Steps to Reopening Your Workers’ Compensation Claim
By: Kevin Kampschror, Esq.
Step 1: Are you eligible?
Nevada has lifetime reopening rights if you either 1) are off work due to the injury; or 2) received a permanent partial disability (“PPD”). Generally, you must wait one year before reopening if you have received a PPD. See NRS 616C.390. If you were not off work or did not receive a PPD, you must reopen your case within one year. Id. If your work injury was minor and you accrued medical expenses less than $300, you may not reopen your claim. Id.
Step 2: If you are eligible, obtain a doctor’s report.
You will need to obtain a report from a doctor indicating that your original workplace injury has now gotten worse and requires more care. Get this on your own at your own expense (this can typically be reimbursed if the claim is reopened).
Step 3: What should the report say?
It is very important that the report specifically states the new recommended treatment is 100% due to the work injury and not due to anything else such as pre-existing conditions. Keep in mind many claims for reopening are denied because the medical report does not state that the recommended treatment is 100% connected to the original workplace injury.
Step 4: Send the report into the insurance company, or have your attorney send in for you.
Once you have the report and it fulfills the legal requirements of NRS 616C.390, attach the report to a letter to the insurer requesting reopening. Also, it is a good idea to put the original claim number on the letter you send. If you hire an attorney, which is highly recommended, your attorney will take care of all of this for you.
Step 5: Was your request approved or denied?
If your request was approved, the insurer will reopen your claim. If not, you will need to file a notice of hearing and begin to litigate the case in court. See NRS 616C.315. This happens all too frequently.
There are some common scenarios that are typically denied. For example, things such as pain are generally not enough to reopen claims. However, a new surgery is. Claims are also denied if a doctor says you have increased pain and recommends an MRI. You would likely have to obtain the MRI on your own prior to requesting reopening. You also do not want to reopen your case until you have the applicable imaging and medical reporting. The reason is if your reopening request is denied and you do not win on appeal, you will have to wait another year to attempt again. Lastly, reopening does not happen overnight and it can take time, especially if you have to go to court to fight the insurance company.
This is not an area of law you should tackle yourself, nor is any part of workers’ compensation. Therefore, it is advised you seek an experienced attorney who is able to assist in obtaining all benefits that you are entitled to under Nevada law.