If you get injured at work there are many possible outcomes. You could have an injury that heals and allows you to return to work. Workers’ compensation may have covered your lost wages and medical expenses while you were gone.
However, for many Nevada residents, an injury may worsen or become complicated after workers’ compensation has been exhausted. Your case may have been closed before you ever received benefits or you may no longer be getting them, resulting in a case closure. In either instance, it is possible for you to reopen your workers’ comp case in Nevada, but there are requirements to follow. A workers’ comp attorney in Nevada can assist you with this process.
Workers’ Comp Claim Reopening
After a workers’ compensation claim is closed, Nevada law prohibits reopening it in the future unless the injured worker was unable to earn full pay for 5 days or more or was on permanent partial disability. A workers comp claim for any other injured workers must be reopened within one year of the claim being closed. The claim cannot be reopened if the medical expenditures paid before the claim was closed were less than $800.
A claimant may request that an insurer reopen a workers’ comp claim that has been closed under specific conditions. If the claimant’s work injury or occupational disease changes or worsens, or if additional medical treatment or vocational rehabilitation is required, the claimant may request a reopening of the claim. The insurer, on the other hand, will require a formal doctor’s report that validates the following:
- The claimant’s occupational injury or sickness has changed or worsened.
- Additional treatment is required for the claimant.
- The claimant is in need of vocational rehabilitation.
- A description of the different treatments that are required
- A direct link between the worsened condition and the underlying injury or disease
The primary basis for reopening the claim is a work injury or disease. Once the doctor’s report is completed, the claimant or the claimant’s workers’ compensation attorney should mail it to the insurance adjuster.
Nevada Workers’ Compensation Benefits
Workers in Nevada are entitled to the following categories of workers’ comp benefits under Nevada Laws:
- Temporary Total Disability (TTD): Provides 66.66% of the injured worker’s weekly income when the worker is unable to work due to a doctor’s certification.
- Temporary Partial Disability (TPD): Supplements an injured worker’s income who is back to work but earning less than pre-injury earnings at 66.66% of the difference between what the injured worker earned at the time of injury and his or her present income.
- Permanent Partial Disability (PPD): Compensation for permanent impairment as a result of a work-related injury, usually in the form of a lump sum settlement, based on the percentage of disability, the injured worker’s age, and his or her wage.
- Maintenance of Vocational Rehabilitation: Provides an injured worker with the same benefit amount as temporary partial disability while he or she is trained for a different occupation.
- Vocational Rehabilitation Training: Training to assist an eligible worker in learning another occupation that is compatible with his or her physical limitations and educational level.
- Permanent Total Disability (PTD): Compensation paid to an injured worker when he or she is unable to work at all due to a work-related injury; often paid for the rest of the person’s life.
- Lifetime Re-Opening: Nevada permits injured workers to reopen their workers’ compensation claim at any time, for life, if the injury or condition has gotten worse.
Workers’ Comp Claim Denial
If a Nevada work injury victim receives a denial from their workers’ compensation insurance provider, they have 70 days to appeal to the Nevada Department of Administration (DOA). A Request for Hearing form, as well as the refusal letter, should be sent to the DOA. There are several ways to attend the hearing. It can be done in person, over the phone, or by a position statement.
A Hearing Officer’s decision can be appealed to an Appeals Officer within 30 days after the decision. If the Appeals Officer dismisses the appeal, individuals may file a petition for Judicial Review with the District Court. This must be done within 30 days after the decision of the Appeal Officer.
In Nevada, the process of appealing a workers’ compensation claim can be extremely difficult and time-consuming. There are deadlines, and the claim must be filed correctly to be considered for reversal. We strongly advise you to contact a qualified Las Vegas work injury lawyer who has handled similar situations.
Nevada Workers’ Comp Appeal
If you disagree with the Hearing Officer’s judgment, you may appeal to an Appeals Officer by submitting a Request for Hearing before the Appeal Officer. You must fill out the form, attach a copy of the Hearing Officer’s ruling, and mail it to the same Nevada Department of Administration address as your initial appeal. Your appeal will be heard within 60 days of its filing.
The Appeals Officer will hold a formal hearing to review the decision of the Hearing Officer. The Appeals Officer will hold a fresh, separate hearing, which will be recorded and transcribed. Because the appeal is like beginning over, you cannot rely solely on evidence presented before the Hearing Officer. Any evidence you wish the Appeals Officer to consider must be resubmitted.
After reviewing the evidence, the Appeals Officer has the following options:
- Confirm the Hearing Officer’s decision.
- Reverse the Hearing Officer’s decision.
- Return the case to the Hearing Officer.
- The Appeals Officer has 15 days to make a decision.
Workers’ Comp Medical Treatment
To treat work injuries, your employer may have a contract with an authorized medical professional. Inquire with your employer or supervisor about the provider and go there for therapy as recommended. If you need to know who your employer’s workers’ compensation insurer is, you should be able to find out from the “Brief Description of Your Rights and Benefits” poster. This is a poster that contains information on your employer’s workers’ compensation coverage. Your employer is required to post it in a common area at work, such as the break room.
Medical treatment is covered by workers’ compensation insurance, but you must see an authorized medical professional. Your company may be a member of a managed care organization (MCO), a health maintenance organization (HMO), have a Preferred Provider List, or cooperate with a third party administrator (TPA). Regardless, your employer is required to supply you with a list of recognized medical providers where you can seek treatment for your workplace injury.
Work-related injuries that are covered include:
- Accidental injuries and occupational diseases that are related to your job.
- Unless you are a firefighter or a police officer, heart disease issues are not covered.
- For firefighters exposed to hazardous substances, certain malignancies are covered conditions.
- Stress-related disorders are only covered if they are induced by significant stress in a dangerous situation.
Contact our workers’ comp attorney in Nevada for help!
For a free Consultation, Please Contact Lach Injury Law. This Workers’ comp attorney in Nevada can assist a client in navigating the workers’ compensation claims process, gathering evidence to support an injured employee’s claim, and assisting a client in exploring further recovery alternatives. If you or a loved one was injured at work in Las Vegas, we can help.