Things You Should Know About Your Work Comp Claim
When a person suffers a workers’ compensation injury, many wonder if they should hire a workers’ compensation attorney. My answer is yes, always, or at the very least, call a dedicated workers’ compensation attorney for a free consultation.
Many people do not understand that when you hire a workers’ compensation attorney, you are not suing your employer; in fact, you are not suing anyone. When the claim is accepted (or denied) it is administered under the laws of the state of Nevada, classifying it as Administrative
Law, not a negligence or tort suit. This means a governmental state agency controls the regulations that mandate how claims are handled and the Legislature makes the laws that correspond with the regulations. The regulatory agency in Nevada is the Department of Industrial Relations and falls under Business and Industry, not the Insurance Commission as many think.
When a work comp claim is denied, the work comp adjuster MUST send the denial letter via the US Mail Return Receipt Requested (some call this certified mail). A claim denial letter MUST be appealed within 70 days to the Hearings Division, otherwise, all appeal rights are
extinguished except under a few circumstances.
When a work comp claim is accepted, the injured worker will begin receiving a lot of letters. It is imperative that all letters received are carefully read and the claim acceptance letter is appealed because it is rarely correct at the beginning of a claim because the adjuster takes the
diagnosis directly from the C4 Form. If this letter is not appealed, and/or the scope of the claim is not expanded per request of the injured worker, it is likely that many body parts will not be treated or rated and can significantly affect the financial outcome of the claim.
An Average Monthly Wage letter will also be sent to the injured worker. This needs to be scrutinized very closely because it stays with the injured worker for his/her entire life since in most cases the injured worker will have lifetime re-opening rights. The Average Monthly
Wage (“AMW”) will generally be calculated based on the past 12 weeks, however, the law says that the injured worker can request a 12-month AMW determination and the work adjuster must use whichever is higher. Additionally, if an injured worker has a second job or works out
of a union hall, concurrent wages must be used to determine the AMW, but adjusters do not know this unless they are told and presented with proof.
If the injured worker is completely taken off work, or only allowed to work fewer than the preinjury number of hours, TTD or TPD might be owed. Remember, an adjuster is not going to tell an injured worker to appeal letters or provide additional wage information because they do not want to increase the value of the injury claim.
Also in the packet of letters is a mileage reimbursement form. If an injured worker travels 20 miles one way, or 40 miles in a week to medical appointments or hearings, they are eligible for mileage to be reimbursed at the state rate of reimbursement. This form MUST be sent in within 60 days of the treatment, there are no exceptions. We encourage our clients to send mileage reimbursement to us at the beginning of the month and we will send it to the adjuster.
One difference from a car accident is that injured workers do not have the right to choose their doctors. Fortunately, a group I created 10 years ago has been working very hard on getting many work comp laws changed, and this is one of them. Now injured workers still have to choose from a list, but it is a much, much larger list and the majority of the doctors are excellent and have been vetted by the Department of Industrial Relations. A dedicated work comp attorney will help you pick all of your doctors to make sure you get the best medical treatment available.
When you are done treating for your injuries, you will be sent to a rating physician. A dedicated work comp attorney will be able to pick the best rating physician for you and help you prepare for this evaluation. If you cannot return to your pre-injury job, a dedicated work comp attorney will also help you get into a vocational rehabilitation program so you can be trained for a different job/career of your choice.
If you need to re-open your claim at any time during your life, no matter if you live in Nevada, Alaska, or another country, a dedicated work comp attorney will help you re-open your claim and get you the medical treatment and benefits you deserve.
If you or a loved one are injured on the job, please call or email us immediately so we can go over your options and make sure you know all the benefits afforded to you under the law. I can be reached at 702-380-2800 or bmorrison@cpklaw.com.