Does An Injured Worker Have to Go to Their Doctor?

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Injured employees in Nevada have a limited right to choose a treating doctor. The workers' compensation insurer or third-party administrator for the employer has a list of doctors that have contracted to provide medical care at reduced fees. Once the injured worker's claim is accepted, he or she has the right to ask for a different doctor on the provider list. If the request is within the first 90 days of the claim, the adjuster handling the claim must approve the request. Requests to change doctors made after 90 days can be denied, but the law says that the adjuster should have a good reason for the denial. NRS 616C.090.

An injured worker who successfully changes her treating doctor may be surprised weeks or months later to get a letter from her adjuster scheduling her to see a different doctor for a consultation appointment. That usually happens when the adjuster doesn't agree with the treatment recommendations of the treating doctor. This type of consultation might also be scheduled when the treating doctor has taken the injured employee off work for a long time.

Nevada law does give insurers and employers the right to require a consultation appointment with a doctor chosen by the employer or insurer from the insurer's provider list. This consultation examination is sometimes known as an IME (independent medical examination). The letter from the adjuster that notifies the injured worker of the appointment date and time will state that the injured worker's benefits will be suspended if he or she does not go to this appointment. NRS 616C.140 (5) states that if the employee refuses to go to the exam or obstructs the exam, compensation benefits can be suspended by the insurer until the exam takes place.

The letter from the adjuster will also tell the injured worker that he or she has the right to file an appeal if they disagree with the consultation. If this is the first time the insurer or employer has scheduled the employee for a consultation, a hearings officer is not likely to reverse the insurer's determination to require the consultation. However, I have had cases where the insurer has scheduled several consultation examinations in an obvious attempt to get a particular opinion from a doctor. If the number of consultations is unreasonable or the insurer is making unreasonable demands concerning cross-country travel to a consultation, a hearing officer will side with the injured worker. Adjusters who schedule multiple consultations are usually gearing up to deny something - beware.

 

Topics:  Healthcare, Workplace Injury

Published In: Labor & Employment Updates, Worker’s Compensation Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Virginia L. Hunt, Law Office of Virginia Hunt | Attorney Advertising

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Virginia L. Hunt
Law Office of Virginia Hunt

Over a thousand administrative hearings tried before the State of Nevada, Department of... View Profile »


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