HELP! THEY'RE CLOSING MY CLAIM

There Are 3 Possible Scenarios Involving Claim Closure:

 

1. Claims with medical expenses under $300

 

The insurer sends a written notice at the beginning of a claim regarding claim closure procedures, and sends another notice during the first 12 months after a claim is opened, that it is closing the claim. If the medical expenses paid by the insurer are less than $300, and if the injured worker does not file an appeal from this claim closure notice, then the claim closes, and it can never be reopened for more medical care.

 

2. Claims closed without a rating evaluation

 

Insurers are required to send a Notice of Intention to Close Claim, along with a form to file an appeal when the insurer decides not to pay for more medical care, or is not paying for more compensation benefits. If an injured worker believes that he does need more medical treatment, or is entitled to more compensation benefits for being off work, then the injured worker must file a timely appeal within 70 days. In order to have any chance of winning an appeal, the injured worker should go to another doctor, and get a report that says more medical care is needed. An injured worker rarely convinces a hearings or appeals officer that a claim should remain open for more medical care based only on the injured worker's testimony. If the injured worker does not also have a medical report that refutes the report of the treating doctor who releases the injured worker from care, then the hearings or appeals officer will almost always affirm claim closure.

 

If the injured worker agrees that no additional medical treatment will improve his condition, but thinks that he should be rated for permanent impairment, the injured worker must file an appeal of the Notice of Intention to Close Claim, and follow the procedures to obtain a rating evaluation to give to the hearings officer.
Please read the article on "The Insurer Refuses to Give Me a Rating".

 

3. Claims closed with a scheduled rating evaluation

 

When a treating doctor writes that no additional medical is necessary, but that the injured worker may have a permanent impairment, instead of sending a Notice of Intention to Close Claim, the insurer sends a different letter that schedules the rating evaluation. In that scheduling letter, the insurer will state that the claim is closed for any additional benefits, except vocational rehabilitation benefits, if applicable. This letter is often confusing and does not tell injured workers that if they think they need more medical care or medication, they must go to their own private doctor now. The injured worker should file an appeal of this letter if he or she wants more medical care now, and should immediately go to a private doctor to get a report that says more medical care is necessary. The injured worker should also attend the scheduled rating evaluation even if he has appealed claim closure, because the assigned rating doctor may agree that the injured worker needs more medical care before the claim is closed.

 

NRS 616C.235, 616C.305.

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