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Reopening Your Claim
In order to reopen your claim, you need
to submit a written request to the insurer or self-insured
employer asking that your claim be reopened for medical
treatment. It is best to include your name, social security
number, date of injury, employer at the time of injury, and
your current address and phone number. If you can include the
number of the claim to be reopened, that will help expedite
the process.
A claim may be reopened if it meets certain
requirements. It is your burden to provide the necessary
medical evidence which justifies having the claim reopened for
further treatment. So, to show that your claim should be
reopened, you must provide medical evidence showing that: 1)
the primary cause of the change in your condition is the
original injury; 2) your condition has changed since your
claim was closed as shown by objective medical evidence; and
3) you need further treatment to help improve your condition.
Therefore, you should enclose, with your request, a
statement from your doctor containing the following
information:
a. What your current symptoms are, and how they relate to
your original industrial injury.
b. How your condition has changed or worsened as shown
through objective medical evidence by your doctor's letter.
c. A statement as to a proposed treatment plan the doctor
thinks is necessary to help your condition improve.
d. Whether you can perform the job duties of your injury
job or the most recent job you were rehabilitated to do.
You must pay the cost of the original medical examination
to substantiate the reopening of your claim. If the claim is
accepted, you may be reimbursed for the medical exam.
You should receive a response within thirty days from the
date your request and the doctor's report are received. These
documents are reviewed by the insurer. You will be notified in
writing after a determination is made as to whether your
application for reopening is approved or disapproved.
If the reopening is approved, your claim will be opened
retroactive to the date your application for reopening was
received. However, you may be allowed the cost of emergency
treatment, prior to your application date, if there is
sufficient evidence to substantiate that the treatment was
necessary and done on an emergency basis. Otherwise, costs of
treatment between claim closure and reopening are not
reimbursed, not paid.
You and your employer will be notified of the right to
appeal the decision regarding the approval or disapproval of
your reopening request. If your reopening request is denied,
you should immediately appeal that determination to the
hearing officer. (You are given 70 days, however do not wait
until the last few days to appeal). The office of the Nevada
Attorney for Injured Workers (NAIW) does not represent at the
hearing office level, but we do answer questions about your
hearing. You may hire a private attorney or represent yourself
at that level. You may be present at the hearing office appeal
over the telephone, if you ask in advance. If you fail to
appear, or do not timely appeal, you may lose your legal
appeal rights. If you do not win at the hearing office level,
immediately appeal that decision to the appeals office. (There
is a strict 30-day time limit). If you ask, the Appeals
Officer will appoint the Nevada Attorney for Injured Workers
to represent you at this second level of hearing. NAIW then
prepares your case with you, and an NAIW attorney represents
you without fee.
Exceptions:
If you are trying to reopen your claim
within one year of claim closure, you need to show the
above points by clear and convincing evidence.
If you did not receive a permanent
partial disability award or were not off work due to your
original injury, you must request reopening within a year
of claim closure.
If your claim was closed due to lack
of treatment for six months and your treatment costs did
not total $500.00 or more it will be difficult to win a
reopening.
If you have voluntarily removed
yourself from the workforce before you reopened your
claim, you are not entitled to temporary total disability
compensation or vocational rehabilitation services.
If you have any further questions or need advise,
please email our
office.
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