What if I Don’t Agree with my Disability Rating?

According to Nevada workers compensation guidelines, any permanent partial disability (PPD) award that is received by the injured worker is based on the calculation of certain factors, including the percentage of impairment determined by the rating doctor. Those who do not agree with the determination of the PPD award amount may file an appeal. However, an appeal will surely fail if the entire reason for the appeal is simply that the award amount is too low. The injured employee must prove why the award amount is too low, typically by showing that the degree of impairment is more than what was originally determined. A second evaluation can be completed at the worker’s expense in order to prove a greater degree of disability in order to receive a larger PPD award amount.

Determination of the Amount of the PPD Award

The permanent partial disability award amount is based on calculation of three factors under Nevada workers compensation law. These determining factors include:

  • • The age of the injured worker when the PPD award amount is determined
  • • The average monthly wage that was earned at the time of the illness or injury
  • • The percentage of impairment determined by the doctor performing the rating

It is important for the injured employee to be sure that the adjuster has all of the correct information, including age and average monthly income even before it comes time to make calculations for receiving a PPD award offer. If this information is correct, the only way the claimant can appeal the amount of the PPD award is to challenge the degree of impairment that was given by the evaluating physician.

Basis for Permanent Partial Disability Award Challenges

If the insurer does not agree with the rating provided by the doctor performing the evaluation, a lower PPD award amount may be offered. The adjuster’s amount may be appealed, but the claimant must be able to prove why the physician’s determination is correct in order to receive a higher PPD award. If the injured employee does not agree with the doctor’s determination for the percentage of impairment, the claimant may appeal as well, but needs to be able to show specifically how the evaluating physician’s percentage determination was wrong. Again, there is not a valid appeal just because the claimant believes that the offered PPD award amount is too low without being able to provide any necessary proof. If the injured worker has a legitimate reason to disagree with the PPD award amount, an appeal must be filed within 70 days of the determination of such amount.

Getting Legal Assistance for Appealing PPD Award

Because of the complexities involved with Nevada workers compensation law, it may be necessary for the claimant to obtain legal advice before proceeding with an appeal regarding a disagreement with the degree of impairment determined by a physician or an offered PPD award amount. An experienced attorney can review the offered PPD award amount and help determine if the claimant should pay to obtain a second evaluation in order to file an appeal. Many times, a qualified attorney will review this documentation as a part of their free initial consultation.

AMA Guides to Evaluation of Permanent Impairment (5th edition)

The evaluating physician must use special guidelines called the AMA Guides to Evaluation of Permanent Impairment, currently in its updated 5th edition, to make the proper percentage of impairment. However, these guidelines are complex, even for rating physicians. Those physicians who are newly added to the list are more likely to make mistakes in percentage determinations based on these guidelines. The injured worker will often mistakenly believe that there are math errors on the PPD calculations, but an experienced attorney can explain how the charts in the Nevada workers compensation AMA guides work in order to make the correct permanent partial disability calculations. An attorney can help an injured worker file an appeal and obtain the necessary second evaluation in the allotted 70-day time period for such appeals.

Filing the Appeal for the Permanent Partial Disability Award

The claimant must complete and return the “Request for Hearing” form included with the PPD award offer and within the 70-day time frame provided. The claimant’s attorney can obtain the name of another rating doctor from the rotating list from the Department of Industrial Relations (DIR). The attorney will make an appointment, pay the fee up front, and send all of the claimant’s medical records regarding the injury. Because a claimant’s attorney is eligible to attend this second evaluation, it is important that the injured employee ask if the attorney will be able to attend this appointment as well before this evaluation is scheduled. The attorney may ask questions and find information that the claimant did not consider.

After the Second PPD Ratings Evaluation

The new determination may or may not find a greater percentage of impairment than that of the first evaluation. If the second evaluating physician found a greater degree of impairment, the results are sent to the insurer. The insurer may make changes to the PPD award offer or not. If the insurer does not agree with the new determination, the hearings officer may or may not order the insurer to pay the higher PPD award amount. If the higher amount is awarded, the hearings officer may also require that the insurer reimburse the claimant for the cost of the second evaluation. If the second evaluation results in a lower rating, the claimant may withdraw the appeal and accept the first PPD award amount offered. According to Nevada workers compensation laws, both the insurer and the claimant have the right to appeal any decision made by the hearings officer.

Appealing the Hearings Officer’s Decision

If either the claimant or the insurance adjuster appeals the decision of the hearings officer, the hearings officer may request a third evaluation. This physician may be one that is mutually agreed upon by the parties or the next from the DIR’s rotating list.

Permanent Partial Disability Award Attorneys

It is important for claimants to understand that once a PPD award offer has been appealed, there is no chance to receive any part of this award as a lump sum. PPD distributions will not be made until the appeal process is over and final determination is agreed upon. Alternately, if the claimant agrees with the PPD award and receives a lump sum payment, no changes can be made at a later date, even if the calculations or percentages were later determined to be wrong. If you receive a PPD award offer, it is best to have this offer evaluated by an experienced Nevada workers compensation attorney, such as from the Morris/Anderson Law firm. Here, a qualified attorney can go over your PPD award offer and help to determine if the amount is correct or if you should file an appeal to receive a higher amount.

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