Certain job categories entitle you to preventive
treatment for exposure to certain diseases.
(Changes Jan. 1,2000)
When your issue is...
(Whether you are entitled to compensation for
lost time from work; what amount.)
Your authorized treating doctor said you could
not work.
A consulting doctor said you can go back to work but
you can't physically handle the job.
You were out of work for at least 5 days after your
injury or within 20 consecutive days.
Compensation is based upon how much you earned the 12
weeks before your injury, or 1-year pre-injury if that is
more representative and you asked for the 1-year basis.
If you worked more than one job, you want all income
added together to calculate average monthly wage, and you
ask for the combination basis.
The insurer is not paying you 66 2/3 percent of your
average monthly wage.
You elected to declare tips for income tax and workers'
compensation, but your tips were not added into your
average monthly wage base.
Your employer has not offered you a job modified to fit
the restrictions set by a physician or chiropractor.
(Amount changes Jan. 1, 2000)
(No Temporary Total Disability is paid to you or your
dependents for or during time you are incarcerated)
| If you need benefits due to a condition your job
partially caused, coverage depends upon meeting
the requirement: primary (51%) causation changes
to substantial contributing (meaningful amount)
causation on Jan. 1 2000. |
When your issue is...
(Whether you are entitled to an award; what
amount.)
You have a permanent impairment which was caused by the
work injury.
You have been rated by a doctor but the rating does not
take into account all your physical impairments.
Disability is rated according to the AMA Guides to
the Evaluation of Permanent Impairment, depending upon
diagnosis and severity of injury. (Pain does not qualify
you for Permanent Partial Disability.)
Your disability rating, your average monthly wage, and
your age are used in calculating your award; if one
element is incorrect then your award could be incorrect.
The procedures for rating a Permanent Partial
Disability are the same whether it is a new claim or a
reopening. Ratings must be done by a doctor on the Nevada
rotating rating panel set by the Division of Industrial
Relations (DIR).
The injured worker may ask for another rater. DIR will
then give the name of the next rater on the rotating list.
The injured worker pays for the comparison rating. May
get some money back after Jan. 1, 2000)
There may be no double payments for any time period
whether the payment is for Temporary Total Disability or
Permanent Partial Disability, Temporary Partial Disability
or Permanent Total Disability or Rehabilitation
Maintenance. Taking a lump sum may cause reduction in
another later.
- Permanent Partial Disability is paid only for work
injury impairment.
- If you wish to appeal the percentage of disability,
do not take a lump sum settlement.
When your issue is...
(Whether you need more treatment after your claim
is closed.)
Your job related medical condition is changed since
your claim was closed and you need treatment, or
vocational rehabilitation.
You ask in writing for reopening and make sure your
doctor's letter t o reopen gets to the insurer. (Keep
copies.)
Your doctor must write:
(1) your condition has changed since claim closure;
(2) you need treatment;
(3) a description of the treatment;
(4) there is a direct relationship between your
condition at the time you ask for reopening and your
original injury;
(5) your work injury is the primary cause for your
need to reopen.
(6) You can or cannot work during a specified time
period.
If you retired or voluntarily left the workforce for
reasons unrelated to your injury before filing for
reopening, you are entitled only to medical benefits.
From the date your claim is closed or your reopening
request is denied, you cannot make another request for a
year, absent unusual circumstances.
If you originally had no lost time and no Permanent
Partial Disability, you must request reopening within
one year of claim closure.
If your claim was closed because you had no treatment
for 12 months or if your treatment cost less than $500.00,
you cannot reopen. (This changes to $300
effective Jan. 1 2000.)
When your issue is...
(Whether you are entitled to
rehabilitation services; which services.)
A doctor says you have physical restrictions that
prevent you from returning to your pre-injury job or the
job you were retrained to do.
Your employer at the time you were injured has not
offered a job within your restrictions.
You are unable to return to work at 80 percent of your
wage at the time of injury.
You can't find a job on your own within your physical
restrictions in your locale. (Your marketable skills are
considered.)
You have skills which can be developed in a short time
to the point you can get a job within your restrictions.
The length and type of program depends upon the percentage
of your permanent impairment.(Length of
time changes Jan. 1, 2000.)
You may be eligible for a second program if your first
program did not work.
Lump Sum Buyout
If you take a buyout you will not be entitled to
rehabilitative services again on the same claim, no matter
how much worse you become or how many times you reopen.
You cannot appeal failure to offer a lump sum or the
amount of the sum offered.
If you live out-of-state a buyout is your
rehabilitation benefit; other benefits exist in-state. (After
Jan. 1, 2000 injured workers who were injured while
temporarily working in Nevada, or who live within 50 miles
outside the state may be eligible for vocational
rehabilitation.)
- NAIW may advise you but not represent you during
buyout consideration, unless NAIW was previously
appointed to your rehabilitation case.
Attend the hearing and bring your evidence.
Tell the parts of your story which explain each point
of each of your issues.
Present your evidence:
(1) documents;
(2) witness testimony;
(3) your own testimony;
on every point to prove each issue.
You may get a subpoena from the Hearing Office if
needed to get a necessary witness.
Witnesses may be sworn to tell the truth.
Ask questions of the other side's witnesses to add to
your own case.
Do not fight with the Hearing Officer or the other
side; present your evidence and state your case as calmly
and fully as you can.
This is your time to try to convince the Hearing
Officer you are entitled to the benefits you seek; your
witnesses and documents must be presented at this hearing.
THE NEXT STEP
If you are aggrieved at the Hearing Officer level (you
lost):
Appeal to the Appeals Officer if you still believe you
are entitled to a benefit.
To appeal, you must complete an appeal form (Notice of
Appeal and Request for Hearing Before the Appeals Officer)
and file it within 30 days
from the date of the Hearing Officer or Managed Care
Organization decision against you.
NRS 616A.455 gives any injured worker the right to
request the free service of an NAIW attorney at hearings
before the Appeals Officer. NAIW has discretion to
represent injured workers at the District Court, Supreme
Court, or for DIR compliance order.
NAIW may be appointed to represent you by an Appeals
Officer. Until an Appeals Officer appoints NAIW, an NAIW
attorney does not represent you for free legal services.
The Nevada Attorney for Injured Workers is a separate
agency of state government in order to represent injured
workers without conflict.
