8 Letters Relevant to Your Workers Compensation Claim
Once you have filed a claim in the State of Nevada for workers’ compensation insurance benefits, there are various letters you may receive regarding your application and your case. It is important that you understand what to expect during the process while you are waiting for or receiving benefits.
The Claim Acceptance or Denial Letter
You should receive the appropriate acceptance or denial paperwork regarding benefits within 30 days after the third-party administrator (TPA) received your C-4 form. If you have not received such notice within the 30-day time period, you should contact the TPA to be sure they have your correct address on file. Make sure that you have all the information provided on the C-4 form is accurate and up-to-date as well.
Receipt of a denial notice
If you received a denial notice for compensation benefits, you may wish to appeal the decision. The necessary information to file an appeal will be included with the denial paperwork. You have 70 days to file an appeal for your case. Nevada law is very strict on filing deadlines, with the only acceptable excuse for not filing on time being that you can prove that you did not receive the denial paperwork. Typically, if you do not file by the deadline, your appeal will be denied.
Losing the first denial hearing
Once you file the appropriate paperwork to appeal the denial, you will receive an answer at the hearing. If you disagree with this decision, you have the option to file another appeal, this time with the Appeals Division. You have 30 days from the appeal denial to file this second appeal.
Receipt of an acceptance notice
If your application for workers’ compensation insurance benefits is accepted, read the notice carefully. Be sure to check that the body parts covered are the ones that are affected by the injury or occupational illness. If any part of the acceptance is inaccurate, you need to obtain an amended acceptance letter that has the proper information or you may choose to appeal the acceptance notice within the 70-day time period allotted for appeals.
Average Monthly Wage Letter
If you missed an adequate amount of work due to any injuries or illness, you may be eligible for compensation. This may occur if you miss 5 days of work in a row or 5 days total within a time period of 20 days. This notice will let you know the amount your benefits based on information provided by your employer regarding your average monthly wage. Your benefits will equal two-thirds, or 66 2/3 percent, of your calculated earnings per month. If you feel the amount provided in your notice is incorrect, you must file an appeal.
Medical Care Information Letter
When filing a workers’ compensation claim in the State of Nevada, you must use certain doctors and physicians within your employer’s insurance provider network. However, if you would rather choose a different medical provider from the approved insurance provider list, you can do so in writing within the first 90 days of your workers’ compensation claim. Requests for a change in physician do not have to be honored after the 90-day time period has elapsed.
Denying, Suspending, Terminating Claim Letters
If you should receive any notice that your benefits are being denied, suspended, or terminated, it is important to file an appeal within 70 days of such notice. If you do not file the appeal in the appropriate time frame, you can lose the chance to receive benefits regarding this incident permanently.
Closing of the Claim Letter
If you feel that you still need to receive additional medical care when the case is going to be closed, you need to appeal this notice within 70 days. In addition, if this notice does not mention that you will be scheduled to receive an evaluation for a Permanent Partial Disability (PPD) rating and you feel that you are eligible to receive the PPD award benefits, you should file an appeal in this instance as well. In the meantime, the State of Nevada allows for you to select an approved doctor to evaluate you and give you a PPD rating at your expense. This cost may be reimbursed if approved.
PPD Award Letter
If you are eligible for a PPD award, you will receive a notice of your PPD rating and the amount you can receive in benefits. If there is any question regarding this amount, or if you are pursuing additional medical care, you should file an appeal within 70 days. Before accepting a lump sum settlement offered by the insurance carrier, you should determine how much additional medical care you think you may need. When you seek additional medical treatment, the costs may add up to more than a lump sum settlement provides, leaving you to pay the additional medical expenses on your own. Since there is no way to know how long your recovery will actually take and the costs involved, taking a lump sum settlement may actually cost you money in the long run.
Denial of Vocational Rehabilitation Benefits Letter
If you do not believe that you can return to the same type of work you performed prior to your injury or illness and need some type of vocational rehabilitation, you should file an appeal within 70 days according to the information provided in the denial notice letter.
Medical Provider(s) Billing Letters
If you receive billing notices from any of your medical care providers, it is important that you contact these physicians in writing regarding your workers’ compensation insurance benefits claim. The State of Nevada provides that treatment providers should not bill injured workers during the claims process. However, if the medical care providers do not have the appropriate information, you may receive such billings. Contact the treatment provider and give them your workers’ compensation insurance claim number as well as the name and address of the TPA in charge of your case.
Legal Assistance for Workers Compensation Letters
If you not getting the results you feel you deserve or feel that you are not being treated fairly in your Nevada workers’ compensation case, the Morris Anderson Law Firm can help. These attorneys have experience in dealing with Nevada workers’ compensation laws to help you maneuver through the system and protect your rights.Go to the Next Article