What Out-of-Pocket Costs Can a Workers’ Comp Claimant Face?

Getting injured while on the job in Nevada entitles workers to insurance coverage under their insurers’ workers’ compensation program. Once a valid claim is started, the insurer will pay for a range of important expenses associated with the worker’s medical care. In some cases, though, an injured worker may need to pay some costs. Nevada’s workers’ compensation system provides a broad basket of benefits to covered workers:

• Medical bills for treatment that is reasonable, necessary, and authorized.
• Wage replacement (up to defined maximums).
• Mileage reimbursement for travel to and from doctors’ appointments.
• Vocational rehabilitation for workers who can no longer continue their prior profession.
• Benefits such as funeral expenses and special payments to heirs in the event that the worker dies as a result of work-related injuries.

All of these benefits are subject to important limitations. Each have caps limiting how much an insurer will pay. Each may also come with strings attached. For example, by accepting certain fringe benefits the worker may sign away his or her right to reopen a claim. On top of these limits, insurers work hard to find ways to limit their financial exposure for each claim. The potential for disputes with the insurer is perhaps the most important source of potential out-of-pocket costs for an employee. The “bargain” of the workers’ compensation system is that in exchange for obligatory, no-fault insurance coverage an employee cannot sue the employer except in rare cases of gross negligence or intentional injury. This limitation can put the employee in a difficult position if the insurer or employer doesn’t provide the kind of coverage that the worker is entitled to. As a consequence, injured workers may need to hire an independent attorney to assist them with their case.

An ethical attorney will examine a potential client’s case and provide an analysis of the kind of value the attorney can add to the client’s claim. By hiring an attorney the client may be able to greatly improve the outcome of the workers’ compensation process. Of course, once coverage limits are reached any further costs must be borne by the injured worker. One goal of a workers’ compensation attorney is to ensure that only relevant costs are allocated to a particular category under a policy, so coverage limits aren’t reached in an artificial manner. There are other, rarer kinds of out-of-pocket expenses that may be necessary to resolve disputes with insurers. A dispute may require payment of administrative fees to obtain hearings. There may be costs associated with elective medical exams that are necessary to refute a questionable diagnosis by an insurer-designated physician.

GGRM Law Firm has represented clients in workers’ compensation cases for over 50 years. For a free attorney consultation about your case call us at 702-384-1616 or through our contacts page.