Workers’ compensation insurers will look for any reason to stop making payments on your benefits. If you’ve returned to work and know that your benefits are coming to an end, this may not come as a surprise, but for many individuals, receiving a notice that the insurance company intends to cease injury payments can cause shock and stress. If you’ve been informed that your payments are about to come to an end and you believe this notice has been sent incorrectly or you’d like to contest the reason for discontinuance, we want to explain the next steps you should take in today’s blog.
Notice Of Intent To Discontinue
A workers’ compensation insurance provider can’t just stop making payments to a claimant out of the blue. Prior to ceasing payment, the insurance company is required to send notice to the employee that they feel justified in terminating their benefits. This letter is called a Notice of Intent to Discontinue, or more simply referred to as a NOID.
If you receive a NOID, the first thing you’ll want to do is read it over carefully. In the notice, the insurance company should clearly spell out why they feel justified in ceasing your benefits. Again, if this is expected, you should find the letter informative and likely no additional action will be needed, but the rest of this blog will focus on what you should do if you believe the insurance company has misjudged when your benefits should end. Read through the letter and work to understand why the insurance company is stopping payments. Perhaps they are misinformed about your condition, there’s a difference of opinion in your doctor’s recommendations, or they believe that you are not following through on care requirements on your end. Knowing why benefits are stopping is the first step in contesting the NOID.
Next, you’ll want to get in contact with your lawyer. If you don’t have a lawyer, you’re going to want to find one ASAP. They regularly handle NOID appeals, and the process can be difficult if you’re inexperienced and up against professionals on the other side who do this for a living. You’ll also want to act quickly, as you may only have 10-14 days to file an appeal before the NOID is considered valid.
Your lawyer will read over the letter and talk with you to better understand why you believe the NOID is invalid. If they believe you have a valid argument, they’ll file an appeal and request a conference to contest the denial. This conference is known as a 239 conference. Your lawyer will brief you about the conference, and in most instances they’ll recommend that you stay home and continue focusing on your health while they go to battle for you at the 239 conference. Lawyers can typically make more convincing arguments based on testimony from the claimant and evidence like imaging tests and examination results, so your presence is not usually needed, but your lawyer will provide you with individualized advice. After both sides have made their case (arguments only), a judge will rule as to whether the NOID is valid or invalid within five business days.
There’s a possibility that the judge’s ruling will stand once it has been rendered, but both sides have additional legal options in the event they disagree with the decision. The insurance company may file a petition to discontinue. Within 10 days, a de novo hearing will be scheduled, and additional evidence can be introduced to make a case (doctor’s examinations, imaging tests, medical reports, other physical evidence to the employee’s condition). A judge will listen to both cases and make a ruling at its conclusion that will act as a final decision. In the event you lost at the 239 conference, you can file an objection to discontinuance and the same de novo hearing will be scheduled and both sides will make their cases in front of a judge.
The only real difference to note en route to a de novo hearing after a 239 conference is that interim benefits will be based on the decision at the 239 conference. For example, if the insurance company is filing a petition to discontinue, benefits must continue to be paid until the de novo hearing and ruling is made. If the employee is filing an objection to discontinuance, benefits may be stopped until the de novo hearing and ruling.
Don’t expect to win a 239 conference or a de novo hearing on your own. Instead, connect with an attorney who can build a strong case and get you the benefits you deserve. For more information on how we can assist with any aspect of your workers’ compensation case, connect with the team at Hey Workers today at (844) 439-9675.
