Lifetime rights to reopen a Nevada workers’ compensation claim are available to injured workers who had a claim expenditure of more than $800, are off work due to injury or occupational disease for more than 5 days, or who receive a permanent partial disability award.
Reopening a Workers Comp Claim
After a workers’ compensation claim is closed, Nevada laws place restrictions on lifetime reopening the claim unless the injured worker was off incapacitated from earning full wages for 5 or more days or on permanent partial disability. For all other injured workers, a workers compensation claim must be reopened within one year after the claim was closed. If medical costs paid before the claim was closed are less than $800, the claim cannot be reopened.
Under certain conditions, a claimant may request that an insurer reopen a workers compensation claim after it is closed. If the claimant’s work injury or occupational disease changes or worsens, or additional medical treatment or vocational rehabilitation is necessary, the claimant can request a claim reopening. However, the insurer will require a written doctor’s report that validates the following:
- The claimant’s injury or occupational disease has changed or worsened
- The claimant requires additional medical treatment
- The claimant requires vocational rehabilitation
- A description of additional treatments needed
- A direct relationship between the worsened condition and the original injury or disease
- The work injury or disease is the primary reason to reopen the claim
Once the doctor’s report is completed, it should be mailed to the insurance adjuster by the claimant or the claimant’s workers compensation attorney. The insurer has 30 days to respond to the request. If the doctor’s report recommends surgery, the insurer will likely request a second medical exam and opinion before authorization. If surgery is approved, the insurer will likely require the claimant to use a surgeon on their preferred provider list.
If an injured worker proceeds with medical treatment or surgery using his/her own health insurance before authorization is given, the insurer is not obligated to reimburse any co-pays or deductibles without proof of a medical emergency. The worker will be required to submit proof of all restricted or off-work time to obtain workers compensation benefits. The insurer will not pay benefits prior to the date of the claim reopening request. If a request to reopen a workers compensation claim is denied, the claimant can file an appeal. If the appeal is lost, the claimant must wait at least one year before requesting another claim reopening.