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Why Did the Insurance Company Close My Workers' Comp Claim?

Rating evaluations and filing appeals in Nevada

Everybody deserves safe and fair working conditions. Unfortunately, work injuries remain a serious problem. According to data from the U.S. Bureau of Labor Statistics (BLS), 35,700 workplace accidents and occupational illnesses were reported in Nevada in 2017 alone.

Through Nevada’s workers’ compensation insurance program, injured employees are entitled to no-fault benefits. That being said, in practice, it is not always easy to get the insurance company to cooperate.

For many different reasons, a workers’ compensation claim may be prematurely closed by the insurance companies. Here, you will find an overview of the two most common reasons why insurers close workers’ comp claims and what can be done to protect your legal rights.

Rating Evaluations

As explained by the Nevada Division of Industrial Relations (DIR), a rating evaluation (also called a permanent partial disability or PPD evaluation) is only given to injured workers whose condition has stabilized and who will likely be dealing with a permanent impairment as a result of their accident. Essentially, a rating evaluation is a medical exam designed to determine the severity of an injured worker’s permanent impairments.

Your rating evaluation will be used to determine the amount of permanent partial disability (PPD) compensation that you will receive going forward.

No Rating Evaluation: Your Claim Can Be Closed If Treatment is Finished

If you aren’t eligible to receive a rating evaluation, you can still get assistance. Nevada workers’ compensation provides benefits for reasonable and necessary medical expenses and for lost wages. In other words, as a baseline, you will get benefits until your condition has healed and you have returned to your previous position at your prior wage level. Once your medical treatment is done and you are earning a full paycheck, the insurance company will move to close your claim.

When to Take Action: The scenario described above is applicable for injured workers who have not received a rating evaluation—meaning the insurer believes that the worker did not suffer any permanent impairments. If you have not received a rating evaluation, but you did suffer permanent impairments in the accident, call a Nevada workers comp lawyer immediately. If you did not receive a rating, but you still need medical treatment, you have 70 days from the date of the denial to appeal the insurance company’s closure of your claim. A lawyer can help.

Rating Evaluation: Your Claim Can Be Closed If Your Condition is Fully Stabilized

If you have received a final rating and the insurance company believes that your condition is fully stabilized, meaning your condition is not expected to change even with more treatment, it may move to close your claim on the grounds that you no longer need ongoing medical treatment.

When to Take Action: If you believe that you have been assigned an unfairly low rating evaluation, you should call an experienced Nevada workers’ compensation attorney right away. You may be entitled to additional compensation. Further, if you believe that your condition has not yet stabilized and, thus, you still need additional medical care, a lawyer can help you file an appeal. You have 70 days to appeal the closure of your claim. 

If you'd like to know more about this area, read our workers' compensation law overview and social security disability.

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