What Happens When Workers Comp Payments Stop?

Last Updated: 3/9/2023

There are a number of reasons why your workers' comp payments may be stopped (which we discuss later in this article), but what happens when they do?

1. You should determine if you have been paid all the payments that you are owed. If you were off work for 8 weeks and have made a full recovery, then chances are you are owed the 8 weeks of workers' compensation. However, if you were paid while you were off work, but have a permanent injury then you are probably owed additional benefits. The amount of the payments that you are owed is covered in detail in our Iowa Workers' Compensation Book that we offer to injured Iowans at no cost or risk so you can avoid making a costly mistake.

2. Regardless if you have been paid the correct amount or not, are you still working? If no, then you will want to consider filing for unemployment benefits. Keep in mind that you cannot receive TTD (temporary total disability) payments at the same time as unemployment. However, you can receive PPD (permanent partial disability) at the same time. You do not want to file for unemployment if you are receiving TTD because you cannot receive both at the same time. If you file for unemployment and are denied, then it is time to speak with a workers' compensation attorney who also can help you with your unemployment claim. If you are still working and you have permanent injuries then you will want to speak with an experienced Iowa workers compensation attorney to determine what additional benefits you are owed. If you would like to speak with one just give us a call at 641-792-3595. There is no cost or risk and we will answer your questions, give you advice and explain what we may be able to do to help.

3. You do not want to rush into a settlement with the insurance company without learning about the true value of your case. Sometimes if you are back to work making the same money with no permanent problems the best advice is that you can handle the case on your own. Although, trying to "settle" a case on your own can be risky business. Almost always the insurance company will want a "closed" file meaning no more medical care and no more workers compensation benefits even if you are terminated because of your injuries. Keep in mind that if you have received a check for TTD or PPD under Iowa law then generally your statute of limitations is increased to 3 years from the date of last payment. However, there are exceptions and you do not want to wait until the last minute to contact a lawyer to learn that your case is over because you waited too long.

Why can my workers' comp payments be stopped?

There are a number of reasons why your benefits may have stopped:

1. You have been paid your TTD (temporary total disability) payments and you are back to work.

2. You are back to work waiting on the results of your functional impairment rating from your workers' compensation doctor. Beginning July 1, 2017, the workers' comp insurance company is now allowed to delay your payments for your impairment rating. The law now allows them not to pay you until you have both reached MMI (maximum medical improvement) and are able to be given an impairment rating. Some work comp doctors say they cannot give you a rating until at least one year after you reach MMI.

3. Your claim is now being denied. Perhaps you were sent for an "IME" (independent medical examiner which are rarely independent if hired by the insurance company) that comes back stating your condition is not work-related. Sometimes they will even only send your records to a doctor (usually in another state) who will say based upon a records review and no examination that your injuries are not work-related, but rather pre-existing.

4. You have been paid TTD and your functional impairment rating has been paid in full. However, keep in mind that even if they pay out what their doctor says your rating is, you have the right under 85.39 to have your own IME examination at the cost of the insurance company. While this sounds great, it is often not as great as it sounds because effective July 1, 2017, the statute now says they only have to pay your IME doctor for the cost of the rating. Many insurance companies are taking the position that they will only pay for a small part of the total cost of the examination and not pay for the review of the medical records, etc. Also, it is not a good idea to use your 85.39 IME with just any doctor. There are board-certified occupational health physicians that we use for our clients and we are happy to discuss this with you in more detail. Just give us a call at 641-792-3595. We will answer your questions at no cost or risk.

5. The insurance company has sent you an Auxier notice. Iowa Code § 86.13 provides that “payments shall be terminated only when the employee has returned to work, or upon thirty days’ notice stating the reason for the termination and advising the employee of the right to file a claim with the workers’ compensation commissioner.” Sometimes, the insurance company will follow the law, and other times they will not. Here are some common reasons that your work comp payments may have stopped:

You failed to attend an IME examination they have set-up which if it occurred after July 1, 2017 will result in a forfeiture of your weekly benefits until you attend the appointment;

You have refused to return to light-duty work that is available with your employer;

You have been terminated from your employment for what the insurance company thinks is "cause" or "misconduct"; or

You have reached MMI and the insurance adjustor only plans to pay you for another 30 days.

As you can probably tell by now, the Iowa workers comp system can be quite complicated, and the insurance company has a team of lawyers working for them trying to find ways to stop paying your benefits. Should you have someone working for you and protecting your rights? If yes, feel free to give us a call at 641-792-3595. We are happy to answer your questions, explain your rights and tell you if we think we can help you or not. There is no cost or risk so call now. 

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