The insurer has thirty (30) days to accept or deny a workers’ compensation (“WC”) claim filed by an injured worker. Once the injured worker’s claim has been accepted, what next? The insurer will send out the claim acceptance via certified mail, and the claim acceptance will state what body part is accepted under the claim. What body parts are covered is commonly referred to as the “scope” of the claim. However, if the body part is not included, then it is not part of the claim. This claim acceptance must be appealed by the injured worker within seventy (70) days in order to preserve the injured worker’s rights under the claim, as the claim acceptance or “scope” is rarely determined thirty (30) days after the accident and injury has occurred because the medical prognosis is going to be uncertain at that time.
For example, most spinal fusion surgeries that occur from a work injury generally start out diagnosed as a “lumbar strain” or “cervical strain” even though the scope expands as the claim progresses. However, if the injured worker does not appeal the original claim acceptance, the injured worker runs a significant risk of not being able to expand the scope of the claim, putting their current and future health at risk. This is one of the most litigated areas in WC claims, and also one of the most important.
However, what body parts should be accepted and to what extent is not always easy to determine early on in the claim. Symptoms can also manifest later on in the claim. When do body parts and symptoms need to come to fruition to be included under the claim? In Nevada, symptoms do not have to be instantaneous, but must manifest themselves within a reasonable time. American International Vacations v. MacBride, 99 Nev. 324, 661 P.2d 1301 (1983).
As discussed above, this is one of the most litigated areas in WC claims. Injured workers should seek an experienced Attorney regarding their claim acceptance and all other applicable benefits. The experienced Attorney will not only be able to give guidance on this process, but also all other laws associated with work injuries.