I WANT A DIFFERENT DOCTOR

The Nevada legislature decides what rights you have as an injured worker to choose who your treating doctor will be. In 1993, state legislators began limiting your right to choose your own doctor. Recently, the Nevada Supreme Court agreed that insurance companies can control which doctors treat injured workers. Insurance companies are allowed to have lists of doctors from which you must choose a treating doctor, provided you ask to change doctors at the right time.

 

Provider Lists

 

Each TPA (third-party administrator) has its own provider list with the names of all their approved doctors. These lists change often. Only in rare cases will the adjuster agree to have a doctor who is not on that TPA's provider list consult on your case or treat you. You can get a copy of your TPA's provider list by sending a written request to your adjuster. Keep a copy of your request so that you can prove you sent it. The adjuster must send you a list within 3 working days of receiving your written request.

 

When To Ask For A Different Doctor

 

If you are not satisfied with the doctor who is treating you, don't delay in asking your adjuster for a different doctor. Most injured workers know when they are seriously injured and will need more than what the initial clinic provides for treatment. If you ask for a different doctor on your TPA's provider list within the first 90 days of filing your claim, your adjuster must authorize it. If you ask to change doctors after your claim has been open for more than 90 days, the adjuster may, or may not, authorize the change. If you wait until the doctor who has been treating you releases you from all medical care, then expect your adjuster to deny your request even if you make it within the first 90 days of your claim.

 

An adjuster won't authorize a different doctor right after you file a claim if the adjuster hasn't decided to accept your claim yet. Remember that the adjuster has 30 days to accept or deny your claim. However, if you have a serious injury, you should request a copy of the provider list right away, and be informed about what doctor you want to treat you.

 

Most surgeons will not agree to take over your care in the first weeks following your surgery. You need to be very careful in selecting which doctor on your insurer's provider list you want to perform any surgery. Even if you have the right to change doctors, you might not be able to get another doctor to take over your care. Many surgeons who are asked to give a second opinion want to look at your medical records before agreeing to see you, and that takes time.

 

An attorney knowledgeable about the reputations of local physicians can be a great help in deciding which doctor should treat you for your particular injury. Your doctor not only treats you, but is also responsible for giving you any work restrictions. Your doctor also tells the adjuster at the end of your case whether you should have a rating evaluation to decide whether or not you get a settlement. If you dislike your treating physician, you have a serious injury, and your adjuster will not let you change to another doctor on the provider list, you will probably need the help of an attorney.

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