How Can Someone Lose Their Benefits?

Are you receiving workers’ comp benefits in Pennsylvania? You may be wondering: How can someone lose their benefits? There are actually a few different scenarios in which it could happen. At DiLoreto, Cosentino & Bolinger P.C., we want to make sure that you are properly prepared. Here, our Franklin County workers’ compensation lawyer explains how a person could potentially lose their benefits in Pennsylvania.

Reason #1: Failure to Comply With Medical Treatment

You have to follow your doctor’s orders to be eligible to remain on workers’ compensation in Pennsylvania. The law requires injured workers to follow reasonable medical recommendations. Insurers can (and often will) move to suspend or terminate benefits if a worker stops treatment, misses appointments, or disregards prescribed restrictions. The insurer argues that the worker is no longer disabled or is failing to mitigate the injury. Continued, documented treatment protects the claim and preserves wage loss benefits.

Reason #2: Adverse Findings From an Independent Medical Examination

If there is a dispute over the nature, severity, or scope of a worker’s injuries, an insurance company may request an Independent Medical Examination under 77 P.S. § 651. If the IME physician concludes that the worker is fully recovered or that work is medically suitable, the insurer may petition to modify, suspend, or terminate benefits. The IME does not control the case, but it creates evidence that the employer uses to challenge disability status. You have the right to counter any adverse findings from an IME.

Reason #3: Return to Work at Pre-Injury or Modified Earnings

If an injured worker in Chambersburg or elsewhere in Franklin County or Pennsylvania returns to a job that pays the same or more than the pre-injury wage, wage loss benefits end as a matter of Pennsylvania Commonwealth law. If the return is to modified duty with lower earnings, partial disability benefits may continue. Problems can arise when the worker refuses a valid job offer. Pennsylvania law permits suspension of benefits if the worker declines suitable work that matches documented restrictions. If there is a dispute over whether you can truly return to the workplace, an attorney can help you protect your rights.

Reason #4: Evidence of Fraud or Misrepresentation

Workers’ compensation is a no-fault system. With that being said, benefits are not automatically paid out. A claimant can lose all benefits if the insurer proves misrepresentation about job duties, prior injuries, earnings, or functional capacity. Video surveillance, social media posts, and inconsistent statements often form the basis of these allegations.

Call Our Franklin County Work Injury Lawyer Today

At DiLoreto, Cosentino & Bolinger P.C., our Chambersburg, PA workers’ compensation attorneys have the skills and experience that you can trust when it matters the most. If you have any questions or concerns about protecting your benefits, we can help. Please do not hesitate to contact us for a free, no-obligation initial consultation. We represent injured workers throughout Franklin County, including in Chambersburg, Waynesboro, and Wayne Heights.