Unilateral Suspension/Termination of Temporary Benefits

An insurance carrier or self-insured employer may end a claimant’s temporary benefits without a hearing in certain circumstances.  Under Rule 6-1 of the Division of Workers’ Compensation Rules of Procedure, claimant’s benefits may be ended without a hearing if the insurance carrier files an admission of liability form with one or more of the following:

1. A medical report from the authorized treating physician stating that the claimant has reached maximum medical improvement;

2. A medical report from the authorized treating physician who has provided the primary care which states that the claimant is able to return to regular employment;

3. A written report from the employer or the claimant stating that the claimant has returned to work;

4. A certified letter to the claimant and their attorney containing both an offer of modified employment, setting forth duties, wages, and hours and a statement from an authorized treating physician that the employment offered is within the claimant’s physical restrictions; and/or

5. A certified letter to the claimant and their attorney advising them that temporary disability benefits will be suspended for failure to appear at a rescheduled medical appointment.

The rules for terminating or suspending temporary disability benefits differ for claims arising before July 1, 1991.  (Rule 6,  Division of Workers’ Compensation Rules of Procedure).