The most important benefit under the Nevada workers’ compensation system is the injured employee’s right to get medical treatment. I have prior blog posts about the limitations on that right that are written into Nevada law, such as the limited right to choose a treating doctor. I also just wrote about insurers’ attempts to deny an injured employee’s right to change doctors by directing care to doctors who will release the patient from care within the first 90 days of the claim.
In the past two months I have seen two insurers get even bolder by writing directly to the treating doctor and telling him to change his diagnosis to the diagnosis accepted by the insurer. For example, two clients with low back injuries were diagnosed with disc injuries as well as lumbar sprains by their treating doctors. The administrator in both cases sent claims acceptance letters to the injured worker, stating that the claim was accepted for "lumbar strain only". When the insurers saw the bills from treating doctors and physician progress reports that referenced a disc injury and a lumbar strain, the insurer wrote to the doctor advising him that the insurer was only going to pay for treatment for a lumbar strain.
The injured workers were copied by the insurers on the letters that were sent to the treating doctors limiting treatment and payment of the bill to only a lumbar strain. However, In one case, this letter to the doctor wasn’t sent until months after the doctor had listed the disc condition on every physician progress report as one of the diagnoses. The insurer had also specifically authorized and paid for injection treatment for the disc condition. It was evident that the insurer was trying to limit the diagnosis now that the claim was closing so as to avoid an impairment evaluation or a higher impairment rating.
In the second case, the insurer wrote to the doctor at the very beginning of the claim, and the insurer wanted to make sure that the only treatment the injured worker got was treatment for a strain. In both cases, the copies of the letters to the doctors confused my clients. It wasn’t clear at all to them that what was happening was an attempt by the insurer to limit their medical treatment in the future or now, and an attempt to limit any impairment due to the work accident.
If you get a similar letter from the adjuster, or are copied on a letter the adjuster sends to your doctor trying to limit your claim, don’t ignore it. You owe it to yourself and to your family to understand what is happening on your claim and how to obtain the best possible medical care under Nevada law.