How Do I Re-Open my Workers’ Compensation Claim?
There are certain times when it is possible to re-open your workers’ compensation insurance benefits claim in the State of Nevada. As long as you meet certain requirements, you can apply to open your case again by filing a written request. This request must be accompanied by written documentation from your physician that includes detailed information regarding the worsening of your work-related injury or illness with a need for additional medical treatment.
In addition, you may also request your case to be opened again if you did not accept any vocation rehabilitation benefits that you were entitled to or if you were eligible to receive a permanent partial disability and the insurer did not grant such benefits before the case was closed. There are certain time frames that must be met. Additionally, you can appeal a denial should you ever receive one.
Eligibility Requirements to Re-Open Workers’ Compensation Claim in the State of Nevada
Before you try to have your case re-opened for additional medical treatment insurance benefits, it is important that you determine if you are entitled to file for a reopening of your case before you begin.
Permanent Partial Disability
If you received a rating and a permanent partial disability benefits award and lost time from work due to your injury or illness, you are entitled to have your case open again at any point during your lifetime if there is a change in circumstances that necessitates an increase or some type of rearrangement of your compensation. You are more likely to have a successful reopening if you wait at least a year after your case was closed before making an application in writing.
Denial of Claim Due to Medical Expenses under $300
If your case was closed because your medical expenses under your workers’ compensation insurance benefits did not exceed $300, you cannot have your claim reopened for your injury or illness based on specific Nevada Revised Statutes, NRS 616C.235(2) and NRS 616C.390(9).
Medical Expenses over $300, No Time Lost, No Partial Disability Award
If your case was closed and you had medical expenses that totaled over $300 but you did not have to miss time from work and you did not receive a rating or a permanent partial disability benefits award, you may apply for a reopening of your case if you do so within the first twelve months after the case was closed.
What to Do if You Are Eligible for Re-Opening Claim
If you meet any of the requirements for reopening of your case, the State of Nevada provides that you will need to apply in writing and provide proper documentation from your doctor.
Medical Report from Doctor
To be considered for a case reopening of workers’ compensation insurance benefits in Nevada, you are required to provide medical evidence that proves the following:
- Your work injury or illness is the primary cause of your worsening condition
- Objective medical evidence shows a worsening of your condition since your case was closed
- Further medical treatment is needed in order to improve your condition
Clarity of Report
It is important that the doctor’s report is thorough and explains in detail how your condition meets the medical evidence requirements listed above. The doctor’s report must be clear that your case needs to be reopened as a primary and direct result of your work injury or illness, exactly how your condition has changed since your case was closed with specific details and medical evidence to back it up, that you need treatment and the exact type of treatment you require to improve your condition, and the exact time period you will not be able to attend work, whether it is the same job or a job that you were retrained to perform. In addition, you and your doctor must provide clear and convincing evidence to prove your request. The more detail and objective medical evidence that is provided, the better your chances for a successful claim reopening.
Documentation to Bring to Your Doctor’s Evaluation
If you received a permanent partial disability rating evaluation, it is important that you bring this to your doctor’s appointment so that the doctor’s report can compare the results and explain in detail how your condition has worsened since such evaluation. If you did not receive an evaluation, bring along any denial notices and medical documentation provided by your insurer in connection with your closure to help your doctor make the best and most accurate reporting possible.
Filing Documents for Re-Opening
You will need to send a written request to your insurer in order to have your case considered and to be reopened again. In this letter, you should include your name, your current address and phone number, your social security number, the date of injury, and employer at the time of the injury. Be sure to also include your claim number of the case you wish to have re-opened. Make copies of all documents you are going to mail to keep for your records.
Filing Appeal if Re-Opening is Initially Denied
If the insurer denies your request to have your case reopened, the State of Nevada allows you to appeal within 70 days. Before the hearing, you need to obtain additional reports and medical proof from your physician regarding your worsened condition and the need for additional medical treatment as well as proof that connects your condition with your original work-related injury or illness. If you do not appeal or your case is still denied following an appeal, you must wait at least one year before you try to have your case opened again according to NRS 616C.390(3).
Re-Opening for Vocational Rehabilitation Services
If you did receive vocational rehabilitation services or a lump sum payment for such benefits, you can request that your case be open again for such services. If you voluntarily left the workforce or retired for reasons that were not directly related to your injury, you are not eligible for these services.
Re-Opening to Obtain Permanent Partial Disability Benefits
In accordance with 616C.392, if you were eligible for permanent partial disability benefits and a rating evaluation or such benefits were not granted to you by your insurer, you may request that your case be open again so that you may receive a rating for these benefits. However, the burden of proof is on you, and you must prove that with the evidence available at the time your case was closed, the insurer violated your rights in regard to such an evaluation.
Legal Assistance for Re-Opening Workers’ Compensation Claim
The Morris / Anderson law firm has extensive experience in dealing with workers’ compensation insurance claims and can help you through the process of requesting a reopening of your insurance claim. The attorneys with Morris / Anderson can help you to navigate the procedures and obtain the documents necessary to support your request.
Important Nevada Revised Statutes on Re-Opening Claim
NRS 616C.390, NRS 616C.392, and NRS 616C.235(2)(c) provide for general requirements, procedures, and limitations, to reopening a workers’ compensation benefits case.Go to the Next Article