Prevent a Denied Heart Claim


By Jason Weinstock on July 2, 2014
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 Heart Disease:  Prevention Is Key to Avoiding a Denied Claim For Fire Fighters and Police Officers

     Given the number of people affected by heart disease each year, it is a tremendous benefit that fire fighters and police officers in Nevada have workers’ compensation coverage for heart disease.  Other employees do not have this coverage, even if they can show that their occupations caused their heart disease.   Fire fighters can take a few preventative steps to ensure that this benefit isn’t lost if heart disease should result in temporary or permanent disability. 

     The law requires that employers of fire fighters pay for an annual heart and lung physical exam each year for the purpose of warning employees of any predisposing conditions that lead to heart disease.  See NRS 617.457 and NRS 617.455.  If a claim is filed, the worker’s comp administrator for the employer will examine the doctor’s reports for the past several years to see whether the fire fighter was warned to correct predisposing conditions and then failed to do so.

     Predisposing conditions that are frequently cited by the examining physician are smoking, high body mass index (overweight), high cholesterol levels, uncontrolled diabetes, and high triglycerides.  Year after year, many fire fighters have the same predisposing conditions noted by the examining doctor.  If these fire fighters were to have a heart attack, you can bet that their claim would be denied.   However, from a legal standpoint in trying to overcome a claim denial, the problem is not that predisposing conditions were noted, but that the fire fighter didn’t document efforts to correct predisposing conditions that could have been corrected.

    I recommend two months before a fire fighter’s annual heart/lung exam,  that he or she does the following, particularly if predisposing conditions and warnings were noted in the previous annual heart/lung physical:

Visit a primary care physician to document your progress on correcting the predisposing condition.   Get any lab work done, discuss nutritional and weight loss efforts, get prescribed medication to help with smoking cessation, and be sure your primary care physician documents that you are making efforts to correct predisposing conditions.

Ask the primary care physician’s office assistant to send you a copy of the doctor’s dictation or notes from your recent appointment, and from any other appointments you had during the past year if you see the doctor periodically for a predisposing condition like diabetes.

Bring a copy of your primary doctor’s notes with you to the annual heart/lung physical to give to the examining doctor.  Ask that the examining doctor make a note that you are trying to correct predisposing conditions.   Your just telling the doctor you tried to change your life style isn’t sufficient; you must prove that you made efforts.

      It is your family who will suffer if you have a disabling heart disease, and your claim is denied.  Take responsibility for your health and show the heart/lung examiner that you are doing all that that is within your ability to correct the previously noted predisposing conditions to heart disease.  

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