Can Insurance Companies Stop Your Benefits in Vermont?

You finally started getting your workers’ compensation checks after weeks of paperwork and waiting. Then, without much warning, the payments stop. If this sounds familiar, you are probably wondering whether an insurance company can really just cut you off like that. At Sluka Law PLC, our Vermont workers’ compensation lawyers hear this question often, and the short answer is that insurers can stop benefits, but only if they follow specific rules first.

Why Would an Insurer Stop Your Benefits?

Insurance companies look for reasons to limit what they pay out, and there are several situations where they may try to discontinue your benefits. These include:

• A doctor says you have reached maximum medical improvement
• You are medically released to return to work, even in a limited capacity
• The insurer believes your injury is not related to your job
• You miss appointments or do not cooperate with your claim
• Video surveillance or social media is used to question your limitations

Sometimes these reasons are legitimate. Other times, an insurer is simply trying to save money by ending your payments early, before you are actually ready to go back to work.

The Rules Insurers Have to Follow

Vermont law does not let an insurance carrier stop your benefits on a whim. Under 21 V.S.A. § 643a, an employer or insurer must notify both you and the Commissioner of Labor before discontinuing payments, using a specific form that lays out the date of the proposed discontinuance and the reasons behind it. The Commissioner then reviews the evidence, and if it does not reasonably support stopping your benefits, payments must continue until a hearing is held and a decision is made. In other words, the insurance company cannot just decide unilaterally and walk away from your claim.

What You Can Do If Your Benefits Stop

If your benefits are discontinued and you believe the decision was wrong, you are not without options. You can request an informal conference with the Department of Labor to challenge the discontinuance, and you can gather medical records, witness statements, and other documentation to support your position. Acting quickly matters here. The longer you wait to push back, the harder it can become to get your payments reinstated without a fight.

Have you received a notice that your benefits are being cut off, or has the money simply stopped showing up? Either way, it helps to understand exactly what the insurance company is required to prove before it can take that step.

Losing your benefits when you still need them is frustrating and often frightening, especially if you are relying on that income to cover your bills. We know how to review a discontinuance notice, challenge it when the evidence does not hold up, and fight to get your payments restarted. If an insurance company has stopped or threatened to stop your workers’ compensation benefits, reach out to Sluka Law PLC today so we can talk through what happened and help you protect what you are owed.

Source:

legislature.vermont.gov/statutes/section/21/009/00643A