Law Office of James M. Hoffmann Articles What Can Happen to Your Workers' Compensation Benefits?

What Can Happen to Your Workers' Compensation Benefits?

By James Hoffmann  Apr. 26, 2018 3:30p

If you work in the state of Missouri, your employer, in most industries, is mandated to carry something called workers’ compensation insurance coverage. This is an insurance policy that serves to compensate someone who is injured on the job.

If the insurance carrier accepts your claim, then they will generally cover the cost of your medical bills and lost wages. The workers' compensation carrier will usually send you a weekly check to total two-thirds of your weekly pay rate.

However, the insurance company may only agree to pay only your medical bills and not to reimburse you for time off from work or to pay your wages while they investigate the validity of the claim. They can also deny your claim, refuse to pay for any time you miss from work and cease paying for your related medical bills.

If your insurance carrier believes that your injury was not sustained while you were performing work-related activities, doesn’t believe that it was as severe of an injury as you claim or they doesn’t think you were injured at all, they might decide that you aren’t eligible and stop payment.

Insurance companies have employees who work as claims adjusters. Each case is assigned an adjuster, and the adjuster is responsible for making sure that your medical costs are all paid. They are also required to make recommendations about your health care.

The problem with adjusters is that they aren’t working for the injured employee, they are working for the insurance company, so they usually do not have the best interest of the worker at heart. Instead, they seek to minimize liability for their employer any way that they can. They do this by spotting fraud.

An insurance company is not allowed to legally stop checks from being disbursed to an injured worker without a court order. For workers’ compensation benefits to cease, there must be a court order that is signed by both the workers’ compensation lawyer and the adjuster. The court order has to be filed in an application to stop paying an employee who files a claim for workers’ compensation benefits.

If an insurance company is going to refuse to pay any further medical costs, they must notify the worker. The employee then has seventeen days to respond to the written notice, or Form 24. Workers’ compensation Form 24 is a document that states that a worker has not been compliant with the requirements of workers' compensation. The worker is then assigned a hearing that is held over the phone to determine if the insurance company is rightfully denying coverage.

If you have received warning that your workers’ compensation benefits are going to terminate due to Form 24, it is critical that you speak with a St. Louis workers’ compensation attorney. If you are deemed ineligible, your weekly payments could stop, and you can be left paying for your work-related injuries out of pocket.

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