When May a NY Workers’ Compensation Carrier Request to Suspend Benefits?

A New York Workers’ Compensation insurance carrier may request to suspend benefits under various circumstances when it is legally justified. These situations can include:

Return to Work: If the injured worker has recovered and is capable of returning to work, the insurance carrier may request to suspend benefits. This typically occurs when medical evaluations or treatment indicate that the worker is fit for employment.

Maximum Medical Improvement: When the injured worker’s condition has reached a point where further medical treatment is unlikely to result in significant improvement, the insurance carrier may seek to suspend benefits. This is often based on medical assessments and reports.

Settlement (Section 32 Agreement): In some cases, a claim may be resolved through a Section 32 settlement agreement, which includes a lump-sum payment to the injured worker. As part of this agreement, ongoing compensation payments may be suspended.

Failure to Comply: If the injured worker fails to comply with medical treatment plans or violates prescribed medical guidelines, the insurance carrier may request to suspend benefits. For instance, if the worker refuses recommended medical procedures or therapies without justifiable reasons, the carrier may take action to suspend payments.

Dispute Resolution: In cases where there is a dispute or disagreement over the continuation of benefits, the insurance carrier may file a suspension request as part of the dispute resolution process. This often involves legal proceedings and hearings.

It’s essential for the insurance carrier to adhere to the regulations and guidelines set forth by the New York State Workers’ Compensation Board (WCB) when requesting the suspension of benefits. This includes submitting the necessary documentation, such as medical reports and compliance with statutory timeframes for filing suspension requests. Additionally, timely communication with the WCB, the injured worker, and other involved parties is crucial to ensure that the suspension process is legally compliant and transparent.

Overall, the decision to request the suspension of benefits in New York State Workers’’ Compensation is based on various factors, including the injured worker’s medical condition, legal requirements, and the specific circumstances of the claim. Insurance carriers typically work closely with claim administrators and legal counsel to navigate these complex situations. Please contact Bedoya & Hussain Law Firm at (201) 880-9374 for more information.