What if workers’ comp benefits end and a worker isn’t better?

On Behalf of | Apr 9, 2024 | Claims Process

Workers’ compensation benefits protect injured employees. People who cannot work due to pain or injuries can apply for benefits. They can potentially receive coverage for necessary medical treatment and also disability benefits while they cannot work.

In theory, workers’ compensation benefits should last until someone fully recovers or can return to work. However, sometimes doctors believe that a worker is ready to go back to their job when they still have debilitating symptoms. What happens if a worker loses their benefits but still has concerning symptoms?

Seeing another doctor might help

The major decisions about someone’s medical treatment during a workers’ compensation claim rely on the opinions of the doctor overseeing their care. Doctors prescribe an appropriate course of treatment and can also determine when a worker has recovered fully or as much as is likely given their condition.

Doctors can make mistakes due to inaccurate assumptions or attempts to apply information from prior cases to a unique situation. A second opinion from another physician affirming that someone still has painful, limiting symptoms might help if a doctor is wrong about someone’s condition.

The worker might actually need to pay for that evaluation using their own resources initially. The workers’ compensation program in Pennsylvania generally only covers second opinions when someone’s treatment plan involves a recommendation for surgery.

That being said, especially when someone stands to lose their benefits prematurely, seeing another doctor can make a major difference. The costs involved in paying for an evaluation can be worthwhile, as those investments may support someone’s request for additional medical benefits or continuation of their disability benefits during their recovery.

Sometimes, a worker has failed to properly communicate with a healthcare professional about the severity of their symptoms and the impact their condition has had on their life. Blue-collar workers are often inclined to downplay their symptoms when coping with physical injuries.

Speaking earnestly about the severity of pain and the limits an injury imposes on someone’s day-to-day life could help workers get the workers’ compensation benefits they need to actually recover and fully return to gainful employment. Those who know what steps to take when facing a premature end to necessary benefits may be able to challenge an unfavorable decision.