Last Updated: 6/15/2023
If you or a loved one is receiving weekly workers comp benefits you are probably wondering if the benefits can be stopped. The answer is yes, they can be stopped at any time for several different reasons some of which are legal and some of which are not. Below is a list of some of the commons reasons and what you may be able to do about it:
1. You receive a 30 day "Auxier" notice letter.
If you have been received workers comp benefits the insurance company is supposed to send you a letter giving you 30 days notice that your benefits will be stopping under the following situations.
a. You have returned to work providing gainful activity benefiting the employer;
b. You have reached MMI (maximum medical improvement) and released to return to work; (note: if you are released to return to work you should contact your employer and offer to work within any restrictions you may have. If you do not have restrictions you should also return to work and at least attempt to try to do your job. If you quit your job, you will likely cause significant damage to your case and cost yourself thousands of dollars. There is a right and wrong way to deal with a return to work issues that we are happy to help you with at no cost; or
c. You have been paid your functional impairment rating in full.
What can you do if you receive a 30-day notice letter?
The best thing to do is to give us a call so we can evaluate your situation and determine if what they have done in your case is proper and legal. If you have made a full recovery, are having no problems because of your work injury, are making the same amount or more money and have been paid all the benefits that you are owed, then you may not need our help. If the insurance company does not properly provide you with notice, then they can be subject to a penalty of up to 50% for the benefits not properly paid.
2. Your claim is being denied.
Despite the fact that the insurance company may have paid for your medical care and paid you weekly benefits, they can deny your claim at any time for any reason. The majority of the time the insurance company will deny your case because they obtain a medical opinion from a doctor who states that your condition is not work-related. They are required to put in their denial letter to you the reason for the denial, but often they do not. If you think that your case may be denied or it has been denied, then it is time to get some help. The sooner you call us, the sooner we can help you with your insurance company's denial.
What if my medical care is being delayed?
One sign that your case may be denied is that the insurance adjuster is not approving your medical care and treatment. For example, if the doctor they sent you to recommends an MRI, surgery, testing, etc. and it is not approved within a few days, then there is a good chance that the insurance company is trying to find a way to deny your case. Often, the first person to get a causation opinion letter from your doctors gets the opinion that they want. This means that the insurance adjuster is likely giving your doctor only part of the facts or even facts that are not true in order to get a letter from the doctor that your condition is not work-related. One of our most important jobs as workers comp attorneys in Iowa is to meet with your doctors and obtain the opinions that we need in order to prove your injuries are work-related. With a causation opinion, you do not have a case so don't delay, Contact or call us now at (641) 792-3595.
What can I do if my claim is being denied?
You really have two choices if your claim is being denied.
1. You can accept the denial and pay the costs associated with your medical care, lose the money that you are owed while off work and lose perhaps tens of thousands of dollars if your work injuries are permanent.
2. Have a qualified Iowa workers comp attorney evaluate your case at no cost to determine if moving forward with a claim is worthwhile or not. We will evaluate your case at no cost or risk and tell you what we think. We may tell you that we have to review your medical records before we will know if we can help or not. We may also tell you that we want to send you to a doctor of our choice for further evaluation that we will pay for at no cost or risk to you. We are only paid if we win your case and obtain money on your behalf.
Note: Regardless of which route you choose, if you have a written denial letter then if you have health insurance and/or disability insurance they are required to pay for your medical care and weekly benefits if you are taken off work. Iowa Code § 85.38(2) provides that "If an employer denies liability under this chapter, chapter 85A, or chapter 85B, for payment for any medical services received by an employee with a disability, and the employee is a beneficiary under either an individual or group plan for nonoccupational illness, injury, or disability, the nonoccupational plan shall not deny payment for the medical services received on the basis that the employer's liability for the medical services under this chapter, chapter 85A, or chapter 85B is unresolved."
3. The insurance adjuster just stops sending you checks.
This is a very common tactic that insurance adjusters use in order to frustrate you and cause further pain. Yes, your workers' compensation check is just like your paycheck so it should be mailed and delivered to you timely and on the same day each week. However, if the insurance adjuster is on vacation or forgets to authorize your weekly check then your checks may stop for a week or even longer. The insurance company can be penalized up to 50% for not paying your weekly benefits in a timely fashion, but that comes later on in the litigation part of your case and does not help you now when you have bills to pay. If your checks are not coming regularly and on time, then it is time to call an Iowa workers comp attorney for assistance.
You can contact or call us now at (641) 792-3595 at no cost and we will answer your questions, tell you how we think we can help and give you advice about how to best move forward. We do not charge a fee on weekly benefits that the insurance company voluntarily pays even if they are a few weeks late and we are able to get them started again. There are no upfront costs and we are paid a percentage of what we are able to get you above and beyond what the insurance company voluntarily pays.