4 Steps To Take If You’ve Been Injured At Work.


By Jason Weinstock on May 29, 2020
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Getting hurt anywhere can be a scary experience but can be even more frightening when it happens at work. On top of the pain associated with the injury, my clients often also express fear of losing their job and costly medical bills. It is important to remember that accidents happen, and Nevada’s workers’ compensation system is a non-fault system. A valid work injury covered by workers’ compensation insurance provides the benefit of covering your medical treatment with no out-of-pocket costs, unlike private health insurance. Here are 4 steps to take if you’ve been injured at work:

1) Assess your injury!

Work accidents happen in many ways and result in different forms of physical or mental injuries. Your health and safety should be your first concern. It should also be your employer’s first concern. Evaluate your injury and seek first aid or call for help depending on severity. Sometimes assessing the injury only requires taking a second to sit down and catch your breath, or sometimes it requires emergency transport to a hospital. Take a second to recognize what happened, what hurts, and what immediate treatment you might need.

2) Notify your employer that you were injured!

Tell your employer about the accident or injury immediately or as soon as possible. NRS 616C.015 requires an injured employee to notify their employer of the injury “as soon as practicable, but within 7 days.”

Too often I have clients that come to me with a denied claim because they did not report the injury to their employer within the 7 days. Their reasoning is not that they didn’t actually get hurt at work but rather they wanted to wait to see if they got better before they “made it a big deal.” While this is completely understandable and in the “real world” a totally normal thing to do, workers’ compensation insurance companies will use this against you.

An example of this is a construction worker who is lifting something heavy, hears a pop and feels pain in his back. He takes some Tylenol and thinks he will sleep it off over the next few days. Eight days later he realizes his back is not getting better and he tells his employer about the injury.

I recommend telling your employer of the accident and injury as soon as it happens, if possible, even if you do not know the severity yet. Your employer should have you complete a C-1 Form also called a Notice of Injury or they may have their own accident report forms. Ask to complete a written accident statement if one is not automatically given to you to complete.

3) Seek Medical Attention!

Although this also falls under number 1 (assess your injury), it is important to mention it again for injured employees like those in the example above. Completing a C-4 Form, also known as a Request for Compensation, is what starts initiates the workers’ compensation insurance claim. This form must be completed by a doctor within 90 days. You may not feel that your injury is severe enough to seek medical attention the instant it happens, that is why the legislature allows you 90 days to see a doctor and file a claim for compensation per NRS 616C.020.

Using the example above, let’s say the construction worker told his employer of the pop and pain in his back the day it happened but wanted to see if the pain would go away on its own in a few days. Even if the construction worker waits 2 months (I DO NOT RECOMMEND THIS), he would still fall within the statutory requirement of reporting a claim within 90 days.

4) Consult with an attorney for a free case review!

Many workers’ compensation attorneys, like myself, offer free consultations and will review your case with you. Although not every workers’ compensation claim will require an attorney’s assistance, taking advantage of a free consultation is always a good idea.

I recently wrote a blog on the types of benefits offered by workers’ compensation insurance. An experienced workers’ compensation attorney will be able to ensure you are receiving all the benefits that you are owed. An experienced workers’ compensation attorney can help you gather evidence and medical records and will also be able to assist in finding the appropriate doctor or getting treatment approved.

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim, filing a claim, or workers’ compensation benefits and deadlines.

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Time deadlines for a Nevada Workers’ Compensation Claim.


By Jason Weinstock on May 1, 2020
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A few weeks ago, I posted a blog regarding “5 Mistakes That Can Affect Your Nevada Workers’ Compensation Claim.” Number one on the list was missed filing deadlines. Filing deadlines refers to filing claims with the insurer, giving notice to your employer, and filing appeals to the Department of Administration. However, there are many deadlines that may affect your claim and they can expire fast. Below are some time deadlines for a Nevada workers’ compensation claim that you should keep in mind!

  • Time to notify your employer that you have been injured at work or have been diagnosed with an occupational disease/illness = 7 days.

    • The statute says the injured worker must notify their employer “as soon as practicable, but within 7 days after the accident.” I recommend telling your employer the day you are injured, regardless of how severe you think it is.
  • Time to notify the insurer (file a claim for compensation) that you have been injured at work or have been diagnosed with an occupational disease/illness = 90 days.

    • A C-4 form (Request for Compensation) must be filed by the injured employee within 90 days after the accident if: (1) the employee sought medical attention, or (2) has missed work because of the injury or illness.
  • Insurers have 30 days from when they received the C-4 form to make a determination on claim acceptance or denial.

  • Time to request mileage or travel reimbursement = 60 days.

    • Requests for mileage or travel reimbursement must be made within 60 days after the expenses are incurred.
  • Time to submit medical billing to the insurer = 90 days.

    • Medical billing must be submitted within 90 days of the date of service.
    • The insurer has 45 days to approve or deny.
  • Time to request a transfer of care = 90 days.

    • An injured worker has 90 days from the date of injury to request a transfer of care to a workers’ compensation doctor of their choosing.
    • However, the workers’ compensation doctor must be off the insurer’s provider list.
    • The insurer has 10 days to grant or deny the request. If there is no response within 10 days, the request is deemed granted. Because of practical reasons, the 10 day rule is hard to enforce.
  • Insurers also have 30 days from the date of any request made by the injured worker or their attorney to issue a determination regarding the request.

  • Time to file an initial appeal with the Department of Administration, Hearings Division = 70 days.

    • This includes appeals of claim denials, claim acceptance, denial of treatment authorizations, denial of mileage reimbursement, a transfer of care, claim closure, etc.
  • Time to file an appeal of a hearing officer’s decision and order = 30 days.

    • Appeals of a hearing officer’s decision and order must be filed within 30 days of the date the decision and order was signed.
    • Appeals are filled with the Department of Administration, Appeals Division.
  • Time to file an appeal of an appeals officer’s decision and order = 30 days.

    • Appeals of an appeals officer’s decision and order must be filed within 30 days of the date the decision and order was signed.
    • Appeals are filed with the District Court and are called a Petition for Judicial Review.

This is not an exhaustive list of all the rapid time deadlines for a Nevada workers’ compensation claim, but it does cover a majority of the most missed deadlines.

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim, filing a claim, or workers’ compensation benefits and deadlines.

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What Are Nevada Workers’ Compensation Benefits?


By Jason Weinstock on April 10, 2020
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If you are injured at work, it is important to know what you are entitled to and what are Nevada workers’ compensation benefits. The Nevada Industrial Insurance Act (NIIA) is the act that governs Nevada’s workers’ compensation in conjunction with NRS 616 – 617 and NAC 616 – 617. In short Nevada’s workers’ compensation benefits can be broken down into “7 types of benefits injured workers may be entitled to.”

  1. Medical Treatment.

One of the main goals of the NIIA is to return an injured worker to preinjury condition/health. This entails getting them proper treatment at no cost to them. When an employee gets hurt at work one of the first steps in initiating a claim entails going to a doctor and completing a C-4 Form.

Once a claim is filed with the workers’ compensation insurance company, the insurer has 30 days to accept or deny the claim. During this time, the injured worker can treat with the physician that completed the C-4 form or any physician that doctor refers the injured worker to, if approved by the insurer.

Once the claim is accepted, insurers have providers list which the injured worker can treat with. Unlike private health insurance, there are no co-pays or out-of-pocket medical expenses for the injured worker to pay for when treating for their work injury. Workers’ compensation insurers help schedule treatment, testing and pay for prescriptions.

  1. Lost Time Compensation (TTD/TPD).

When an injured worker is taken out of work due to their injury for more than 5 consecutive days or is working light duty, but making less than they normally would, they may be entitled to compensation. The amount of compensation depends on the injured workers’ average monthly wage at the time of the injury. Benefits are paid at a rate of 66 and 2/3% of the injured workers’ average monthly wage.

Temporary total disability (TTD) benefits are paid when the injured worker is taken completely off work due to the doctor’s work restrictions or if the employer has no “light duty” work that falls within the doctor’s work restrictions.

Temporary partial disability (TPD) benefits are paid when the injured worker is working light duty but making less than his/her calculated daily rate (or less than 66 and 2/3% of their preinjury average monthly wage).

  1. Permanent Partial Disability (PPD).

At the end of all the injured worker’s treatment, their treating physician will indicate that the injured worker is “stable,” at maximum medical improvement, and whether there may be a ratable impairment. If the treating physician does indicate there is a ratable impairment the insurer has 30 days to schedule a permanent partial disability (PPD) examination.

The PPD examination is done by a licensed rating physician, who uses methods prescribed by the American Medical Association Guides to the Evaluation of Permanent Impairment to determine a percentage of whole person impairment. This percentage of impairment is used to determine settlement amounts and the length of vocational rehabilitation, if an injured worker is entitled to vocational rehabilitation.

  1. Permanent Total Disability (PTD).

Permanent total disability (PTD) benefits come into play if an injured worker is injured so severely that he/she cannot return to any form of employment again. Injured workers’ eligible for PTD receive monthly payments for life.

  1. Vocational Rehabilitation.

If an injured worker is released from their treating physician with permanent work restrictions, meaning they can never return to their preinjury employment, their employer has to offer a permanent light duty job position. If their employer cannot offer a permanent light duty position, the injured may be entitled to vocational training. This is where the injured worker can attend schooling to learn a new skill or trade that will assist them in finding meaningful employment.

The schooling is paid for and the injured worker receives bi-weekly maintenance checks (similar to TTD benefits). If the injured worker does not want to attend schooling, they may request a lump sum buy-out in lieu of vocational rehabilitation.

  1. Dependent’s Payments in the Event of Death.

In the event of an injured workers’ death which is the result of a compensable work injury, his/her dependents may be entitled to the financial benefits that the injured worker himself/herself would have been entitled to.

  1. Other Claims-Related Benefits or Expenses.

Nevada’s workers’ compensation system also allows for additional benefits including mileage and travel reimbursement. Mileage is paid at a current rate of 57.5 cents per mile and this amount is subject to change every year on January 1st. If an injured worker lives out of state and is required to come to Nevada for medical treatment, the injured worker may be entitled to have their hotel and food paid for while in Nevada for the medical treatment. Additionally, there may be times when prosthetics or other claim related expenses would be covered by the insurer.

Although the above list of workers’ compensation benefits is a good basic overview, I recommend consulting with an experienced workers’ compensation attorney, as eligibility to each of these benefits requires a case-by-case analysis.

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim, filing a claim, or workers’ compensation benefits.

 

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Update on How Coronavirus Impacts Workers’ Compensation.


By Jason Weinstock on April 2, 2020
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It was on March 17, 2020, that Nevada Governor Sisolak closed all casinos and gaming establishments in Nevada and recommended the closure of all “non-essential” businesses. This has led to non-essential surgeries being cancelled, massive layoffs/furloughs, and the partial closure of the Department of Administration. Below is an update on how Coronavirus impacts workers’ compensation.

I have been very impressed with how the workers’ compensation insurance companies/ adjusters and the workers’ compensation doctors have been working to accommodate Nevada’s injured workers. I have not had any more than the usual difficulty getting a hold of adjusters, in fact I have found that most adjusters are even easier to get a hold of! From what I can tell all adjusters are working from home and have gone great lengths to be able to have full access to their files.

Workers’ compensation doctors have been continuing to treat injured workers. Most have established telemedicine capabilities and have been treating injured workers over the phone. This has been instrumental in the ability for injured workers to continue treatment with out negative implications on their claim. Doctors are continuing to give work restrictions if necessary, so injured workers can continue to receive TTD. Some doctors are still seeing patients in person, while complying with the CDC guidelines for cleanliness and minimal close contact.

Most employers have offered full pay to injured workers, while their businesses are shut down. The employers who cannot offer full pay have been proactive in informing their workers’ compensation insurance company that they no longer have light duty and that temporary total disability (TTD) benefits need to be paid. For employer who have not been proactive in informing the insurance company, it has been my experience that when I inform the insurance company, TTD is being processed and approved quickly.

The Department of Administration (workers’ compensation courthouse) tried hard at first to accommodate telephonic hearings and appeals, but quickly became overwhelmed as they had to minimize their staff. Unfortunately, this has led to an inability to conduct hearings or appeals. However, attorneys, claimants, insurers, and employers are still able to timely file hearing and appeal requests, no dates are being calendared yet. Rumor has it, the Department of Administration is working on their abilities to reopen in some capacity that may allow for the hearing of contested issues sooner rather than later.

The way the Las Vegas community comes together during a crisis never ceases to amaze me. While there is no doubt that Coronavirus is and will continue to effect Nevada workers’ compensation claims, I am incredible impressed with the efforts of attorneys on both sides, workers’ compensation insurers, adjusters, and doctors during these times. Injured workers’ and the community as a whole have continued to be #VegasStrong!

Let’s continue to work on our social distancing and follow the CDC guidelines for preventing the disease from spreading, so that we can stop the spread and return to normal as quickly as possible! In the meantime, my office continues to stay open and I can be reached by phone or email!

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim, filing a claim, or workers’ compensation benefits.

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How the Coronavirus Has Been Affecting Nevada’s Workers’ Compensation Community.


By Jason Weinstock on March 18, 2020
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The Nevada workers’ compensation community includes, but is not limited to injured workers, claimant’s attorneys, the Department of Administration, healthcare providers, third-party administrators, insurers, employers, and defense attorneys. The Coronavirus is affecting workers’ compensation for everyone in some way or another.

The effect of the Coronavirus on Nevada’s workers’ compensation community is being felt the most by Nevada’s injured workers. “If workers’ comp will still be paid out during the COVID-19 / Coronavirus outbreak” has been a popular search on Google this week. The answer is yes. If you have an accepted workers’ compensation claim you can expect your temporary total disability “TTD” checks to continue and your doctor’s appointments to continue to get scheduled. This is as of today, March 18, 2020.

Despite Governor Sisolak’s closure of all “non-essential” businesses, law offices and health care providers continue to remain open. I am finding the same to be true regarding the workers’ compensation insurance companies, however, most are now working from home. My office continues to remain open and fighting for the rights and benefits of injured workers. Should the need arise to close the office in the future, rest assured that we have the technology available and are fully capable of functioning from home.

Many injured workers are incapable of showing up for work, as their employer has shut down for the next 30 days as requested by the Governor. These injured workers should notify their attorneys or adjusters immediately, so that TTD benefits can be requested. Additionally, I have been in touch with many doctors’ offices and none have informed me of any cancellations or closures.

The Department of Administration, Hearings Division (the workers’ compensation courthouse) starting tomorrow, March 19, 2020, will stop having all hearings and appeals. All currently scheduled hearings will be continued until they resume hearing cases. The time frame of how long they will stop having hearings for is currently unknown.  Attorneys and claimant’s will still be able to file hearings and appeals via fax, email or mail. However, when these hearings and appeals will be scheduled is unknown.

Here is the information needed to file a hearing or appeal:

Las Vegas Office

      • Mail: 2200 South Rancho Drive, Suite 210A, Las Vegas NV 89102
      • Email: hearingsandappeals@admin.nv.gov, or
      • Facsimile for Hearing Officer (702) 486-2879; for Appeals Office (702) 486-2555

Carson City Office

      • Mail: 1050 E Williams Street Suite 450, Carson City, NV 89701
      • Email: teaton@admin.nv.gov; or
      • Facsimile for Hearings Officer (775) 687-8441;  for Appeals Office (775) 687-8421

The impact from the court not hearing cases will be enormous. This means injured workers’ who have been denied surgery will have to wait to have a judge determine whether the denial was proper. Injured workers’ who are now out of work and their TTD has been denied will now be forced to continue to wait without any income, before a judge can decide if the denial was proper.

My recommendation is that we continue social distancing and following the CDC’s preventative guidelines of maintaining good hygiene. The goal is to minimize exposure to the virus, decrease the spread, and put this behind us. In the meantime, my office will remain available to fight for my client’s rights and benefits, as well as, attempt to answer all questions and concerns.

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim, filing a claim, or workers’ compensation benefits.

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If I Get the Coronavirus Will Nevada Workers’ Compensation Cover My Missed Work and Medical Expenses?


By Jason Weinstock on March 14, 2020
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With growing concern over the Coronavirus (COVID-19) the last few weeks, many are asking, “If I get the Coronavirus will Nevada workers’ compensation cover my missed work and medical expenses?” The answer is… probably not, unless you are a first responder or health care provider (paramedic, doctor, firefighter, or police officer).

coronavirus update Nevada

This is extremely concerning after the recent positive cases here in Las Vegas. Las Vegas is a hot spot for conventions, sports tournaments, shows, and large social gatherings of all types. Social distance is not something that is typically practiced in our community that caters to large events and thrives on tourism.

One of the confirmed cases of the Coronavirus in Las Vegas was a woman, who traveled from New York, to attend the Women of Power Summit at the Mirage. More than 1,000 people were registered to attend the event. That means there is the potential for more than 1,000 people to have encountered this woman. This does not account for the guest room attendants, who cleaned her room if she stayed at a hotel, the taxi drivers who drove her to and from the event, the servers that waited on her at a restaurant, and the numerous other Nevadans who may have come in contact with her or someone else that came in contact with her.

So what happens if you are the server that waited on her after the conference, and now you are positive for the virus? First, take the necessary precautions to prevent others from getting infected. Second, seek medical attention to get yourself healthy. Third, don’t expect workers’ compensation to cover your medical expenses or time missed from work.

The reason workers’ compensation insurance likely won’t cover the restaurant server, the taxicab driver, or the guestroom attendant that gets sick, is because the Coronavirus will not be considered an injury, but rather an occupational disease/illness. In Nevada, an occupational disease/illness needs to be shown to have arose out of and in the course of employment. Now the argument will be that their employment put them at a greater risk of becoming infected, but it will be tough to show that they weren’t infected elsewhere. This argument may have greater success for a receptionist of a hospital or a hospital cleaning crew than the restaurant server or taxi driver.

So what does this mean for an employee that caught the virus at work and workers’ compensation won’t accept liability? You will need to treat with a doctor under your private health insurance if you have, and pay your normal co-pays. If you don’t have private health insurance, you will need to treat out of pocket and risk expensive medical bills. As for your missed work… don’t expect your employer to pay you while you are out of work. Some employers are offering paid leave, while you undergo the recommended 14 day quarantine, but most will recommend you use your saved up paid time off or sick/vacation time.

However, if you are health care provider or a first responder, I expect that Nevada workers’ compensation insurance companies will cover these medical professionals and first responders who are more likely to have encountered the virus due to the nature of their job. Now, they will still need to meet the requirements of NRS 617 for timely reporting of the occupational disease/illness to their employer and insurer.

If a Coronavirus claim is accepted by a Nevada workers’ compensation insurer, the benefits you could expect are temporary total disability (time for missed work), if you missed more than five consecutive days, and paid medical benefits.

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim, filing a claim, or workers’ compensation benefits.

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5 Mistakes That Can Affect Your Nevada Workers’ Compensation Claim.


By Jason Weinstock on March 6, 2020
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Nevada workers’ compensation claims can be confusing, frustrating, and entail a lot of claims management. The timelines for filing a claim and appealing determinations are frequent and rapid. I always recommend taking advantage of a free consultation and/or case review with an experienced workers’ compensation attorney. However, if you insist on handling your claim on your own, here is my:

List of 5 mistakes that can affect your Nevada workers’ compensation claim in a negative way

1. Missed filing deadlines.

If you have been injured at work, there are two very important deadlines to remember from the start.

    • First, you must notify your employer within seven (7) days of your injury or from the date you learn your occupational illness or disease is work related. This entails completing a Notice of Injury or C-1 form with your employer.
    • Second, you must notify your employer’s workers’ compensation insurance company with in 90 days of the injury, or from the date you learn your occupational illness or disease is work related. This is done by being seen by a doctor and completing a Request for Compensation, also known as a C-4 form.

2. Missed appeals.

Every determination from the workers’ compensation insurance company is appealable. Appeals must be filed within 70 days from the date on the determination. Determinations can be anything from a claim acceptance, claim denial, surgery denial, denial of temporary total disability benefits, notice of intent close claim, along with many other issues. Appeals should be filed through a Request for Hearing with the State of Nevada Department of Administration, Hearings Division.

3. Not appealing the claim acceptance letter.

Even if your claim for workers’ compensation benefits has been accepted, it is important to look at what the injuries/diagnoses/body parts the workers’ compensation insurance company is accepting liability for. Not having the correct injuries/diagnoses/body parts can possibly affect your treatment, your settlement, and future re-opening rights. You have 70 days to appeal the initial claim acceptance letter.

4. Missing doctor’s appointments.

Your “life” and outside obligations do not stop when you have a workers’ compensation claim. I get that, and most insurance adjusters and doctors understand that. However, missing doctors’ appointments can cause a workers’ compensation insurance adjuster to prematurely close your claim or suspend your benefits for non-compliance. If you need to miss a treatment appointment it is important to call prior and reschedule with the doctor’s office, as well as, let your adjuster know (or your attorney if you are represented, so that they can notify your adjuster).

5. Not getting the appropriate care.

In Nevada, injured workers have a limited ability to select their workers’ compensation doctors. However, the law allows an injured worker to select a transfer of care to a doctor of their choosing, within the first 90 days of the claim. Now, the doctor must come off the workers’ compensation insurer’s provider list and the care must be for an accepted body part. Picking an appropriate specialist for the injured body part or occupational disease is only half the battle. The other half of the battle is picking a doctor that is going to fight for you and work to truly get you better, rather than just get you back to work.

6. BONUS – Not consulting with an experienced workers’ compensation attorney.

Although, the above list is my opinion of the 5 most common mistakes that can affect your Nevada workers’ compensation in a negative way, an experienced workers’ compensation attorney can provide valuable assistance in these areas and many more.

    • Knowledgeable attorneys know what adverse determinations from adjusters should be appealed along with the case law and statutes to apply.
    • Knowledgeable attorneys are familiar with common work-related injuries and can assist in making sure the proper treatment and doctors are being used to direct your care.
    • A knowledgeable attorney will fight for the proper benefits and settlement in your workers’ compensation claim.

Take advantage of a free consultation for your Nevada workers’ compensation claim!

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How Does Nevada Workers’ Compensation Work?


By Jason Weinstock on February 28, 2020
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A question I often get is, “How does Nevada workers’ compensation work?”

As I have explained in a previous blog post, workers’ compensation is an exclusive remedy in Nevada to compensate employees that are injured in the course and scope of their employment. The steps to filing a claim require that there be a specific accident that caused an injury, the injury is timely reported to your employer (as soon as possible, but within 7 days), and that you timely filed a request for compensation by going to the doctor and completing a C-4 form (within 90 days of the injury).

Once the C-4 form is completed, the form will be sent to your employer’s workers’ compensation insurance company and an adjuster will be assigned. Upon receiving the C-4 form the adjuster has 30 days to accept or deny the claim. Whether they accept or deny the claim, my office always appeals the initial claim acceptance letter (click here to find out why). If they send you a denial, you will need to appeal the Notice of Claim Denial within 70 days of the date on the letter. If they accept the claim, you can now begin receiving treatment and compensation benefits you deserve.

They accepted my claim, what benefits should I be receiving?

(more…)

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More Changes From The Division Of Industrial Relations Just In For 2020.


By Jason Weinstock on February 14, 2020
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More changes from the Division of Industrial Relations just in for 2020! The Division of Industrial Relations (DIR) is a division within the State of Nevada Department of Business and Industry, which is responsible for overseeing workers’ compensation in Nevada. The DIR has been rolling out changes ever since the end of the 2019 Legislative Session and will likely continue through 2020.

The most recent changes published by the DIR include changes to the C-1 form (Notice of Injury or Occupational Disease, the C-3 form (Employer’s Report of Industrial Injury or Occupational Disease), and the D-2 (Brief Description of Your Rights and Benefits if You Are Injured on the Job). DIR says the effective date of the new forms is January 24, 2020, despite their notice of the new forms not going out until February 11, 2020.

The C-1 form is a form that an injured worker completes with their employer, notifying their employer that they have suffered an injury or occupational disease. This form was last revised in 2005. The only change appears to be the inclusion of the phone number, website, and email for the Office of the Governor Consumer Health Assistance.

The C-3 form is a form that the employer completes and returns to the workers’ compensation insurer to report the employee’s injury or occupational disease. This form was last revised in 2005, as well. The only change appears to be the website for the Office of the Governor Consumer Health Assistance.

The D-2 is a notice that is sent to injured employees by the workers’ compensation insurance company informing them of their rights and benefits pursuant to NRS 616C.050. The last revision to this form was in 2018. The only change appears to be the website for the Office of the Governor Consumer Health Assistance.

Although these changes are not significant nor will they effect how a claim made by an injured worker for workers’ compensation benefits will be handled, it is good to see any type of progress being made at the DIR. Keep an eye out for more changes from the Division of Industrial Relations in the future, which may impact workers’ compensation claims.

In a previous blog post I wrote about SB 381, which will affect the provider lists (list of approved workers’ compensation doctors) the workers’ compensation insurance companies maintain. The DIR is now tasked with maintaining and updating, their much outdated, list of workers’ compensation doctors, from which the insurance companies can compose their own lists. Expect the DIR to have their lists complete at the beginning of July.

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim and DIR forms.

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Top Reasons a Nevada Workers’ Compensation Claim Gets Denied.


By Jason Weinstock on February 7, 2020
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Workers’ compensation insurance is a requirement for all employers, with one or more employees. It is meant to protect employer’s from negligence lawsuits when an employee is hurt in the course and scope of employment, but also meant to give the injured worker a remedy and to provide medical and compensation benefits when they are hurt at work. Workers’ compensation insurance, however, doesn’t cover every injury just because it happened at work. Below are the top reasons a Nevada workers’ compensation claim gets denied.

  1. Course and Scope.

To have a valid workers’ compensation claim, your injury must have happened within the course and scope of your employment and that your injuries arose out of your employment. Put simply, this means that you were working at a time you were scheduled to be there, and you were performing your typical job duties when the injury occurred.

An example of an injury that would satisfy the course and scope element would be: A roofer, who’s job duties include going on top of a house to install a new roof, falls off a roof, while working on a job he was told to do. An example of an injury that would not satisfy the course and scope element would be: This same roofer showing up on his day off because he forgot his phone on the roof and falling off because he was hungover from the night before.

2. Accident and Injury.

The accident and injury elements, which are required for a valid workers’ compensation claim, tend to be the reason for most of the claim denials I see. The statute defines accident as “unexpected or unforeseen event happening suddenly and violently, with or without human fault, and producing at the time objective symptoms of an injury.” Injury is defined as a “sudden and tangible happening of a traumatic nature, producing an immediate or prompt result which is established by medical evidence.”

In short this means there must have been some event that lead to some type of identifiable “injury” that can be causally connected by medical evidence. A doctor must state that the accident that occurred is the cause of injury you have now. The first place this medical evidence often shows up is on the C-4 form where the doctor has a question that reads, “From the information given by the employee, together with medical evidence, can you directly connect this injury or occupational disease  as job incurred?” This question goes to both the injury element and the course and scope element. A “no” in this section can be a reason to deny a claim within itself.

An example of an injury that would satisfy the accident and injury element would be: The roofer falling off the roof and fractures his back. In that scenario, the accident is the event that took place, where he fell off the roof, and the injury is the pain he immediately felt in his back and the resulting fractures. An example of an injury that would not satisfy the accident and injury element would be: A roofer that develops cancer…unless, a doctor states that it is the roofer’s occupation that caused the cancer.

3. Notice.

Not timely reporting a claim is another big cause of a claim denial. In Nevada, you have seven (7) days to notify your employer of an injury that occurred at work and 90 days to inform the workers’ compensation insurer. The statute on reporting the injury to your employer says to tell them “as soon as practicable, but within 7 days.” This means ideally, you should let your employer know anytime you are injured at work, as soon as it happens, whether you think it is serious or not.

If you tell your employer the day you got hurt, but do not see the doctor for a month you can still timely file a claim! The 90 days to inform the insurer also starts the date of the injury, but it allows some time for you to see if the injuries will heal on their own (however, I do not recommend this). The notice to the insurer is done when you complete a C-4 form, request for compensation, at the doctor’s office. This form lets the workers’ compensation insurance company know that there are medical benefits that need to be paid as a result of a work-related injury.

Although there are many other reasons a claim may get denied, not meeting the basic requirements for a valid workers’ compensation claim account for most common denials. Workers’ compensation insurer’s like to argue that failed drug tests or pre-existing conditions you not to meet a basic requirement discussed above.

Give me a call or send an email for a free consultation if you have questions or concerns about your Nevada workers’ compensation claim and reasons for a claim denial.

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