What if I am Not Happy with my Doctor or Surgeon?

Workers compensation laws in the State of Nevada limit your rights by allowing only treatment by a qualified doctor or surgeon that is identified on a provider list. It is very unlikely that you will be able to receive paid treatment from a provider that is not identified on such list. If you are seriously injured, you should request a copy of this list in writing immediately so that you may begin searching for a qualified treatment provider from the available options. While your choices may be limited to those providers specifically named, your rights under Nevada workers compensation laws allow you to choose your own medical care provider from the available choices. If you are unhappy with the medical treatment you receive, you may be able to change your treatment provider to another available option from the list.

Approved Provider Lists by the Third Party Administrator (TPA)

You should request the list of available providers in writing from the TPA assigned to your Nevada workers compensation case as soon as possible, especially if you have already received approval for your claim. While you are always welcome to ask for your preferred physician, the TPA does not have to approve this request if your choice of doctor or surgeon is not included on the list. In order to receive the appropriate list of approved medical care providers, you should do the following:

  • Any request for such a list of approved providers must be in writing
  • Make a copy of the written request for your records
  • Send the request by certified mail, saving any receipts and tracking information provided by the post office with your copy of the request

The TPA has 3 working days to send you the provider list once your written request has been received. Once you receive the list, your rights include making an individual choice on which doctor or surgeon you would prefer to handle your medical treatments.

When should I ask for a different Doctor?

It is important that you receive good medical care when you are approved for benefits. When the doctor or surgeon who is treating you does not provide appropriate medical care, you should request a new medical provider from the approved provider list right away. According to your rights by workers compensation laws in Nevada, if your request for a change in medical provider is received within the first 90 days, the adjuster must approve your choice as long as the new provider is on the list.

 When will my request for a new doctor be denied?

While you have rights to appropriate medical care under Nevada workers compensation laws, there are times when you will not be able to change your medical care provider or your requests may be denied, so it is important to try to make a good choice in the first place or follow the proper guidelines for making any changes.

After 90 days your request may or may not be approved

If you wait until after 90 days of the opening of your insurance benefits claim, you may not be able to make changes, even if you are not receiving adequate care. Your adjuster has the right to deny any change requests after this point in time. If you notice you are having difficulty with the provider you originally selected, be sure to put in a request for any changes within the allotted 90-day time frame.

If doctor releases you from care

If the medical care provider you have chosen releases you from care regarding your workers compensation injuries, the adjuster in your case will most likely deny any request to change your medical care provider. Even if your chosen provider releases you from care within the first 90 days of your claim, the adjuster will most likely deny any request to change providers.

If claim has not been approved yet

If you have recently filed your claim, your adjuster will most likely deny your request to change medical care providers if your claim has not even been accepted yet. It is important to remember that the adjuster has 30 days in which to accept or deny your claim for benefits. You may, however, still ask in writing for a provider list so that you may be prepared to choose your care provider once your claim has been accepted. This is especially important if your injuries are serious.

What if I need surgery?

If your injuries are serious enough that you require surgical procedures, choose who you wish to perform your surgeries with great care and research prior to making any decisions. While you are always free to change medical providers, it is much more difficult to change surgeons. Many times, these specialists will not want to take over your medical care any time soon after any surgical procedures have been performed. In addition, many surgical specialists will want to review your medical records, whether it is to take over your care or even for simply a second opinion, all of which may take extra time.

 When should I consider getting an Attorney involved?

If you have any doubts or questions regarding your workers compensation benefits in the State of Nevada, you might wish to consult with a qualified attorney at any point in the claim process, even if you have not yet filed your claim for benefits. However, you may choose to hire an attorney regarding certain medical events.

Recommendation

A good attorney with extensive experience may be familiar with the approved medical care providers and may be able to make a recommendation based on your injuries and projected needs.

If you dislike your treating physician or question their reputation

If you wish to make any changes in your medical care or treatment, an experienced attorney may understand what is needed in your specific case and can point you in the right direction regarding the necessary changes to your provider.

You have a serious injury or illness

If you are seriously ill or injured, you may wish to hire an experienced attorney from the very beginning of the process so that you can immediately receive assistance if you do not feel you are receiving adequate treatment.

Problems with your adjuster

If your adjuster does not allow you to change doctors on the provider list, especially if you have filed properly and in a timely manner, you may wish to get an attorney involved in your case. An attorney can help with the appropriate paperwork and any appeals that may be necessary to get you the care and treatment you deserve.

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