Can I Get a Second Disability Rating?
Once an injured worker receives an offer for a permanent partial disability (PPD) award from Nevada workers compensation, this worker has the right to contend that offer. Claimants are more likely to challenge lower PPD award offers when they are based on an inaccurate determination of the degree of impairment that was given by an evaluating physician. An appeal can be made along with a second rating evaluation from a qualified physician from the Department of Industrial Relation’s (DIR’s) rotating list. It is always best for the injured worker to consult with a qualified attorney that is familiar with Nevada workers compensation laws before challenging an award offer.
Filing an Appeal
When an injured worker receives an offer for a permanent partial disability award, they are also provided with the necessary forms to file an appeal if the worker does not agree with the amount set by the adjuster. The Request for Hearing form should be completed and submitted to the Department of Administration Hearings Division within the allowable 70-day time frame provided by Nevada workers compensation laws. A second rating evaluation must also be completed when challenging the decision. However, even if the injured worker cannot obtain the required examination within the 70-day time period, the proper forms still need to be completed and submitted on time. Then, the claimant can ask for a continuance to push back the hearing date to allow time for the second examination to be completed. It is important to note that the necessary forms must be submitted within the 70-day time period without exception. Being unable to afford a second examination for percentage of impairment at this point in time is not a valid excuse for waiting and filing a late Request for Hearing.
Getting a Second Rating Doctor Assigned from the DIR Rotating List
Once the appeal paperwork is submitted, the injured worker must make an appointment for another assessment. Requesting a second doctor from the DIR’s rotating list by submitting the appropriate approved paperwork by Nevada workers compensation guidelines completes this step. The physician used to provide the evaluation must be from the DIR’s rotating list, or the insurance adjuster will not be able to use any recommendations from that physician in order to make a new PPD award determination.
Scheduling and Paying for the Second Rating Exam
Before the appointment with the second physician, the claimant must send all of his or her medical records to the new physician. This means all records from every treating doctor for the qualifying illness or injury. Some physicians have strict requirements regarding the scheduling of exams, so the claimant must be prepared to have an appointment when the doctor is available and be sure all records reach the physician before this time. Additionally, the injured worker will need to pay for this second evaluation in advance, typically when scheduling the appointment. The rates for these assessments are determined by DIR by the number of affected body parts, with rates currently starting around $700.00 for such an examination.
Giving the Insurer a Copy of the Second Rating
The claimant should receive the new evaluation report within two weeks following the examination. If this new percentage of impairment is greater than the first determination, the injured worker should send a copy of this report on to the insurance adjuster along with a letter asking if the adjuster will honor the new assessment to determine a higher percentage of permanent partial disability award amounts. If the adjuster does not agree with this new percentage of impairment and will not increase the amount of the PPD award offer, the injured worker simply allows the appeal to continue on to the Hearings Division. If the percentage of impairment is lower or equal to the original determination, the claimant can withdraw the appeal by writing to the Hearings Division. The claimant has no obligation to show this second physician’s report to the insurance adjuster and will accept the first permanent partial disability award offer as was given in the first place.
The Hearing and Challenging the Rating
If the insurance adjuster does not increase the PPD offer after the second examination, the injured worker should be prepared to attend the hearing and provide necessary information to the hearings officer. The claimant can attend the hearing in person or by phone. If attending by phone, it is important that all documentation is sent and received by the Hearings Division well in advance of the hearing. Documentation that can help in challenging the permanent partial disability award offer include a copy of the new assessment with the greater percentage of impairment, a copy of the paid bill for the cost of this second examination in order to receive reimbursement if approved, and a copy of the form provided by DIR showing the assignment of the second assessing physician.
Additional Appeals and the Insurer’s Options
The hearings officer may or may not agree with the new determination of percentage of impairment. While the claimant will be trying to prove his or her side, the insurance adjuster will also be arguing to back up their own opinion on the determination. In some cases, the hearings officer will order the insurer to pay for a third evaluation. The insurance adjuster is not obligated to agree with this third decision either, and may stand by the first PPD award offer given. If the claimant still does not agree with this decision, another appeal can be filed after the third assessment report. Even if the hearings officer orders the insurer to pay a higher amount, the insurer may challenge this decision as well.
Hiring an Attorney for the Permanent Partial Disability Award
Challenging a permanent partial disability award offer takes a lot of time and can be discouraging, especially if there are many appeals filed form either side and upfront costs associated with additional evaluations. The insurance adjuster knows this and the fact that many injured workers will give up challenging the first offer if the length of time is extended and may result in additional expense. Additionally, many claimants will not challenge the offer, because filing an appeal against the PPD award offer results in the inability of the claimant to accept the award as a lump sum payment. Nevada workers compensation regulations can be complicated, especially in the determination of the PPD award, making it especially important to contact an attorney prior to accepting an award offer. The experienced attorneys at Morris/Anderson Law can help to determine if your award offer is accurate based on your disabilities and help you to decide if you should accept or challenge such an offer.Go to the Next Article