While emergency medical care will never be denied to an injured worker in Nevada, whether you get any additional, non-emergency care depends on whether your claim is accepted or denied. The adjuster handling your claim must decide to accept or deny your claim within 30 days of receiving a copy of the Claim for Compensation form (C-4 form) from the doctor who first treated you for your injury.
Once your claim is accepted, if it is taking too long to get diagnostic tests done, or physical therapy authorized, or a consultation with a specialist scheduled, do the following:
Find out whether a request was actually sent to your adjuster
Make sure that the clinic or your doctor actually put in a request with the adjuster and that the adjuster received the request. Call or visit your doctor's office and ask someone to make sure that the request for physical therapy or the request for the MRI was in fact faxed to the adjuster's correct fax number. An adjuster has 5 business days to respond, but only if the adjuster actually receives the request.
Show the adjuster that the request was sent more than 5 days ago.
If you can show that the adjuster did get the request, and has not acted on it in 5 business days, then fax the adjuster a note stating that he or she has not acted within the 5 days required by law. That should be sufficient to spur the adjuster into action. If not, file a complaint with DIR, and copy the adjuster on the complaint.
Check whether your doctor already has authorization to proceed.
Call your clinic or doctor and make sure that the delay is not with their office in failing to schedule a procedure or care that has been authorized.
If nothing seems to be progressing with your medical care, and you have followed the above steps to make sure that the problem is not with getting care authorized, you need to have a frank discussion with your doctor. Tell your doctor about your concerns, and then make sure that you understand what the doctor is telling you, and what he is recommending for treatment. Does your doctor think your progress is on schedule for your type of injury? Ask for and read your doctor's dictated progress reports that are sent to your claims adjuster after each visit. Frequently, an injured worker is not aware of what the doctor is telling the adjuster and putting in the patient's chart. Often the injured worker thinks the doctor has said one thing, only to read something very different in the doctor's written reports. You might even want to consider changing doctors.
