If I have an accepted workers’ compensation claim, can I see any doctor?
By Herb Santos, Jr., Esq.
One of the first questions I receive from my clients is whether they can see any doctor they want for their industrial injury. Unfortunately, there are some attorneys who advertise that they can get you into any doctor. This is nothing more than a marketing ploy because the law in Nevada is very clear. An injured worker is required to seek medical treatment from an authorized medical provider. So, what is an “authorized medical provider?”
Determining whether a medical provider is authorized, you must know whether your Insurer has entered into a contract with an organization for managed care or with providers of health care services pursuant to NRS 616B.527. To confirm if your Insurer has such a contract, go to the following website: https://dir.nv.gov/WCS/Insurers%E2%80%99_Treating_Provider_Lists/
From there you can locate your Insurer and review the list. If the Insurer has not entered a contract with an organization for managed care or with providers of health care services pursuant to NRS 616B.527, then you must select a doctor from the DIR panel of providers. You can find that list here: https://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/MedicalDocs/Physicians%20and%20Chiropractors%20by%20Specialties.pdf
Changes of the treating doctor are also limited by statute. If you are not satisfied with the first physician or chiropractor you choose, you may make a different choice of physician or chiropractor from the panel if the choice is made within 90 days after the injury. If you wait past the 90 days, any further change is subject to the approval of the Insurer. The Insurer must approve or deny the request within 10 days after the written request for such a change is received from the injured employee. If no action is taken on the request within 10 days, the request is deemed granted. If you make a request, you must include the name of the new physician or chiropractor in the letter.
What happens if your doctor wants to refer you to a specialist? If the doctor treating you refers you to a specialist for treatment, the doctor is required by law to provide you with a list of the panel that includes the name of each physician or chiropractor within the area of specialty your injury requires. After receiving the list, you must, at the time the referral is made, select a physician or chiropractor from that list. If you do not select a physician or chiropractor, the insurer may select a physician or chiropractor with that specialization for you.
If at some time you move to an area that is not covered by the panel, and the Insurer determines that it is impractical for you to continue treatment with the physician or chiropractor, you must choose a treating physician or chiropractor who will agree to the terms of that contract unless the insurer authorizes you to choose another physician or chiropractor from their list that will treat you in the new area where you moved.
So, when you see an attorney advertise on TV that they can get you into their doctor for a work comp claim, ask yourself whether you want a work comp attorney that either doesn’t know the rules or is simply baiting you into calling their office.
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Herb is a NJA Board Certified Workers’ Compensation Specialist. He is recognized by the National Workers’ Injury Law & Advocacy Group as one of America’s leading attorneys representing injured workers. Herb was also selected as the 2018 Trial Lawyer of the Year in Nevada and the 2020 AITL Workers’ Compensation Litigator of the Year.
Contact:
Herb Santos, Jr., Esq.
Board Certified Workers’ Compensation Specialist
2018 NJA Trial Lawyer of the Year
2020 AITL Workers’ Compensation Law Litigator of the Year
Nevada Justice Association Pillar
Governor, Nevada Justice Association
