Suspended Benefits for a Non-industrial Medical Condition


By Jason Weinstock on March 23, 2013
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Some injured workers are delivered a low blow by their adjuster when their treating surgeon for their Nevada work comp injury finds that they first take care of a unrelated medical problem before surgery can go forward. For example, many hurt workers will find that their blood pressures spike from being in pain from the severe work injury, particularly if they have had borderline or high blood pressure in the past. A primary care doctor performing the pre-surgical clearance may want a cardiologist to run some more diagnostic studies, such as a treadmill stress test. Clearance can then take weeks. Meanwhile, the adjuster sends a letter that the injured workers benefits will be suspended until the patient is cleared for surgery.

I have successfully argued that this practice is wrong. Hearings and appeals officers generally agree that the correct interpretation of NRS 616C.230(5) on suspension of benefits allows the injured worker to avoid suspension if he shows that he did everything as quickly as possible to take care of the nonindustrial medical problem. The problem is that it takes an appeal, reversing the insurer’s suspension of benefits to get the injured worker paid. Many injured workers are intimidated by the appeals process and just go without benefits during the weeks it takes them to get surgical clearance. My recommendation is that you get surgical clearance as quickly as possible, show the adjuster that you are doing things quickly, and file an appeal of any suspension of benefits.

 

 

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