Out-of-State Medical Care for Nevada Injured Workers

 Nevada has a highly transient population, with people moving in and out of the state frequently, particularly in this volatile economy.  I remember the days when they used to publish the Las Vegas phone book twice a year. (Now no one uses a phone book; we use our smart  phones.)  

When an injured worker with an accepted Nevada claim moves out of Nevada while still needing medical care, he or she must do the following:

1. Before the move, find the name of  a reputable doctor you want to treat you.  Do some homework and ask people in your new hometown.  You may also ask your adjuster on your Nevada claim whether a nurse case manager she knows can ask for names, as they sometimes belong to a network of nurse case managers nationally.  

2. Send this link to the doctor and ask the doctor whether they will ask as payment what the Nevada fee schedule provides.

3. Once the doctor responds that she will accept the Nevada fee schedule of payments, request in writing to the adjuster that she authorize the change of doctors.  All of this takes time, which is why you need to start this process about a month before you move. 

4. Print out and take a copy of the Physician Progress Report you will have the doctor fill out after every doctor visit (that must occur monthly at a minimum).  This form will be necessary in order for you to receive benefits if your doctor takes you off work.  (If the doctor gives you work restrictions, whether you get benefits will depend on whether or not your employer at the time of the accident has light duty work available.  If not, you get benefits.  If the employer does have light duty, you don't get benefits simply because you moved and can't report for light duty work.)

5. If the doctor checks the box that you have a likely ratable impairment at your last doctor's visit, the insurer will pay for you to return to Nevada for a permanent partial disability evaluation (also known as a rating.) 

--Written by Virginia Hunt, Hunt Law Office

How to Get Medical Care in Another State on Your Nevada Claim

If you reside in another state and were injured while working temporarily in Nevada, and you have a a Nevada claim, you may want to move back home to have family and friends around to help you while you still need medical care.  While it can be more difficult to obtain medical treatment and benefits when you are in another state, with some careful planning, it can be done.  Either you, or your attorney, should do the following :

1. Notify your adjuster in writing of your new address and phone number.

2. Before you move, find a doctor who is willing to treat you and who will accept what the Nevada fee schedule provides for payment for medical services.  Provide this link to the doctor so that the doctor's office has the Nevada fee schedule.

3. Request authorization from the adjuster for out-of-state care with the doctor you have chosen to treat you, and tell the adjuster that the doctor will accept the Nevada fee schedule.  Occasionally, the adjuster will have a network of doctors in other states, and you will have to choose a treating physician from that network.  While prior authorization is necessary under the regulations, it cannot be arbitrarily denied by the adjuster.

4. Have the doctor complete the same  physician progress report form the Nevada doctors use to let the adjuster know whether you have work restrictions or should be off work completely.  Be aware that if your employer had temporary light duty work available for you when you moved from Nevada, you will not be entitled to compensation benefits unless your doctor takes you off work completely.

5. If your doctor states that you may  have a permanent impairment when you are released from care,  the adjuster should pay you to return to Nevada to have a rating evaluation.  The adjuster should schedule the rating appointment  within 30 days of receiving your doctor's last report.

6.  If you run into problems and must file appeals on adverse letters from the adjuster, call the hearings division and request that you be allowed to participate in the hearing by telephone if you do not have an attorney representing you.

Managing out-of-state claims does take more planning and often  more effort with doctors who are not familiar with Nevada's workers compensation system.  However, out-of-state care may be very important to you if you are seriously injured and want to go home for care.  You do need to be aware that while medical care should not be comprised with your move back home, your entitlement to other benefits may be affected.