Frequently Asked Questions: Workers’ Comp Benefits
How are benefits calculated?
You will be paid benefits equal to two-thirds of your average monthly wage. In most cases, your wages from the last 12 weeks before you were injured will be used to calculate your benefits. When the last 12 weeks do not accurately represent your normal wages, payment amounts from the last 12 months may be used instead.
When can I expect to get my workers’ compensation benefits?
If your claim is approved, your employer’s insurer or claims administrator has 30 days from the day they were notified about the accident or illness to begin making payment.
Can I qualify for workers’ comp if I was partly at fault for my injuries?
In most cases, yes. Under Nevada Workers’ Compensation law, fault is not typically considered when processing a claim for compensation for work-related injuries. If your intentional harm to yourself caused your injuries, however, or you were impaired by alcohol or drugs when the accident happened, you could be prevented from recovering workers’ comp benefits. Give us a call, we’ll help you determine whether you have a viable claim.
Are you required to accept light duty work?
If your employer offers you light duty work that accommodates your work restrictions, you are obligated to accept it or risk going without pay. If you are unable to perform the light duty work that is offered or the work aggravates your symptoms, be sure to speak with your doctor right away to see if changes to your restrictions can be made. Don’t just stop showing up for work.
How much vocational training am I entitled to?
The amount and type of vocational training you are entitled to will depend on the severity of your injuries, your education, previous training, and marketable skills, and your job interests. Most vocational rehabilitation plans last between six and eighteen months. Some people are able to get extensions for up to thirty months, however.
What is Average Monthly Wage?
Your average monthly wage is calculated by considering the wages you’ve earned over the last 12 weeks prior to your injury. In some cases, the last 12 months wages are used instead. Your actual wages, tips, commissions, incentive pay, meals, sick leave, vacation pay, applicable room and board pay, and pay for piecework are all included when calculating your average monthly pay.
Will my immigration status affect my workers’ compensation benefits?
According to Nevada Law
, every person who is in service to an employer is covered by workers’ compensation insurance and therefore entitled to benefits if injured on the job. Whether the worker is lawfully or unlawfully employed is irrelevant. Undocumented workers, however, will not be eligible for vocational training.
What is a vocational rehabilitation counselor?
A vocational rehabilitation
counselor is appointed when your work restrictions are determined to be permanent and your current job or job skills do not allow for accommodations. The counselor will evaluate your skills and abilities, consider your career interests, and help you create a plan to obtain the training you need to get back to work.
Am I entitled to workers’ compensation benefits if I’m self-employed?
Self-employed workers in Nevada may be entitled to workers’ compensation benefits in some circumstances. Because the laws that apply to the classification of workers is extremely complicated, you may have been misclassified as an individual contractor by your employer, in which case you would be covered under the employer’s policy. Additionally, your own workers’ compensation policy may provide coverage for your work-related injuries.
What happens if my employer doesn’t carry workers’ compensation insurance?
If you suspect that your employer does not carry workers’ comp insurance, you should seek medical treatment for your injuries anyway and be sure to submit a C-4 form. Tell the medical staff that you are unsure whether your employer has insurance. The WCS will investigate and you will be notified if no workers’ comp insurance exists. If there is truly no insurance, you have two options.
1. You can file a claim with the Nevada Division of Industrial Relations.
2. You can elect to deal directly with your employer to recover money for medical bills and lost wages.
Frequently Asked Questions: Workers’ Comp Appeals
Who judges my or my employer’s appeal of the insurance company’s determination?
If you or your employer choose to appeal the insurer’s decision
, the Department of Administration, Hearings Division (Hearings Officer or Appeals Officer depending on the level of appeal) will judge the appeal. If you disagree with the insurance company, you’ll need to file a Request for Hearing a Contested Claim within 70 days of the decision. After receiving your request, the Hearings Officer will review your case and make a decision. If you disagree with the Hearing Officer’s decision, you must then file an appeal with the Appeals Officer within 30 days of receiving the decision. The Appeals Officer will reverse, remand, or uphold the decision.
When should I file an appeal?
There are numerous times throughout the processing of your claim in which you may need to file an appeal. You can appeal when you receive the initial denial letter, an inaccurate acceptance letter, an incorrect or inaccurate average monthly wage letter, any notice denying, suspending, or terminating your claim, a premature closing of the claim letter, an unacceptable PPD Award letter, a denial of vocational rehabilitation letter, or other notices and decisions as determined by your case.
Do I need an attorney to file an appeal?
While the law does not require that you hire an attorney to file an appeal, doing so is highly recommended.
Frequently Asked Questions: Medical Treatment
Can I see my own doctor?
No. For injuries that are not a medical emergency, you must seek treatment from an authorized medical provider. The provider must be a member of the Panel of Treating Physicians and Chiropractors
. To determine the correct medical provider, ask your employer for their MCO, HMO, or preferred provider list. Additionally, the Form D-1, Brief Description of Your Rights and Benefits poster should be located in a common area such as your employee break room. If you are seriously injured, however, or your injuries are life-threatening, you should go to the nearest emergency room for medical care.
Can I get treatment if I’m in another state?
If you are approved for workers comp benefits in Nevada and you need to seek medical treatment out of state, your medical care may be transferable if certain requirements are met. Your out of state provider must either be on an approved provider list with another state or agree to the Nevada fee schedule. The appropriate progress reports and pre-authorization for medical services must be sent by your new medical provider.
How can I get approved for medical treatment faster?
To receive approval for medical care faster, first make sure the process has not been slowed down by miscommunication or scheduling delays. Make sure your doctor has authorized any additional procedures, that requests for recommended testing, therapy, or treatments with a specialist have been made by your doctor, and that the adjuster received the request. The adjuster has five days to review and approve or deny requests for medical treatment under Nevada law. Sometimes the adjuster may need to be nudged along. If you or your attorney has contacted the adjuster with proof that five days have passed since the request was made and you still do not receive an appropriate response, you may need to file a complaint with the Nevada Division of Industrial Relations (DIR).
How does a Functional Capacity Evaluation work?
Your FCE should take about 2-3 hours at a physical therapist’s office selected by the adjuster. The exam is used to help determine whether you should have permanent work restrictions. It is designed to measure your physical abilities by having you perform certain activities that simulate on-the-job work. Your strength, endurance, physical demand work level, and positional tolerance will be evaluated. You may be asked to bend, twist, reach, lift, climb stairs and perform other activities to demonstrate your abilities. While your treating physician has the final authority when deciding whether to return you to work at full capacity, with restriction, or not at all, the FCE carries a lot of weight.
What if I don’t know when my injury happened?
If you aren’t sure when your injury happened or when you obtained an occupational illness, it may be difficult to prove that your injuries are work-related. For workers’ comp coverage to be provided, you must be able to report the date, time, place, and cause of your injuries.
Frequently Asked Questions: Employer/Employee Relationship
Should I provide my employer notice that I was injured on the job?
Under Nevada Law, you are required to report your injury “as soon as practicable, but within 7 days after the accident”. The longer you wait to notify your employer that you were hurt, the more likely that they will try to deny your claim.
Can my employer fire me for filing a workers’ compensation claim?
No. The Nevada Supreme Court asserts that an employee may not be fired simply for filing a workers’ compensation claim. If your employer terminates your employment because you filed a claim, you may have the right to sue your employer. The burden of proof, however, lies on you and you must prove that you were not terminated for any other reason.
If my employer changes insurance companies, what happens to my claims and benefits?
If your injury occurred before your employer changed coverage to a different insurer, your claim will stay with the original insurance provider. Your benefits will remain the same as they would have been had your employer not changed insurers. If your date of injury took place after your employer changed insurance companies, your claim will be handled by the new insurer.
Are all workers’ compensation insurance companies required to offer the same benefits?
Yes. In Nevada, all benefit types and calculations are the same regardless of the workers’ compensation company.
Frequently Asked Questions: Firefighters and Police
Are there separate laws for firefighters and police injured on the job?
How does the workers’ compensation system differ for firefighters and police officers?
Firefighters and police have a lower burden of proof for certain health conditions that are caused by their work. Nevada law provides for a conclusive presumption that heart or lung disease and hepatitis are occupationally related under certain circumstances. When conclusive presumption applies, your employer cannot try to prove that the condition arose out of something other than occupational activity. Additionally, certain contagious diseases are treated differently under the special laws that apply to firefighters and police officers.