If your workers’ comp check suddenly drops, you may not know why. New York’s workers’ compensation system allows insurers to reduce your benefits under specific legal conditions.
Maximum medical improvement
A doctor may declare that you have reached Maximum Medical Improvement (MMI), meaning your condition has stabilized. Under New York Workers’ Compensation Law Section 15, your weekly benefit is calculated as two-thirds of your Average Weekly Wage multiplied by your disability percentage. If an insurance-appointed doctor lowers that percentage, your benefit drops immediately.
Returning to light-duty work
Your employer may offer you a modified role while you recover. If that job pays less than your pre-injury wages, you may receive reduced earnings benefits. These pay up to two-thirds of the difference between your old and new wages. Refusing a suitable offer without cause can suspend your benefits entirely.
Missing medical appointments
Non-compliance with treatment gives insurers a reason to challenge your claim. This can include:
- Missed appointments: Skipping scheduled visits with your treating doctor.
- Refused therapy: Declining physical therapy your doctor prescribed.
- Ignored prescriptions: Failing to take medications as directed.
Consistent non-compliance may lead the insurer to argue you are not actively recovering.
Surveillance and fraud allegations
Insurance carriers may hire investigators to monitor your activities. Footage showing physical tasks that contradict your stated limitations can be used to reduce or terminate your benefits. Social media posts can also serve as evidence. New York Workers’ Compensation Law treats fraud as a serious matter and the Workers’ Compensation Board has authority to act on those findings.
What to do if your benefits are reduced
You have the right to challenge a reduction through a formal hearing before the New York State Workers’ Compensation Board. Gather updated medical records from your own physician. Document all appointments and keep records of any job offers you receive. Act quickly, as appeal deadlines are strict. An attorney can help you understand your options and whether the reduction followed the rules under New York Workers’ Compensation Law.