How to Get Medical Care in Another State on Your Nevada Claim

By Jason Weinstock on May 15, 2009

If you reside in another state and were injured while working temporarily in Nevada, and you have a a Nevada claim, you may want to move back home to have family and friends around to help you while you still need medical care.  While it can be more difficult to obtain medical treatment and benefits when you are in another state, with some careful planning, it can be done.  Either you, or your attorney, should do the following :

1. Notify your adjuster in writing of your new address and phone number.

2. Before you move, find a doctor who is willing to treat you and who will accept what the Nevada fee schedule provides for payment for medical services.  Provide this link to the doctor so that the doctor’s office has the Nevada fee schedule.

3. Request authorization from the adjuster for out-of-state care with the doctor you have chosen to treat you, and tell the adjuster that the doctor will accept the Nevada fee schedule.  Occasionally, the adjuster will have a network of doctors in other states, and you will have to choose a treating physician from that network.  While prior authorization is necessary under the regulations, it cannot be arbitrarily denied by the adjuster.

4. Have the doctor complete the same  physician progress report form the Nevada doctors use to let the adjuster know whether you have work restrictions or should be off work completely.  Be aware that if your employer had temporary light duty work available for you when you moved from Nevada, you will not be entitled to compensation benefits unless your doctor takes you off work completely.

5. If your doctor states that you may  have a permanent impairment when you are released from care,  the adjuster should pay you to return to Nevada to have a rating evaluation.  The adjuster should schedule the rating appointment  within 30 days of receiving your doctor’s last report.

6.  If you run into problems and must file appeals on adverse letters from the adjuster, call the hearings division and request that you be allowed to participate in the hearing by telephone if you do not have an attorney representing you.

Managing out-of-state claims does take more planning and often  more effort with doctors who are not familiar with Nevada’s workers compensation system.  However, out-of-state care may be very important to you if you are seriously injured and want to go home for care.  You do need to be aware that while medical care should not be comprised with your move back home, your entitlement to other benefits may be affected.