Workers comp benefits cut off, what can I do? McCormick Law Office attorneys get asked this question every day and our answer is we will fight for worker’s compensation benefits. Each case is different, and how we go about obtaining worker’s comp benefits depends on the nature of your injury, the stage of the workers compensation process and your ultimate goal, whether it’s a lump sum loss of earning capacity settlement, payment for retraining benefits or vocational rehabilitation, or a return to work after receiving necessary medical treatment.
Another factor is the reason why workers comp benefits were cut off in the first place. The most common reason worker’s compensation benefits are denied or stopped is that the injured worker’s treating doctor does not provide the necessary paperwork or documentation that the medical condition is in fact work related. It is very important that the doctor state to a reasonable degree of medical probability that the injury or condition is either caused by a traumatic incident at work or caused by job duties or exposure over time. The next most likely reason for denying a worker’s compensation claim is that the injury or condition is not work-related. This defense usually comes courtesy of the worker’s compensation insurance company doctor, called an independent medical examiner or IME doctor. This IME doctor will do a quick 10 minute examination and then issue a narrative report for the insurance adjustor saying that in his medical opinion the injury or condition either never was or is no longer work-related. The IME doctor very often says the injury or condition is a pre-existing, degenerative condition not related to the work injury or job duties. Other times, the IME doctor will say that there was a work injury, but it was only a temporary aggravation of a pre-existing condition and now the work injury part is healed. This IME defense often comes out just when an employee with a neck or low back injury is scheduled for surgery. Worker’s compensation insurance companies do not like to pay for discectomy or fusion surgery for herniated discs or degenerative disc disease like spinal stenosis or spondylolisthesis and the only way they can legally deny paying for surgery after the treating surgeon recommends it, is by having their own IME doctor issue a contrary opinion.
Our attorneys can file for a hearing to get the worker’s compensation insurance company to pay for the surgery and restore the workers comp benefits cut off while you heal or you can get the surgery done by using health insurance and then we file for hearing after the surgeon says you are at an end of healing and he issues permanent work restrictions.