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Can the Adjuster Communicate with your Doctor Behind your Back?

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By: Kevin Kampschror, Esq.

NRS 616D.330(1)(b) states that “An insurer, an employer, an organization for managed care, a third-party administrator, or the representative of any of those persons, the Nevada Attorney for Injured Workers or an attorney or other compensated representative of an injured employee shall not initiate . . . Any written communication relating to the medical disposition of the claim with the injured employee’s examining or treating physician or chiropractor unless a copy of the communication is submitted to the injured employee or the injured employee’s representative in a timely manner.”

In other words, the adjuster is not allowed to communicate with the physician without copying you and/or your attorney. This generally comes up in two different areas: 1) annotated letters, and 2) communication with the doctor (usually phone conversations). If the adjuster wants the physician to answer questions about diagnosis, what body parts should be accepted and to what extent, the adjuster may write the physician an annotated letter with these questions. You and/or your attorney must be copied on this, or it appears as though the adjuster is attempting to steer the physician’s opinion that is favorable to them. Additionally, the questions can be extremely suggestive and leading, which is even more of a reason you and/or your attorney need to be copied on it. Next, if the adjuster calls the physician’s office and asks questions or gets updates, the adjuster is required to keep a communication log. This is required by law under NRS 616D.330. These communication logs should be requested because you will want to see what conversations, if any, are happening between the adjuster and your physician. An experienced attorney can help you requesting this information and how to go about it.

There are consequences for violating NRS 616D.330. If an adjuster is communicating with a physician behind your back there are remedies you can seek. Attempting to steer the physician’s medical opinion is very serious and can have significant consequences to you and your health. It does occur, although surely not in every case, but this is another reason to hire an attorney who is experienced in the area of workers’ compensation. If you are represented, the adjuster likely will be less prone to do things behind your back.

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