Denied or Terminated Maintenance and Cure: What to Do When Payments or Medical Care Stop

Maintenance and Cure Denied or Cut Off? Get the Reason Reviewed.

The second problem is the one this page is about, and it starts with a point worth stating plainly:

A denial or cutoff does not, by itself, establish that maintenance and cure is no longer owed. It is the employer's position. Whether that position holds up depends on the reason given and the evidence behind it.

Two quick definitions so the rest of this page is clear. Maintenance is the daily living-expense support a seaman injured or taken ill in the service of the vessel is owed while recovering ashore. Cure is the payment of reasonable medical care for that injury or illness. Neither is wage replacement, and neither is a settlement. They are separate obligations under general maritime law, and they can be disputed separately. Ordinary carelessness in causing the accident—yours or the employer's—does not ordinarily defeat them, although courts recognize exceptions for a seaman's willful misconduct, discussed below. For a fuller explanation of how these benefits work, see our overview of maintenance and cure rights and claims.

The Young Firm is a maritime injury law firm in New Orleans representing seamen injured in Louisiana and along the Gulf Coast. If your benefits never began, stopped entirely, or arrive late and unpredictably, we can review what happened and tell you what we see. We cannot promise a payment date or an emergency order. What we can do is identify what stopped, what reason was given, and whether that reason deserves to be tested.

Contact The Young Firm to request a review of your denied or stopped benefits. You do not need a denial letter or a complete file to ask.

What to Do Now When Your Employer Stops Maintenance and Cure

You do not need a formal denial letter, a lawyer's permission, or a complete file to take these steps. Do them in roughly this order.

1. Write down what actually stopped and when. Note the date of the last maintenance payment you received, the period it appeared to cover, and any treatment, prescription, therapy, or appointment that has been refused, canceled, or left unauthorized. If nothing was ever paid, write down the date you reported the injury and to whom.

1. Ask for the reason in writing, and ask for the records behind it. Send a short, polite request by email or text to whoever has been handling your claim: "Please tell me in writing why my maintenance and cure was stopped and send me any medical report or other document you relied on." Ask for the explanation and supporting records in writing even if the decision was communicated only by phone. You do not need a formal denial letter to request a legal review. Asking anyway creates a record of what you were told and when.

1. Save everything. Texts, emails, letters, envelopes with postmarks, check stubs, bank deposit records, voicemails. Start a dated log of every call about your claim: who you spoke to, what they said, what you asked for. Do not rely on memory and do not assume the company is keeping a record you will be able to see later.

1. Do not stop treating. If a company-scheduled appointment has been canceled or a bill is unpaid, tell your treating physician what is happening and ask how to continue care. If you have an urgent medical problem, get medical help now. A legal review is not a substitute for a doctor, and waiting for one before seeking care can hurt both your health and your claim.

1. Read before you sign, and do not let a check pressure you into a release. Routine claim paperwork—a medical records authorization, a wage verification form—is one thing. A release, a "settlement" agreement, or a new medical questionnaire presented alongside a payment is another. If you cannot tell which you are looking at, have it reviewed promptly before signing. Cooperating with legitimate requests is fine; signing away a claim to get a check is not.

1. Do not assume the adjuster's ongoing conversation protects your deadlines. A friendly adjuster who says "we're still looking at it" is not stopping any clock. Maritime claims have time limits that depend on the claim, the parties, and the facts, and those limits are analyzed case by case.

1. Contact a maritime lawyer. Bring what you have. Gaps in your file are normal at this stage and are not a reason to wait.

Denied, Terminated, Late, or Underpaid: Identify the Actual Dispute

The words "denied" and "cut off" get used loosely, and the distinction matters because each type of dispute points to different evidence and different next steps. Start by identifying which one you have.

Two things follow from this table.

First, maintenance and cure are separate obligations, and payment of one does not establish that the other has been satisfied. An employer that keeps sending maintenance checks while refusing to authorize treatment still has to answer whether that treatment was owed as cure. An employer that pays a hospital bill while sending nothing for living expenses still has to answer whether maintenance was owed for that period. When you describe your situation, say which one has stopped, or whether both have.

Second, the last two rows are related but distinct problems with their own pages. If your payments are arriving but the amount is too low, the question is how the rate is calculated; see disputing the maintenance rate. If a specific procedure, doctor choice, or medical expense is being refused while benefits otherwise continue, see medical treatment and cure disputes. This page focuses on the situations where payments or care have stopped, never started, or are not arriving when they should.

A word about late payments specifically. There is no universal statutory due date for maintenance and no automatic penalty that attaches when a check is a certain number of days late. Whether a delay matters legally depends on the pattern, the explanation, any agreement about payment frequency, and the consequences to you. What you can do now is document the pattern precisely: the date each payment arrived, the period it covered, and the gaps. That record is what a lawyer needs to evaluate whether the delays are a bookkeeping problem or something more.

Match the Employer's Reason for Denial to the Records That Matter

When benefits stop, the employer usually gives a reason—sometimes in a letter, sometimes in a phone call, sometimes not at all until asked. The reason determines what has to be examined. An adjuster's statement that you have "reached MMI" or "weren't a seaman" or "didn't disclose a prior condition" is an assertion, not a finding. Each assertion is tested against specific records.

A few essential qualifications on the reasons that come up most often.

Maximum medical improvement

The cure obligation runs until the seaman reaches the point where further treatment will not improve the condition—often called maximum cure or maximum medical improvement. The Supreme Court described this endpoint in Farrell v. United States, 336 U.S. 511 (1949), and in Vella v. Ford Motor Co., 421 U.S. 1 (1975), emphasized that it is a medical determination. A cutoff based on MMI therefore has to be measured against the medical evidence, not just labeled.

The first questions are: Which doctor said you had reached MMI, and what exactly did that report say? Does your treating physician agree, or has your treating physician recommended surgery, injections, therapy, or further evaluation? A company-arranged examination that concludes "no further treatment recommended" while your own surgeon has scheduled a procedure is a conflict in the evidence, and conflicts are not resolved by the employer choosing the opinion it prefers. Be careful about the reverse assumption, too: continuing pain or disability does not by itself mean maintenance and cure continues. A permanent condition that treatment cannot improve may be at maximum cure even though you cannot return to work. How that line is drawn is covered in detail at maximum medical improvement and benefit duration.

Preexisting conditions and alleged nondisclosure

Employers sometimes invoke what maritime lawyers call the McCorpen defense, after McCorpen v. Central Gulf Steamship Corp., 396 F.2d 547 (5th Cir. 1968). The defense has specific elements the employer must establish, and the analysis turns on what the preemployment questionnaire actually asked and how it was answered, whether the condition mattered to the hiring decision, and whether it is connected to the injury now claimed. Having a prior condition is not, by itself, enough to defeat benefits.

Get a copy of every medical questionnaire you completed and gather your prior medical records. Do not accept a characterization of what you "should have disclosed" without seeing the questions you were actually asked. The full analysis belongs with maintenance and cure eligibility disputes.

Firing, quitting, or returning to work

An employment event after the injury does not automatically end an obligation that arose when you were injured in the service of the vessel, but the facts can matter, particularly around return to work and fitness-for-duty releases. Save the paperwork and let a lawyer sort out the effect. See maintenance and cure eligibility disputes.

Seaman status

Maintenance and cure is owed to seamen. If the employer says you do not qualify, the dispute is about your work: how much of your time was spent in service of a vessel or identifiable fleet of vessels, and whether your duties contributed to the vessel's function or mission. Gather crew lists, assignment records, and anything showing where and how you worked. If you turn out not to be a seaman, you may have rights under a different framework—the Longshore and Harbor Workers' Compensation Act—which has its own benefits, its own procedure, and its own deadlines administered through the U.S. Department of Labor. That is a different claim, not a different version of this one. See whether you qualify as a seaman and Longshore Act benefits and claims.

Blame for the accident

Maintenance and cure is not a negligence claim. It is owed for injury or illness that occurs while a seaman is in the service of the vessel, without regard to whether the employer was at fault or, generally, whether the seaman was careless. An employer that says "you weren't paying attention" or "you didn't follow the procedure" is describing ordinary fault, which does not ordinarily defeat maintenance and cure. Courts have recognized exceptions for a seaman's willful misconduct—intoxication and deliberate misbehavior are the classic examples—and the employer bears the burden of proving that kind of conduct. If the company is alleging something specific, ask for the evidence. Whether the employer was negligent in causing your injury is a separate question with separate remedies, addressed at Jones Act negligence.

"We need more paperwork"

Employers are entitled to investigate a claim. They are not entitled to investigate forever while a seaman goes without living expenses and care. The useful record here is a simple chronology: what was requested, when you provided it, whether receipt was acknowledged, and how long the file has sat since. A two-week wait for a signed medical authorization is one thing. A four-month "investigation" with no explanation and no payment is another. Neither conclusion should be assumed; the chronology is what allows a lawyer to tell them apart.

Build a Payment-Gap Record Without Waiting for a Complete File

You do not need to be organized to ask for help. But a lawyer can move faster and speak to the employer more precisely when the payment gap is documented rather than estimated. Here is what to gather, and why each item matters. Keep the originals. Your summary is useful; the underlying records are what prove it.

Payment record

Keep the claimed gaps in their own list, clearly labeled as your belief rather than a confirmed figure. This worksheet organizes facts; it does not determine what is legally owed, and the amount you believe is missing may differ from what turns out to be recoverable once the rate and duration questions are analyzed.

Documents to preserve

• Bank statements and deposit records showing each maintenance payment.
• Check stubs, remittance letters, and envelopes, including postmarks, which establish when payments were actually sent.
• Every email, text, and letter about the claim, from anyone: employer, insurer, administrator, nurse case manager, or company doctor.
• A dated call log: date, time, who you spoke with, what was said, what you asked for.
• Denial or termination communications, formal or informal.

Medical side, kept separate

• Outstanding medical bills and any collections notices.
• Treatment recommendations from your treating physicians, especially anything recommended but not yet performed.
• Authorization requests you or your doctor's office submitted, and any response.
• Appointment cancellations attributable to nonpayment or lack of authorization.
• Prescriptions you could not fill and pharmacy records showing it.
• Any report from a company-arranged examination, if you have been given a copy.

Consequences of nonpayment

Keep a short, dated list of what happened because payments stopped: rent or mortgage notices, utility disconnections, missed appointments, canceled procedures, borrowed money. Not every expense or hardship is legally recoverable, and no one should tell you otherwise before reviewing your claim. But if an improper refusal caused specific harm, the record of that harm is what makes it provable.

One caution: this file contains sensitive medical and financial information. Do not email or upload it to an address or portal you have not confirmed belongs to the lawyer you are actually working with. Ask how the firm wants to receive documents before you send anything.

How a Lawyer Can Challenge Unpaid or Terminated Benefits

Hiring counsel does not restart payments by itself, and it does not create an automatic procedure the employer must follow. What it does is put the employer's position under scrutiny by someone who knows what the law requires and what the records show. The steps below are what that work typically involves. They are conditional, not a fixed sequence, and which ones apply depends on your facts.

Identifying who actually owes the obligation. The person who called you is usually a claims adjuster or a third-party administrator. The maintenance and cure obligation belongs to the employer or vessel owner. Knowing who is legally responsible, and how the company is structured, matters for every step that follows.

Assessing entitlement. Before challenging a cutoff, a lawyer confirms the foundation: that you were a seaman, that the injury or illness arose while you were in the service of the vessel, and that no recognized defense clearly applies. If the employer's stated reason goes to one of these points, that is where the analysis begins.

Reviewing the refusal against its own support. The lawyer obtains the report or records the employer relied on and compares them with your treating physicians' records, the payment history, and the communications. This is where a stated reason either holds together or does not.

Targeted record collection. Missing pieces—a treating physician's narrative, the actual preemployment questionnaire, crew assignment records, an itemized bill—are requested from the sources that have them.

Documented demand. Where the review supports it, counsel presents the employer with a written demand identifying what is owed, why the stated reason does not justify the cutoff, and what the supporting evidence shows. Some disputes resolve here, particularly those that turn on missing documentation or an incomplete medical picture. Some do not.

Evaluating a lawsuit or other formal proceeding. If the employer does not respond or maintains its position, the next step may be a lawsuit under general maritime law seeking the unpaid benefits and any other relief the facts support. Whether a suit is the right route, and where it would be filed, depends on a review of the appropriate forum and of any enforceable arbitration or other dispute-resolution agreement that may govern the claim. Maintenance and cure claims are frequently brought alongside Jones Act and unseaworthiness claims arising from the same injury, though they do not have to be. Court procedures exist to seek payment of benefits proven to be due, but courts do not issue instant orders, and no lawyer can promise an expedited ruling or a reinstatement date.

Two points about what this process is not.

It is not a workers' compensation appeal. There is no administrative board, no hearing officer, and no form to file with a state agency. Maintenance and cure is a federal maritime law obligation, and disputes over it are ordinarily resolved through a lawsuit or, where an enforceable dispute-resolution agreement applies, the procedure that agreement sets out—not through a state agency or an LHWCA administrative process. If you have been told to "appeal" a denial through some agency process, that is either a misunderstanding or a sign that your claim may actually fall under a different statute, which is worth clarifying immediately.

And it does not pause deadlines. Sending a demand, negotiating with an adjuster, or hiring a lawyer does not toll a limitations period. Which time limits apply, when they began running, whether the doctrine of laches is relevant, and how any employment or union agreement affects the analysis are questions answered claim by claim. The safe assumption is that time is running and that waiting for the employer to change its mind is not a strategy.

Unpaid Benefits and Bad Faith Are Different Questions

Seamen who have been cut off often ask about punitive damages. Recovering the benefits you are owed and proving that the employer should pay something more are separate questions.

If maintenance and cure was owed and not paid, the core remedy is the unpaid maintenance and cure itself. Additional damages, punitive damages, or attorney's fees require more. They depend on why the refusal happened, what the employer knew and did, and what harm followed—and nonpayment does not automatically establish bad faith. The Supreme Court has recognized punitive damages for an employer's willful and wanton disregard of the maintenance and cure obligation, Atlantic Sounding Co. v. Townsend, 557 U.S. 404 (2009), and attorney's fees for a willful and persistent failure to investigate and pay a claim, Vaughan v. Atkinson, 369 U.S. 527 (1962). In the Fifth Circuit, the available remedy depends on the character of the employer's conduct, Morales v. Garijak, Inc., 829 F.2d 1355 (5th Cir. 1987). Whether those standards are met in your case turns on the evidence and the controlling law in your forum.

Be skeptical of anyone who promises punitive damages based on a phone call, and do not import the late-payment penalties that exist under the Longshore Act; those belong to a different statute and do not apply to a seaman's maintenance and cure. For the standards that govern enhanced remedies and how they are analyzed, see bad-faith refusal and potential additional damages.

The Cutoff Date Matters—So Does What the Employer Knew Then

A generic answer to a stopped-benefits question is "it depends on the medical evidence." That is true and not very useful. The more useful approach is to treat the cutoff as a decision made on a particular date by a particular person relying on particular information, and then to reconstruct that moment.

The method is a chronology built from the records described above. On one timeline go the payments: when each arrived, what it covered, when they stopped. On a second go the medical events: the injury report, each examination, each treatment recommendation, each authorization request and response, and each report the employer received. On a third go the communications: what you were told, what you asked for, and what came back. Laid side by side, these timelines answer questions that a denial letter does not.

• Who made the decision? An adjuster, a nurse case manager, an in-house claims department, or counsel for the employer.
• What did they have in front of them? If the cutoff came the day after a company-arranged examination, the question is what that report said and whether anyone compared it with the treating physician's records.
• What did they not have? If your surgeon's recommendation for a procedure was dated before the cutoff but never requested or never reviewed, that gap is significant.
• Did later records change anything? If the employer received contrary medical evidence after the cutoff and did nothing, the analysis of its conduct is different from the analysis of its original decision.

Sometimes this reconstruction shows that the employer had a defensible basis and that the real dispute is a genuine conflict between doctors. Sometimes it shows that the stated reason was attached after the fact to a decision made for other reasons. Sometimes it shows that a payment gap was an administrative failure no one caught. None of these conclusions can be assumed from the outside. Each is reached by matching the decision to the record as it existed at the time—which is why the written request for the reason and the supporting records, recommended at the top of this page, matters so much. It fixes the employer's position at a point in time.

Legal Authority Behind This Guidance

This page addresses the federal general maritime law obligation of maintenance and cure owed to seamen. It does not describe a Louisiana workers' compensation appeal, an LHWCA administrative proceeding, or any state benefits process. Those are different systems with different rules. How the principles here apply to any particular seaman depends on the facts, the parties, and the controlling law in the relevant forum.

The authorities referred to above, and the propositions for which they are cited:

• ***Farrell v. United States*, 336 U.S. 511 (1949)** — United States Supreme Court. The obligation of maintenance and cure extends to the point where the seaman's condition has been cured or declared permanent and no further improvement is expected; it is not a lifetime obligation coextensive with disability.
• ***Vella v. Ford Motor Co.*, 421 U.S. 1 (1975)** — United States Supreme Court. The endpoint of the cure obligation is fixed by a medical determination that the condition is permanent and incurable, not by the employer's own judgment.
• ***Vaughan v. Atkinson*, 369 U.S. 527 (1962)** — United States Supreme Court. A shipowner's willful and persistent failure to investigate and pay a maintenance and cure claim can support an award of attorney's fees; the opinion also reflects the long-standing principle that doubts about maintenance and cure are resolved in the seaman's favor.
• ***Atlantic Sounding Co. v. Townsend*, 557 U.S. 404 (2009)** — United States Supreme Court. Punitive damages are available under general maritime law for an employer's willful and wanton disregard of the maintenance and cure obligation.
• ***McCorpen v. Central Gulf Steamship Corp.*, 396 F.2d 547 (5th Cir. 1968)** — United States Court of Appeals for the Fifth Circuit. Sets out the defense based on a seaman's concealment of a material preexisting medical condition connected to the injury claimed.
• ***Morales v. Garijak, Inc.*, 829 F.2d 1355 (5th Cir. 1987)** — United States Court of Appeals for the Fifth Circuit. Describes graduated remedies for failure to pay maintenance and cure depending on the character of the employer's conduct.
• U.S. Department of Labor, Longshore and Harbor Workers' Compensation Act guidance — Federal agency material describing the separate benefits framework that may apply to waterfront workers who are not seamen.

A note on the Fifth Circuit. Federal district courts in Louisiana, Mississippi, and Texas are bound by Fifth Circuit precedent, which makes those decisions especially significant for seamen working out of Gulf Coast ports. But the Fifth Circuit does not control every maritime matter with a Gulf Coast connection. Where a case is filed, the parties involved, and any applicable agreements can point to a different forum or different controlling law. Geography alone does not decide which rules apply.

The examples on this page are hypothetical illustrations, not descriptions of actual clients or results. This page provides general information about maritime law. It is not legal advice for your situation and does not substitute for a review of your specific facts by a lawyer.

Ask The Young Firm to Review Your Denied or Stopped Benefits

If your maintenance and cure was denied, cut off, never started, or is arriving late, you can ask us to review it. You do not need a written denial letter. You do not need a complete file. You need to be able to tell us a few things:

• What stopped: maintenance, cure, or both—or whether nothing was ever paid.
• When it stopped: the date of the last payment or the last authorized treatment.
• Who communicated the decision: the employer, an insurer, or an administrator, and the name if you have it.
• The stated reason, if you were given one, in whatever form it came.
• Your employer and the vessel you were working on, and a brief description of your duties.
• Your current treatment and living-expense concerns: what care is pending or interrupted, and what bills are behind.
• Whether another lawyer is already representing you on any part of this injury.

Contact The Young Firm to request a review of your denied or stopped maintenance and cure. When you do, ask how consultations and representation work; the terms will be explained before you commit to anything. Before sending medical or financial records, ask how we want to receive them and confirm the address or portal rather than sending sensitive documents to one you have not verified.

Contacting us starts a conversation. It does not by itself create an attorney-client relationship, and it does not stop any deadline or obligate your employer to resume payments. A representation agreement, if we go forward together, will set out what we are undertaking and on what terms.

What we can offer at this stage is a focused look at a specific problem: benefits that a seaman was receiving, or should have been receiving, that have stopped—and whether the reason given for stopping them holds up.