employee must take immediate steps. An employee wishing to contest the petition needs to contact their attorney immediately, as certain documents and procedures must be performed within an allotted period. Failing to do so may allow the employer or insurance company to make their case without an answer from the injured party.
What Happens to Benefits While the Petition Is Being Processed?
An injured person’s benefits will continue until the workers’ compensation judge makes an order. However, the judge can order, using a “supersedeas,” that benefits be suspended until the final ruling. This becomes increasingly more likely if the employee does not have an attorney to offer a defense. If the employee or their attorney cannot show contradictory evidence to the employer’s claims, a judge will likely grant the supersedeas.
What If the Employee Has Agreed to a Lump Sum Settlement?
In some cases, an employer or insurance company may seek a lump sum payout rather than continued workers’ compensation benefits. If both parties reach such an agreement, then the employer will file a petition to terminate.
While lump-sum settlements are appropriate in some cases, remember that an employer or insurance company will only agree to one if they believe that such a settlement will save them money in the long run. Sometimes, both the employer and the employee will benefit from this arrangement. However, sometimes the lump sum is designed to be enticing in the short-term — it is a larger amount of money — but is actually a means of paying less to an injured person in the long-term.
An experienced attorney is an employee’s best defense against a bad settlement. An injured employee should never enter into a lump-sum-settlement agreement with an employer or insurance company without consulting with an attorney first.
What If the Employee Has Not Actually Recovered?
An employer will usually file a termination petition when the company’s approved doctor decides that the employee has recovered. However, there are some cases in which the employer-approved doctor and the employee’s personal doctor do not agree. In these cases, both doctors will be asked to present their information, and the judge will rule one way or another.
If both the company-approved doctor and the personal doctor agree that the employee is ready to return to work, then the judge will terminate workers’ compensation benefits in all but the rarest cases.
Are There Signs That an Employer May Be Preparing to File a Termination Petition?
While it is unwise to assume that a termination petition is forthcoming without receiving an official notice, certain signs may indicate that an employer is preparing to file one. In such cases, it may be wise for an employee to contact an attorney so that they are prepared when the actual petition notice arrives.
An impairment rating evaluation (IRE) is used to determine the degree of an injured employee’s impairment. The doctor that performs the IRE is chosen by the Bureau of Workers’ Compensation and is thus deemed to be independent, advocating neither for the employee nor the employer. However, an employer may request an IRE if they feel that the initial evaluation no longer applies.
An employer may also request an independent medical exam (IME). Unlike the IRE, the IME is conducted by an employer- or insurance-company-approved doctor. As such, this examiner is being paid to find evidence of an employee’s health and fitness for returning to work. While a judge will know that the IME was performed by an employer-approved doctor, the evidence collected can be used in support of a termination petition.
Finally, an employer may request an evaluation to be performed by a vocational counselor. These evaluations are used to determine an employee’s ability to work for pay. In many cases, the vocational counselor will be looking for potential wage-earning opportunities, even if those opportunities involve lighter workloads. If the counselor can identify that a lighter activity is available at the injured party’s place of employment, they may recommend either a termination or change of benefits.
If an employee has been working with a personal injury lawyer, then that attorney should be informed the moment that any of these evaluations are requested. The attorney can then start collecting and preparing the appropriate evidence for presentation at the hearing.
Petition to Suspend Workers’ Compensation
In termination petitions, the employer is seeking an end to both lost-wage payments and financial responsibility for future medical bills. In other words, the employer is looking to return to the employer/employee financial arrangement that preceded the injury.
However, there are some cases where an employer may seek to drastically change their financial relationship with an injured employee without fully terminating their responsibility. In such cases, the employer will file a petition to suspend workers’ compensation. There are several specific instances when the approach is appropriate.
What If an Employee Refuses Reasonable Medical Treatment?
When receiving workers’ compensation benefits, it is assumed that the employee will seek medical treatments that will allow them to recover and return to work. For example, if an employee suffers a severe leg injury that requires surgery, it is assumed that they will undergo the procedure in a reasonable amount of time. Similarly, if an injury has caused mobility issues that prevent an employee from returning to work, it is assumed that they will attend physical therapy to help improve mobility.
In some cases, an employee may refuse treatment. If the judge determines that the treatment is reasonable and appropriate, the judge can then suspend lost-wage benefits. The employer will still be responsible for future medical costs, including those of the refused treatment.
The employer and employee may, in some instances, disagree over the reasonableness of treatment. A simple fear of surgery, for example, is considered unreasonable. However, if a procedure is deemed risky with only a limited chance of a positive outcome, then the refusal may be considered reasonable.
What If an Employee Can Return To Work?
An employer may also seek a suspension if the injury does not prevent the employee from returning to work. For example, imagine an employee’s foot is injured in an office when a stack of paper falls on them. However, the employee’s job is clerical, meaning that they can easily perform their assigned tasks, even if their foot has not yet healed. In such cases, the employer will likely petition to suspend missing-wage benefits while still taking responsibility for future medical costs.
On the other hand, there are instances when an injured worker may return to work and assume that they can continue their regular duties despite their injury, only to discover weeks or months later that their job is exacerbating the injury. In these cases, the employee may file a petition to reinstate benefits.
What If an Employee Becomes Totally Disabled By a Non-Work Related Event?
Unfortunately, sometimes a person who is partially injured in a work-related accident suffers another injury or illness that renders them entirely disabled.
For example, consider a worker who suffers a hand injury on the job. While receiving workers’ compensation benefits, they are in a car accident and permanently paralyzed. The employer can no longer expect the person to return to work, but is not financially responsible for the injury. In such cases, the employer would file a suspension petition, as they would still be financially responsible for the treatment of the hand injury.
What If an Employee Refuses an IRE or IME?
Because the employer has a right to collect evidence of an employee’s ability to return to work, refusal to attend an IRE or IME could be considered grounds for a suspension petition.
What If an Employee Is Then Incarcerated?
An employee is not entitled to workers’ compensation benefits while incarcerated. If an employee does wind up in prison, the employer will file a suspension petition. If the sentence is short, workers’ compensation benefits may be restarted after the employee is released.
What If a Vocational Counselor Determines That an Employee Can Return to Work, Even Part-Time?
If the vocational counselor determines that an injured person does have earning potential, an employer may request either a suspension or modification of lost wage benefits. This is especially common for those who work in labor-intensive industries. While it may not be possible for the worker to return to their regular duties, a desk job may be available that could suit them despite the injury.
What If an Injured Employee Declares That They Have No Intention of Returning To Work?
In most circumstances, it is difficult to prove that an injured worker has voluntarily removed themselves from the workforce. However, if an employer has evidence that a worker does not intend to return to work, it can be used in a suspension petition.
As a result, it is crucial that injured workers not make declarations of their intentions. Even if the worker makes such a statement out of frustration about the persistence of their injuries, it can be used as evidence against them. If an employee is receiving a medical or vocational examination, it is important that they always maintain their desire to return to work, regardless of how bad the situation is. Even if the employee privately feels that they have little chance of succeeding in their industry again, it is important that they keep those feelings to themselves.
Getting the Results You Deserve
Whether you have received a petition to terminate or suspend your workers’ compensation benefits, you need someone who is going to work with you to ensure you get the compensation you deserve.
Here at KBG Injury Law, we have the experience and tenacity to make sure you are never pushed around by an employer looking to force you back to work before you are ready. We also take your injury as personally as you do and understand that you are more than a case to win in court. An injury can cause you pain that isn’t physical, and recovery means so much more than just getting back to work.
If you have been injured on the job here in Pennsylvania, and you need someone to help you navigate the complications of the Commonwealth’s workers’ compensation benefits system, request a free consultation and get the results you deserve!