A briefcase icon

free case review

All of our consultations are 100% FREE & confidential.

Take Two: Reconsideration of the Termination of Benefits

Workers’ compensation claims can span years, involve multiple medical treatment providers, result in a number of expert opinions and carry through periods where the claimant may actually return to work.  As the claimant’s medical and work status changes, his or her workers’ compensation benefits are also similarly adjusted.  But what happens when the workers’ compensation panel terminates a claimant’s benefits based on inaccurate evidence?


Take a claimant who hurt his or her arm operating machinery and required surgery.  Suppose benefits were awarded while the claimant underwent a year of rehabilitation and recovery.  Eventually, an orthopaedic surgeon concludes that the claimant has reached maximum medical improvement and finds that the claimant is no longer disabled.  The physician approves the claimant’s return to work with some restrictions.


The claimant returns to work and the workers’ compensation benefits subsequently cease.  A few months later, however, the employer gives written notice to the claimant that it can no longer accommodate his or her work restrictions and that it could not identify a suitable reassignment.  The employer advises the claimant to take unpaid medical leave or to use up any accrued leave.  How does a claimant now urge the workers’ compensation board to reopen his case and reconsider the termination of the benefits?


Speak to a Lawyer


A workers’ compensation board may decide to reopen a case if there is clear evidence of error.  The burden is on the claimant to present clear evidence of error, and the claimant should aim to present only evidence that may be deemed material and relevant.  The workers’ compensation board will certainly scrutinize the evidence proffered in support of reopening a case for its precision, strength and clarity.  These circumstances undergo a limited reviewed that is specifically targeted on the question as to whether the new evidence shows clear error when juxtaposed to the record of the case.  The reviewing board is not looking for mere conflicts in the evidence (such as differing medical opinions) but rather whether the weight of the evidence has shifted in favor of the claimant – to such an extent that a substantial question arises as to the correctness of the initial decision.


In light of this framework, the claimant should argue that the termination of benefits was based on the incorrect assumption that the claimant was fully able to work.  The claimant should present the employer’s own written admission that the claimant required accommodations but that the employer was not able to restructure the job without undue hardship.


As you can see, there are many phases to this claim.  Claimants should seek guidance from skilled workers’ compensation attorneys to advise them through such procedural hurdles.  A workers’ compensation attorney could assist in persuading the board that the employer’s letter above clearly shows that the claimant was not ready to perform his essential job functions and that there is manifest error in terminating the claimant’s benefits.

get started on your claim

let our Houston law firm injury lawyers focus on fighting insurance company so that you can focus on getting better.