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Health Care Choice and Workers’ Comp

Healthcare Choice and Workers’ Comp

People who are injured on the job can feel forced to work with health care providers that the insurance administrator dictates. Too often claims adjusters choose doctors more for their insurer-friendly track record rather than their concern for patient welfare. Injured workers should know that the law gives injured workers a choice of doctors, but exercising that right requires the patient to follow certain steps.

Nevada’s industrial insurance law specifies the procedures for selecting a physician to evaluate and treat a worker’s injuries. The Nevada Division of Industrial Relations maintains a list of physicians it has qualified to treat workplace injuries. Insurers keep their own lists of physicians, whom they choose from among the DIR-approved list. After an injured worker submits a claim for benefits, the insurer can request the employee undergo an independent medical examination, or IME, with a doctor from the insurer’s list. The patient has the right to select the doctor who performs the IME from the insurer’s approved list, without first getting insurer approval. However, this exam is not optional, and failure to attend can be grounds for denying a claim.

If the injured worker isn’t satisfied with the doctor who performed the IME, NRS 616C.090 provides that he or she has the right to choose a second doctor from the insurer’s approved list. Although insurers and physicians are required to notify employees of this right, many don’t. The choice must be made within the first 90 days of the claim. A request for a change of doctor after the 90-day window becomes subject to insurer approval.

Even though there are limits on which doctor a patient can choose, making a choice is a vital part of protecting an injured worker’s rights. Insurers are in the business of finding ways to deny claims. Their incentive is to choose doctors who will diagnose conditions and recommend treatments that impose the least cost upon insurers. The doctors similarly have a strong financial incentive to keep their patient volumes high by making the “right” choices for insurers. In this system it’s essential for injured workers to actively seek out caregivers who will put the worker’s health ahead of profit.

In circumstances where the deck seems to be stacked against an injured worker, an experienced workers’ compensation attorney can make a big difference. For over 45 years the law firm of Greenman Goldberg Raby Martinez has represented injured workers in the Las Vegas area. If you have been injured at work and have questions about your right to choose a doctor, our attorneys can help. To speak to an attorney at no cost, please give us a call today at 702-388-4476. We can also be reached through our contacts page.