Nevada Workers' Compensation Law Blog : Nevada Workers' Compensation Lawyer & Attorney : Virginia Hunt Law Firm : Las Vegas Job Injuries & Worker Accidents

I receive many phone calls and emails each week asking my help in reopening a closed claim. If you are shopping for an attorney, ask whether the attorney’s fee includes help in reopening your claim. If you need more medical treatment after your claim is closed and your attorney has been paid, you need to know whether you can count on that attorney to help you.  It is difficult to get a new attorney to help you reopen your claim if the new attorney has no way to get paid for helping you.  

 The following questions should help you better understand the reopening process.

1.    Are you sure that you have reopening rights on your claim?

Only injured workers who receive temporary total disability benefits or a permanent partial disability award before their claims are closed have lifetime reopening rights. If your injury costs the insurer less than $300 in medical expenses, and the insurer gives proper notice of claim closure rules, you may not reopen your claim. If you had medical expenses over $300, but you did not receive TTD benefits, or did not receive a PPD award, you may only reopen your claim within a year of its closure.  

2.    Have you gotten a medical report to attach to a reopening request letter?

You must either use your private medical insurance or pay cash  to get a written report from a doctor that states that your injury has worsened from the time your claim was closed.   The insurer will not reopen a claim without this medical report. Attach this report to a letter requesting reopening of your old claim, and reference your claim number.  After the claim is reopened, send the insurer the receipt for your expenses in getting this medical report. If you cannot afford to get a medical report, do not ask to reopen your claim until you can pay for a report to attach to your request. The insurer will not pay for you to get this report- no exceptions!

3.    Does the medical report identify an objective worsening of your injury?

The medical report must clearly state that your injury has worsened. If the report only says that the doctor wants another MRI because you are complaining of more pain, the insurer will not reopen your claim until after you pay for a MRI, and the MRI must show that your injury has worsened.  Your doctor should discuss in what way your injury has gotten worse.   Medical reports that only state that you have increased symptoms are not enough.  If the doctor is only prescribing more pain medication or a few more visits of physical therapy to make you feel better, then your reopening request will be denied.

4.    Does the medical report recommend additional treatment?

Again, If your doctor only states in his report that he wants more x-rays or a MRI before he knows what treatment you need, don’t ask for reopening until after you get more x-rays or a MRI so that your doctor can state what you need.   Give your doctor a copy of your rating evaluation that was used for your permanent partial disability award so that your doctor knows what treatment you have already tried in the past.   Your condition may have worsened, but if no additional treatment is recommended, the insurer will deny your reopening request.

5.    Are you asking for treatment to a body part that was accepted?

An insurer will not reopen a claim for treatment to a body part that was never accepted and treated before the claim was closed.  If you try to reopen your claim to get treatment for some other body part, it can be very difficult to convince the insurer or a hearings officer that you did not know that this other body part was injured in the original accident and  that it now requires medical attention months or years later.  If you aren’t sure what body parts were accepted, review the rating evaluation report that was used for your permanent partial disability award. It discusses what body parts were injured and treated.

It is important that you have all the information necessary to successfully reopen your claim before you send your reopening request to the insurer.   If the insurer denies your request because you did not have complete information, and you do not appeal, or you lose your appeal, you cannot request reopening again for another year. 

For more information about reopening a closed claim, see “How Do I Reopen My Claim?”

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After every visit to a treating doctor, the injured worker should make sure that he or she leaves with a copy of  a physician progress report (PPR).  Most doctors who are on insurers' provider lists use the DIR- approved physician progress report form.  However, some doctors have forms on their own stationery that  have the same information, but in a different lay-out.  If the nurse or assistant checking you out after the doctor's visit does not offer you a copy of the PPR, please insist that they give you a copy before you leave.  Then read the PPR before you leave the doctor's office to make sure that the information is correct and that you understand what the doctor has written..  A copy of  this form will be sent to the adjuster handling your worker's compensation claim, and a copy is often sent to your employer.

The top portion of this form states in abbreviated medical terms what your injury and diagnosis is.   If you have injured more than what is stated in this section of the form, you should have a discussion with the doctor to make sure that he or she has examined and noted all body parts that were injured and that need treatment. 

The second section of the form is important when the doctor releases you from care.  In that section, the doctor checks boxes that state that  you are, or are not, ratable and may have suffered a permanent disability.  If the doctor checks "no" to those two boxes, the adjuster is not likely to schedule you for a permanent partial disability evaluation, which is necessary to receive a settlement for your injury.

The section entitled "Treatment plan" often tells you whether the doctor will be requesting approval for MRI's, more physical therapy, or a referral to a specialist.    Hopefully, your doctor's staff will then follow-up with the proper authorization request form so that the treatment plan is approved and put into motion.

The bottom third of the PPR is very important and tells the injured worker whether the doctor has taken you off work completely (totally temporarily disabled), or whether the doctor has given you work restrictions.    If the doctor gives you temporary work restrictions, it is your responsibility to give a copy of the PPR with these restrictions  to your employer and ask whether your employer has work available within these restrictions.    Keep in mind that a copy of this PPR goes to your adjuster, and if the employer tells the adjuster that light duty work is available,  the adjuster will not continue to pay bi-weekly  TTD benefits to you.

Read the PPR before you leave the doctor's office to make sure you know whether the doctor has released you to  full duty or with temporary work restrictions.  Often injured workers misunderstand what their doctors verbally tell them about returning to work.  You need to know what the doctor writes on the PPR, and if you disagree with what the doctor writes, you want to calmly and politely ask to speak to the doctor again to get a clarification before leaving the doctor's office.

Some doctors tell injured workers that they are prohibited by Nevada law from taking an injured off work completely.  That is false information.  The doctor has a legal obligation to provide care for his patients regardless of who is paying for his services.  Many doctors, however, feel pressure from adjusters and case managers to give work restrictions instead of taking injured workers off work completely for extended periods of time.   So long as the employer provides work within whatever restrictions the doctor gives on the PPR, the injured worker must show up for work, or take leave without pay if available, or use whatever sick leave is available.   The only other recourse the injured worker has is to request a change of physicians to a more caring doctor.

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