Benefits Unfairly Suspended? Fight Back!

By Jason Weinstock on March 26, 2012

Workers’ compensation insurers and their TPA’s often suspend compensation benefits when an unrelated  medical problem  surfaces to delay surgery or  treatment for the work injury.  Insurers call it "Care Interrupt". I call it kicking an injured worker when he’s already down.

For example, I had an injured worker last month who was scheduled for a work-related back surgery.  She was already receiving TTD benefits when her surgery was scheduled for the following week.   She had to get an EKG done as part of the usual pre-surgery clearance.  Her EKG was slightly abnormal and her doctor thought she should have a cardiac treadmill stress test just to make sure she didn’t have a heart problem before she underwent back surgery.   It took her almost four weeks to get an appointment with a cardiologist to get the stress test done and to have her primary care doctor review it and give the workers comp doctor clearance for the back surgery.

When the work comp adjuster heard that she had an abnormal EKG, my client’s TTD benefits were suspended until she gave the work comp doctor surgical clearance.  I successfully argued before a hearings officer that the adjuster was wrong in stopping  benefits,  because my  my client did everything as quickly as she could to get surgical clearance. 

I argued this issue before the Nevada Supreme Court years ago, and the Court agreed with me that suspension of benefits is wrong under  NRS 616.230(5) when the injured worker is not deliberately delaying treatment for the work injury.  Unfortunately, the Court did not publish that decision. The  Court  does not publish its decision in every case, and an unpublished opinion cannot be cited as legal precedent.  This means I have to present this same legal argument in each new  case, and that insurers keep suspending benefits, betting on the fact that most injured workers don’t pursue an appeal.  

If your benefits are suspended because you  need medical treatment for an injury or illness that is not work-related, make sure that you talk to an experienced attorney.  Each case is different, but many suspensions for "care interrupt" can be reversed on appeal.  Fight back!

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