Under which circumstance must an insurer request suspension of benefits from WCD?

The requirement for an insurer to request a suspension of benefits from the Workers' Compensation Division (WCD) hinges on the worker's compliance with scheduled medical evaluations. When a worker fails to attend an Independent Medical Examination (IME), it raises questions about their ongoing eligibility for benefits. The IME is crucial as it provides an unbiased assessment of the worker's medical condition and its relation to the work-related injury. Without the IME, the insurer does not have the necessary information to determine whether the worker's claim should continue to be honored or whether benefits should be adjusted or suspended.

This process is in place to ensure that claims are managed fairly and that benefits are appropriately allocated based on the worker's current medical status. If a worker actively participates in their medical treatment, cooperates with investigations, or has received a final award of compensation, these situations do not prompt the need for benefits to be suspended. Instead, they indicate ongoing engagement in the claims process and compliance with requirements set forth by the WCD.