When Workers’ Compensation Benefits Are Stopped Without Explanation

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Employees injured on the job in Illinois rely on workers’ compensation benefits to cover medical expenses and lost wages while they recover. In some cases, these benefits may suddenly stop, even though medical treatment is ongoing and the employee has not yet been cleared to return to work.

Consider a common scenario: An employee sustains a serious back injury at work, receives immediate medical care, and has their bills paid through workers’ compensation insurance. Temporary Total Disability (TTD) benefits are paid for several months. Then, without warning, the checks stop, despite the fact that the treating physician has not yet released the worker to return to their job.

Generally, an insurance company cannot legally stop paying workers’ compensation benefits unless there is good cause. Some valid reasons for terminating benefits may include:

• Independent Medical Exam (IME) Findings: An insurance-appointed physician concludes that the employee can return to work or that the injury is unrelated to the job.
• New Evidence About the Accident: The insurer uncovers facts suggesting the injury occurred outside of work.
• Surveillance Results: Video surveillance reveals that the employee is exaggerating or misrepresenting the injury.
• Doctor’s Release to Work: The treating physician clears the worker to return to work, even if the employee disagrees.
• Available Work Within Restrictions: The employer offers a suitable position that meets the employee’s medical limitations.

If none of these circumstances apply, the insurance company may be acting improperly by stopping payment. It sounds dumb, but it happens all of the time.

In many cases, delays or stoppages occur because of administrative issues. There may be poor file management or the claim adjuster assigned to the case quit or was fired. In other cases, an adjuster may try to pressure an injured employee into returning to work before they are medically ready. It’s actually an insurance company business tactic to cut people off.  Their hope is that you will just go away. Sadly this sometimes works.