What if the Insurer Doesn’t Give Me a Disability Rating?
Those receiving workers compensation benefits in the State of Nevada may have their claim closed with or without receiving a disability rating. Without such an assessment, benefits will end once the claim is closed. The insurer is not legally obligated to order an evaluation in order to make a determination of permanent impairment. If an injured employee feels that a permanent partial impairment assessment should be made, it is important that the treating physician include such recommendations in the report. If the adjuster attempts to close the claim without setting up an appropriate impairment evaluation, the injured worker can file an appeal.
When the Adjuster Tries Closing the Claim
A Nevada workers compensation claim can be closed with or without the injured employee receiving an assessment of permanent partial disability (PPD). The injured worker will receive a notice letter in either case. If an impairment assessment is ordered, the injured employee will receive notice of an appointment with a specific physician who will determine the percentage or impairment present. In the alternative, if the injured party receives a Notice of Intention to Close Claim, this indicates that the insurer has no intention of setting up an appointment for a rating evaluation in which the injured employee may receive a PPD award and the related benefits that go with it. An injured worker who receives a Notice of Intention to Close Claim that feels an assessment for permanent impairment is in order should file an appeal according to the instructions provided with the Intention letter.
According to Nevada workers compensation regulations, the insurance adjuster is not required to set up a rating evaluation for every claimant, especially if the treating physician did not specifically designate that the injured worker may have a ratable impairment in any progress report or in the final report. Many treating physicians are not familiar with the specific regulations regarding permanent impairment and benefits and their responsibility in proper reporting of potential impairment. These mistakes that are made in the physicians reports may prevent a necessary assessment from being performed, particularly when the injured worker is able to return to full employment with no restrictions, even if a permanent disability may be present. If the adjuster notices that there may be some form of impairment present, the adjuster should send notification to the treating physician regarding the guidelines for a permanent impairment and asking the physician for clarification on the matter. However, most adjusters will not take the incentive to clarify a physician report and will simply send out the closing letter. While an injured worker should file an appeal, he or she may also wish to secure the services of a qualified attorney who is familiar with workers compensation issues in the State of Nevada. The lawyer can send the treating physician the appropriate guideline information showing that the injured worker’s specific injury is a ratable impairment. This will provide the treating physician with the opportunity to amend the progress report or final report to show that the injured worker should receive a PPD assessment for such ratable impairment.
Obtaining a Rating Even When the Insurer Refuses
If the insurance adjuster refuses to schedule a PPD assessment, the injured worker may follow the same steps that would be taken to obtain a second rating evaluation. The injured employee must file an appeal in a timely manner then contact the Division of Industrial Relations (DIR) to request assignment of physician from the list of those available to make such an assessment. On the request form, the injured worker should include the fact that a first PPD assessment was never scheduled. All of the injured workers’ medical records regarding the injury should be sent to the physician performing the assessment. This assessment will have to be paid for out of pocket by the injured worker and in advance when scheduling the assessment appointment. The amount paid for this permanent partial disability assessment is based on the current fee for such assessments at the time of scheduling the appointment. If the physician performing the assessment determines that there is impairment, a report will be sent to a hearings officer for further consideration. The hearings officer may then order the insurance adjuster to pay the percentage of impairment determined by the physician. In some cases, the adjuster will also have to reimburse the injured worker for the cost of the impairment assessment.
Getting the Insurer to Pay for the rating Evaluation
While the cost of the impairment assessment for PPD may be a necessary step toward obtaining benefits, this amount may be difficult to afford, especially for an injured worker who has missed significant pay due to missed work from an injury or illness. In these cases, an injured employee may be able to request that the hearings officer order the insurance adjuster to schedule a permanent partial disability assessment with no expense to the injured worker due to financial hardship. In order to convince the hearings officer, the injured employee must be able to prove a ratable impairment through the medical records and the AMA Guide to Evaluation of Permanent Impairment. The injured employee should show the hearings officer proof of any surgeries, procedures, or limitations in the medical report, as well as the appropriate AMA guidelines that directly relate to such medical information. It is especially important that the injured worker be able to correlate the medical records with the AMA guidelines to show that the treating physician made a mistake when making the notation that there is no permanent impairment.
If you are receiving workers compensation through the State of Nevada, you may wish to secure legal services. If you have received a Notice of Intention to Close Claim without an impairment hearing, yet you feel that you have a permanent partial disability and should receive an assessment, the attorneys at Morris/Anderson Law firm can help you with filing the appeal and obtaining a rating through an approved physician.Go to the Next Article