Every stop has a reason. Find the reason, attack the reason. Move fast.
What's happening
Your indemnity benefit has been suspended or reduced. The carrier has filed an SROI-04 (or similar suspension notice) stating its basis — IME report concluding no disability, stale C-4, alleged return to work, classification at MMI, alleged refusal of light duty, or another specific reason. Until challenged, the suspension is in effect. Every week without benefits compounds the problem and weakens settlement position. This stage is time-sensitive in a way other stages are not.
What comes next
- Pull the eCase docket and identify the stop reason. The carrier's SROI-04 filing states the basis. Without knowing the reason, you can't structure the response.
- Get updated medical from your treating physician. If the stop is medical-based (IME, stale C-4), updated treatment-physician documentation is the core of the response.
- File an RFA-1LC requesting a hearing. The Request for Further Action puts the issue in front of a Workers' Compensation Law Judge. Filing promptly is critical — delays let the carrier control the narrative.
- Read any IME report carefully. If the stop is based on an IME, the IME report is the document to attack. Run it through the IME Red Flag Checker to identify adversarial language and analytical weaknesses.
- Address whatever specific issue the carrier raised. Return-to-work stop? Get medical confirming continued disability. Light-duty refusal? Get the actual terms of the offer in writing and evaluate whether it was valid. Classification stop? Understand the rate change and challenge any improper basis.
Common pitfalls at this stage
- Waiting weeks before responding. Every week off benefits compounds. The carrier's leverage grows. Move within days of the stop, not weeks.
- Submitting medical without challenging the legal basis. A new C-4 alone may not be enough if the carrier has an IME contradiction. The response has to address both the medical and the legal basis.
- Accepting 'the IME said so' without reading the IME. IMEs frequently contain language a competent challenge can dismantle — premature MMI, no objective findings boilerplate, history inconsistent boilerplate. The IME Red Flag Checker catches the common patterns.
- Missing the SROI-04 entirely. Some carriers stop benefits without sending you a clear notice. The docket still has the SROI-04. Don't assume no notice means no basis.
- Settling under pressure to restart cash flow. Settlement offers made during a benefits stop are leverage plays. The right move is usually to restore benefits first, then evaluate settlement from a position of strength.
Tools, FAQs, and pages relevant to this stage
When to call now
Now. A benefits stop is the single most time-sensitive event in a workers' comp case — the longer it sits, the longer the catch-up and the worse the settlement leverage. Call within days, not weeks.
Attorney Advertising — Educational Use Only. This page provides general information about New York workers' compensation. It is not legal advice and does not create an attorney-client relationship. Every case turns on its facts. For analysis of your matter, contact Levi directly.