Can Benefits Stop After a Workers’ Compensation Award Order?

award order

If you sustain a work injury and your claim for workers’ compensation benefits is approved, the Virginia Workers’ Compensation Commission puts an award order in place. After issuance of an award order, your employer cannot unilaterally stop your workers’ compensation payments in most situations. However, they can file an application with the Commission requesting review of your benefits based on a change in circumstances. If that happens, you have the right to dispute the request. Assistance from a workers’ compensation lawyer is strongly recommended.

Importance of a Workers’ Compensation Award Order

When you’re injured on the job, the Virginia Workers’ Compensation Act and the rules of the Commission require you to follow specific procedures in making a claim for workers’ compensation benefits. If your claim is approved, either by voluntary agreement of the employer’s insurance company, a stipulated order, or a favorable hearing outcome, the Commission issues an award order that protects your rights as an injured worker.

Having an award order is the only way to guarantee payment of your benefits. When an order is in place, your employer’s insurance company cannot stop paying your benefits unilaterally, with one exception. If you reach a combined 500 weeks (the maximum) of wage loss benefits, the insurer can stop the benefits without additional proceedings, unless your award includes payment for a permanent injury.

Even when there is an award order, there is no guarantee that benefits continue indefinitely. A provision in the workers’ compensation law allows your employer to file an application to request termination, modification, or suspension of your benefits.

Employer’s Application for Review of an Award

A specific section of the Act, Virginia Code § 65.2-708, permits any party to apply for Commission review of an award of compensation based on a change in condition. The Commission has authority to end benefits or modify them by increasing or decreasing the amounts. The law includes time limitations on when an application may be filed. The injured worker or the employer may file an application for a hearing under this provision.

The statute requires that you receive notification if your employer files an application for review based on a change in circumstances. You can dispute the request. If you receive notice of an application, the best approach is to contact an experienced workers’ compensation lawyer immediately, if you do not already have an attorney assisting you. Representing yourself in the proceedings is not likely to get you the most favorable result.

Reasons for Changes in a Workers’ Compensation Award Order

There are a number of changes in circumstances that can lead to changes in your workers’ compensation benefits. They include:

  • Failure to get medical treatment recommended by your treating doctor.
  • Unjustifiable refusal to cooperate with required vocational rehabilitation.
  • Indefensible refusal to comply with a request or order for an independent medical examination (IME) scheduled by the insurance company.
  • An independent medical examination doctor states that you can return to regular work.
  • Unjustifiable refusal to cooperate with a functional capacity evaluation (FCE).
  • Your treating physician releases you to full duty work.
  • Refusal to accept light duty work within your doctor’s restrictions.
  • You returned to work making the same amount of money (or more) as before your injury.
  • You went back to work but did not report your earnings.
  • You settled a third party claim without getting the employer’s permission.
  • You recovered fully and signed a Termination of Wage Loss Award.
  • You accepted a lump sum of money to close your case and signed a Compromise and Release.
  • You are incarcerated after arrest or conviction for a crime.

If your employer files an application for review with the Commission for one of these reasons or another change in circumstances, Commission rules establish a specific process for handling the review request. You can dispute the request for changes in your benefits and provide evidence to contradict the allegations in the application. It’s essential to have a workers’ compensation lawyer represent you in the proceedings.

Commission Rules for an Application for Review

Rule 1.4 of the Rules of the Virginia Workers’ Compensation Commission governs an employer’s application for review of an award. The rule sets specific requirements that the application must satisfy.

You have only 15 days to respond to the application, so it’s essential to contact a lawyer immediately when you receive notification. When you respond, you can dispute the employer’s allegations regarding the reason for ending or changing your benefits.

If the employer’s application is accepted by the Commission, it will be referred for a hearing. While you can appeal the referral of the application for a hearing within 30 days, there are other legal strategies that may be more advantageous. An experienced workers’ compensation attorney will explain the options and help you decide the best way to proceed.

If you do nothing after receiving notification of your employer’s application to change your benefits, you risk losing some or all your benefits. In many cases, getting help from a lawyer to oppose the application or take a different legal approach can prevent that from happening.

Schedule a Free Consultation with Our Virginia Workers’ Compensation Attorneys

If you receive notification that your employer filed an application for review of your award order and you do not already have legal representation, our experienced Virginia workers’ compensation attorneys at Renfro & Renfro are here to help. We welcome you to contact us for a free consultation.