Expensive to Obtain a Second Rating

 Each year the WCS Medical Unit of the Division of Industrial Relations (DIR) updates the Medical Fee Schedule that determines the fees for medical services, including impairment evaluations.  Effective February 1, 2012, the current 138 authorized rating doctors may charge $693.31 for up to two body parts.  $231.54  is chargeable for each  additional body part.  For example, an injured worker with an injury to his neck, his low back, and to his left shoulder has  three injured body parts. A rating exam of all three injured body parts would cost $924.85.

An injured worker has the right to obtain a second rating if he disagrees with the percentage determined by the initial rating doctor.  However ,the cost of a second rating must be paid up front by the injured worker.  Whether it makes sense economically to pay for a second rating, or whether a less costly rating review based only on the medical records  is a better tactical move is a decision for experienced legal counsel.  Sometimes it is possible to convince a hearing officer to order the insurer to pay for a second rating exam without having a second rating evaluation.   An injured worker, or her attorney, must be very knowledgeable about how percentages are determined under the AMA Guides before paying for a second rating.  This office will review a rating report for free to help injured workers determine whether to accept the PPD offered, or to contest the percentage.

Be Careful What You Read

The problem with the Internet articles I see on many sites that look like they provide good information for injured workers is that the content is not specific to Nevada workers' compensation law.  Each state has its own laws that determine work comp benefits. If information is not specific to Nevada law, then injured workers in Nevada will be misinformed.  Injured workers may think that they are getting state-specific information just because they click on a particular state.  However, despite the professional appearance of these websites, they rarely provide timely information on Nevada laws and claims practices.  

When you are surfing the web,  check whether the article or blog post is authored by a Nevada lawyer.  Many companies that market search engine optimization for law firms sell  canned articles that lawyers can post as their own on their websites, blogs, or twitter accounts.  The ethics of an attorney doing this is questioned by Kevin O'Keefe, founder of the Lexblog company that provides a publishing platform for my law blog.  Lexblog  has never tried to sell me blog posts written by their company marketing agents. What Internet marketing agent  is going to know more about Nevada workers' compensation law than I do?  Be careful that what you are reading on the Internet is from a reputable Nevada attorney .

5 Huge Mistakes Injured Workers Make

1. Going along with bad medical care

You don't have to accept substandard medical care just because you were injured at work. It is hard to correct a botched surgery.  If you feel reluctant or have a gut feeling that the surgeon the insurer has assigned to you isn't very good or isn't listening to you, change doctors.  You have the absolute right within the first 90 days of your claim to change to a different doctor on the insurer's provider list.  And even after the first 90 days, you may still request a different doctor.  Make your request for the provider list in writing, and make your request to change doctors in writing.

2. Getting unreliable information about the claims process 

Instead of relying on friends and co-workers to educate yourself about the Nevada claims process, why not read the blog posts I've written on almost every topic concerning Nevada  workers' compensation claims?  If you want to research the law yourself, in addition to reading the statutes (NRS 616 and 617), and the regulations (NAC 616-617), you must be familiar with Nevada Supreme Court decisions  interpreting the law.  You must also know about the actual practice of the hearings and appeals officers to have some idea of what appeals officers, the district court judges, and Nevada Supreme Court justices are likely to do in your case.    Take advantage of a free consultation with a reputable attorney.

3. Accepting a PPD award when  you want more medical treatment

Even if you don't elect to receive your permanent partial disability  (PPD) award in a lump sum, and the insurer is paying your PPD award  in  installments, you must appeal claim closure if  you want more medical treatment.  First ask the adjuster whether he or she will allow you to return to the last treating doctor for more treatment.  If not, then go to any rating exam the insurer schedules  so that your benefits aren't suspended.  Also, you must file an appeal.  You will have to get a report from your private physician to  show the hearings officer that you need treatment.  Don't wait, thinking that you can easily reopen your claim later.  It's hard to reopen claims.

4. Waiting to add other injured body parts

Remember that you can't reopen a claim to get treatment for an injured body part if it was never accepted before the claim was closed.   If your claim acceptance letter only references some of your injuries, notify the adjuster in writing.  Ask  the adjuster to at least allow your doctor to examine your other injuries before the adjuster outright denies these  injuries to other body parts. File an appeal on time (within 70 days) of any letter the adjuster sends denying injuries to other body parts. You may also need to go to your own doctor using your health insurance if other injured body parts are denied.

5. Not planning for your vocational future

Be realistic and honest with yourself and your doctor when discussing whether you are going to be able to return to your job at a later date.  If you know or think you might not be able to return to your usual occupation, try to find out now whether your employer is likely to offer you a permanent modified job or not.  If you or a family member is dependent on the  health insurance your employer provides, then you must start being creative and persistent now in persuading your employer to keep you despite any permanent physical work restrictions.  Your employer does not have to find you permanent light duty work.  Alternatively, start thinking about retraining programs and start visiting schools that have 9 to 18-month vocational programs. 

 

            

Neck Pain Update on Physical Therapy

I promised to give my honest assessment on whether the McKenzie Method used by the physical therapist I am seeing is helping me.  Today, back at work with many people needing to get back on track with their medical care and benefits on their claims after a long holiday weekend, my neck is stiffer than ever.  I have only been able to schedule physical therapy appointments once a week with the two holidays, so I should mention that. On most accepted Nevada workers' compensation claims, physical therapy is scheduled for three days a week, and that may make a huge difference.  (I do not have a workers' compensation claim.  My neck problems are related to age, hours spent in sub-optimal postures in front of a computer, reading late into the night in bed, a few rear-end fender benders over the years, and several significant horse-back riding injuries).

I'm finding that it is frustrating that I am forgetting to do the exercises I have been taught by the therapist at least five times a day.  The exercises probably take all of ten minutes to complete, so I don't have a good excuse for not remembering.  I think I will simply have to set the alarm on my phone today to make myself do them. Of course, it would be so much easier to take a pill of some sort and have the problem with decreased range of motion, stiffness and pain just disappear.  However, I cannot do that.  I want to remain clear mentally and crisp with my reaction time for my horse-back riding. 

I see that I reported that my range of motion was improved when I actually did the exercises, so I will resolve to make a better effort this week.  I did do a lot of horse-back riding the past five days.  The type of riding I do is strenuous- jumping and advanced English riding (dressage) on a young Thoroughbred who is emotionally the equivalent of a teenage boy.  I also had to survive a New Years Eve party at my house for my son's 22 birthday.  This last holiday wasn't exactly relaxing for me.   So, here's to trying to  take more personal responsibility for my own health in 2012.