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  1. #1
    Join Date
    Oct 2008
    Posts
    18

    Default How Can They Just Stop Paying?

    My claim has been accepted and they have been paying all medical up until 1/15, which is when I went back to work. They have now stopped paying anything.

    What are reasons they would stop paying like this??

  2. #2
    Join Date
    Oct 2006
    Posts
    9,109

    Default Re: How Can They Just Stop Paying?

    they were told no more benefits were needed.

  3. #3
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: How Can They Just Stop Paying?

    ... I went back to work....
    What benefits are you thinking should still be provided...?
    If your PTP has released you to RTW, the TTD/wage replacement stops.

    If you are not in need of additional medical care at this point... (??)

    If you have a rating to permenant impairment... and there is indemnity/award due, that would begin, usually within 14 days on the same schedule as the TTD.
    IF the rating has not issued, or been disputed, then a hearing will be necessary to have the judge order benefits.

    Based on the limited information here... don't know what your looking for.

  4. #4
    Join Date
    Oct 2008
    Posts
    18

    Default Re: How Can They Just Stop Paying?

    I don't know what I'm looking for except what reasons are there for the benefits to be stopped like this. We have not received a notice to controvert stating the benefits have been stopped. I found this out through my HR Dept. When I called the State Board, they do not have anything other than a week that I was out due to being sick, but other than that, there is nothing at all. Wouldn't they be required by law to send a notice to controvert when they are stopping any and all benefits?

    Thank you for your time.

    Quote Quoting BvIA View Post
    What benefits are you thinking should still be provided...?
    If your PTP has released you to RTW, the TTD/wage replacement stops.

    If you are not in need of additional medical care at this point... (??)

    If you have a rating to permenant impairment... and there is indemnity/award due, that would begin, usually within 14 days on the same schedule as the TTD.
    IF the rating has not issued, or been disputed, then a hearing will be necessary to have the judge order benefits.

    Based on the limited information here... don't know what your looking for.

  5. #5
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: How Can They Just Stop Paying?

    I'd have to review the GA statutes to give you a difinitive answer...but generally, when your treatment is over, and you RTW, the TTD ends.. .and there are no more benefits due.
    If there aren't benefits due... I don't know what would be paid to you once you are released. (?)
    That's why I asked what benefits you are looking for to be paid...

    If you need additional treatment/care for the injury, you go back to the treating physican.

    Have you received a impairment rating from your doctor ?
    Or have you contacted the CA to pose your questions...?

    We have not received a notice to controvert stating the benefits have been stopped.
    The benefits stopped because there are no more benefits due at this time. The IC isn't disputing anything..obviously you are not either...except for the stoppage...but there is nothing for you to dispute.

  6. #6
    Join Date
    Oct 2008
    Posts
    18

    Default Re: How Can They Just Stop Paying?

    I was taken back out of work. I never reached MMI nor am I anywhere close to reaching MMI. The atty for the IC is saying they are not aware of anything happening. It is an accepted claim. I just had a deposition two weeks ago. Treatment was continuing when I returned to work. I have been in and out of work since the injury late last year. I was not released by the MD...no where close.

    Quote Quoting BvIA View Post
    I'd have to review the GA statutes to give you a difinitive answer...but generally, when your treatment is over, and you RTW, the TTD ends.. .and there are no more benefits due.
    If there aren't benefits due... I don't know what would be paid to you once you are released. (?)
    That's why I asked what benefits you are looking for to be paid...

    If you need additional treatment/care for the injury, you go back to the treating physican.

    Have you received a impairment rating from your doctor ?
    Or have you contacted the CA to pose your questions...?

    The benefits stopped because there are no more benefits due at this time. The IC isn't disputing anything..obviously you are not either...except for the stoppage...but there is nothing for you to dispute.

  7. #7
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: How Can They Just Stop Paying?

    I was taken back out of work. I never reached MMI nor am I anywhere close to reaching MMI.
    You RTW in a light duty capacity?
    Has your treating physican reported to the CA/IC that you are once again TTD...?
    My claim has been accepted and they have been paying all medical up until 1/15, which is when I went back to work. They have now stopped paying anything.

    What are reasons they would stop paying like this??
    That's your first post.. there could be LOTS of reasons to stop benefits... and those reasons would be based on the factors of your claim...there are no 'standard' or 'usual rules' to stop benefits.

    Follow to trail...check with the PTP, you already talked to the DA, call the CA... who knows your case.
    Asking a generic question on a message board w/o associated details can't generate much of a valid answer.

  8. #8
    Join Date
    Oct 2008
    Posts
    18

    Default Re: How Can They Just Stop Paying? UPDATE

    Well, the reason has finally come out. The adjuster is stating my time out of work is not related to this claim, which is it! I have the notes from the MD stating I have to be out due to restrictions not being met by the employer.

    Now, the IC is wanting to settle my case. I do not want to settle and will not settle as my injury is only a few months old and at some point the Surgeon would like to go in and look inside my knee (I can not have an MRI). He feels on top of nerve damage from the injury, he feels I have either a torn mensicus and/or a torn ligament. Further, they are not paying for all of the things that are related to my knee (another MD, medications, etc).

    They are probably hoping I will take a small settlement and be done with it. I'm not that stupid!

  9. #9
    Join Date
    Feb 2007
    Location
    Calif
    Posts
    18,021

    Default Re: How Can They Just Stop Paying?

    Well, the reason has finally come out. The adjuster is stating my time out of work is not related to this claim, which is it! I have the notes from the MD stating I have to be out due to restrictions not being met by the employer.
    Ok, then you'll have to file for a hearing with the WC court...and get a judge to order the benefits reinstated.
    That will take some time to get the hearing on calendar... so file now.
    Questions and Answers About Mediation

    What is mediation?

    Mediation is a process in which a neutral third party (mediator) helps the parties communicate with one another in an attempt to reach an agreement that is acceptable to everyone. Mediation is a forward-looking process in that it encourages the participants to focus on their current and future needs and interests rather than focusing on fault and blame for past actions. Mediation differs from a court proceeding in that the parties maintain control of their dispute. The decision-making power in mediation lies with the parties, not with the mediator.http://sbwc.georgia.gov/00/channel_m...018585,00.html

  10. #10
    Join Date
    Oct 2008
    Posts
    18

    Default Re: How Can They Just Stop Paying?

    Quote Quoting BvIA View Post
    Ok, then you'll have to file for a hearing with the WC court...and get a judge to order the benefits reinstated.
    That will take some time to get the hearing on calendar... so file now.

    Thank you for your help, BvIA. We do have a hearing that had been rescheduled. We go in a few weeks.

    I can't believe they are wanting to settle with me!!! Someone is smoking crack, and it isn't me!!

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