Re-opening Your Nevada Workers’ Compensation Claim
Know whether you have re-opening rights and when to time your request. Only injured workers who received a permanent partial disability award, or who were off work due to the work injury or occupational disease have lifetime reopening rights. The law makes it more difficult to re-open a claim within a year of the date a claim with lifetime reopening rights was closed. However, if you weren’t off work or didn’t receive a PPD award, you may only re-open within a year of the date your claim was closed. If less than $300 in medical costs were paid before your claim was closed, you cannot re-open your claim. NRS 616C.390.
2. Attach a convincing medical report to your written request to re-open your claim.
The industrial insurer will not pay for you to get this medical report. You must either pay cash or use your health insurance to get a medical report to attach to your re-opening request. Also, be sure to include your old claim number.
3. The medical report must say that your work condition has worsened and that you need more treatment. If the report only says that you have increased pain and that the doctor wants an MRI to see whether your injury has worsened, your re-opening request will be denied. You may have to pay for an MRI for your doctor to be able to say that your injury has worsened and to recommend specific treatment. Give your doctor a copy of your PPD rating report or your old medical records so that your doctor can discuss how your injury has worsened.
4. Don’t attempt re-opening your claim until you have what is necessary.
If your re-opening request is denied, and you don’t win on appeal, you can’t request re-opening again for a year. Keep in mind that the insurer won’t re-open for you to get more pain pills or a few more sessions of physical therapy. Nor will the insurer re-open your claim for you to get treatment for a part of your body that wasn’t ever accepted on the claim.
It takes time to reopen your claim.
The insurer has 30 days to respond to your letter requesting re-opening. If the doctor’s report you attached is recommending surgery, don’t expect the insurer to automatically authorize surgery. The insurer may want another medical opinion after another exam, or may send the request to a reviewing doctor. The insurer will also require that your treat with a surgeon on their provider list. If you go ahead with medical treatment using your health insurance, the industrial insurer won’t be obligated to reimburse you for any co-pays or deductibles you incurred unless the surgery was a true emergency. You will also be required to submit off work or restricted work slips to obtain compensation benefits, and the insurer won’t pay benefits before the date of your re-opening request.