For what reason might an insurer suspend benefits?

An insurer may suspend benefits if the worker fails to cooperate with the investigation. This situation is significant because insurers rely on the cooperation of the claimant to gather necessary information about the circumstances surrounding the claim. Cooperation can include providing medical records, attending scheduled evaluations, and participating in interviews that help verify the legitimacy of the claim. If a worker does not engage in this process, it raises concerns about the validity of the claim, making it appropriate for the insurer to suspend benefits until the worker complies with the request for information.

Other situations, such as participating in job training or improving medical conditions, do not directly justify the suspension of benefits in the same way. Participation in job training may indicate a willingness to return to work, and improvement in the worker's condition could lead to a reassessment of benefits rather than suspension. Additionally, refusal to take medication could be part of the worker's treatment plan, but does not inherently lead to benefit suspension if the overall cooperation with the claims process is maintained. In summary, the failure to cooperate during the claims investigation is a direct and justifiable reason for an insurer to suspend benefits.