Nevada law requires third-party administrators and self-insurers of workers’ compensation claims to send accepted claimants a notice of their right to choose a different doctor from the appropriate provider list. Not all TPA’s and insurers are sending this notice. If they do send it, most injured workers don’t read or understand how important it is to choose a different doctor before their claim is closed.
I have been seeing too many claims where adjusters are trying to deprive injured workers of their right to change doctors by having a doctor close the claim within the first 90 days of the claim. What usually happens is that the injured worker is first directed to go to Concentra for initial medical care and to complete the C-4 Claim for Compensation form. If the injury persists after 45-60 days, the adjuster sends the injured worker a letter transferring their care to a doctor the adjuster chooses. These doctors are usually physiatrists- physical medicine specialists who treat occupational injuries by prescribing therapy and medication, or by giving injections. If the injury is very serious, these doctors can request a consultation exam by a surgeon. These doctors have agreed with insurers to treat at rates below the Nevada fee schedule in exchange for a volume of business. Their relationships with adjusters, and self-insurers are important to their businesses. If an adjuster doesn’t like it that the doctor is taking patients off work too much or is finding that claimants should be rated for impairment, the doctor is quickly removed from the provider list and loses business.
Injured workers have the right to change doctors within the first 90 days of the claim. The injured worker must attend whatever consultation exams the insurer schedules, but within the first 90 days, the worker can refuse treatment with the doctor chosen by the adjuster and ask for a different doctor. The catch is that the alternate doctor must be another doctor on the insurer’s provider list. The worker must also know to request a copy of the provider list.
The injured worker should immediately request a copy of the provider list, and should try to get as much information as possible about the doctors on this list before choosing another one. There is usually at leasat one doctor with some integrity and a sense of loyalty to the patient on these stacked provider lists.
If you feel that the doctor your adjuster has chosen for you is not listening to you, request a change of doctors in writing immediately. Doctors are legally and morally obligated to do what is medically right for their patients. However, some doctors tell their patients that the law does not allow them to keep the patient off work. That is not a correct statement of the law. The laws do not prohibit doctors from taking injured workers off work completely if the doctor thinks the patient should not be working. These same doctors also might not ask for necessary diagnostic tests or treatment if the adjuster or employer tell the doctor that the request will be denied. The patient then never has an opportunity to appeal a denial because the doctor didn’t actually send a written request.
Some adjusters try to deny injured workers of their right to choose a different doctor by funneling claims to particular physiatrists who report within the first 90 days of the claim that no further care is necessary. The doctor states that the patient can return to work full duty without a rating evaluation, and the adjusterthen closes the claim within the first 90 days of the claim. Can the adjuster deprive the claimant of her right to choose a different doctor by closing the claim before 90 days is up? At least two hearings officers have ruled in favor of my clients in these situations, and have allowed the injured worker to have a consultation with a different doctor before their claim was closed.