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Under Nevada workers compensation laws, if an injured worker is determined to have some form of permanent disability as noted in the reports provided by the treating physician, the insurance adjuster will schedule a disability assessment with a special physician who is qualified to make such a determination. These special physicians may be medical doctors, chiropractors, or other qualified specialists who have successfully completed testing and competency in using the AMA Guides to Evaluation of Permanent Impairment. These special physicians use the guidelines to determine a percentage of disability, which is used to provide injured workers with a financial settlement called a permanent partial disability award, or PPD for short. The names of those physicians who are qualified to provide such assessments are placed on a rotating list that is kept current and maintained by the Department of Industrial Relations (DIR).
Finding the Right Doctor for the Rating Evaluation
Nevada workers compensation regulations provide that an injured worker or attorney may have some say in the doctor selected to perform the assessment for an impairment award. If the injured worker refuses the doctor selected by the insurer, the next physician from the rotating list may be selected. While certain types of specialists may be selected for certain types of disability, say a chiropractor for musculoskeletal issues or an eye doctor for vision issues, complex medical problems or damage to internal organs can only be evaluated by a medical doctor. The assessing physician who will determine the percentage of impairment may not have had any prior consultations with the injured employee or be the injured workers treating physician in the claim.
The Rating Evaluation
While the insurance adjuster is responsible for sending all of the injured worker’s medical records to the selected physician prior to the PPD impairment evaluation, there is the possibility that some of the records may be missing. The injured worker should always maintain personal copies of all medical records and bring an additional copy of these records to the assessment to determine any permanent partial disability. The actual assessment will take place in the physician’s office just like any other medical examination. If the injured worker has an attorney, this legal representative is entitled to be present for such examination as well. The insurer is required to pay for this impairment rating evaluation. Nevada workers compensation guidelines allow that the cost for such examination varies by the number of injured body parts to be used in making a determination for the PPD award.
AMA Guides and Rating Determination
Injuries involving joints, such as in the arms or legs, are often measured through the loss of range of motion. This may be a time-consuming process, with the physician taking several different measurements to make an accurate determination. Some injuries, such as amputations, are easier to measure as they include complete and total loss of use due to the missing limb or body part. The percentage amount for permanent partial disability may be different between one assessing physician and another and is often affected by the assessing physician’s competence and ability to apply the guidelines set forth by Nevada workers compensation. While these differences in percentage may be small, depending on the assessing physician, the difference in percentage may result in a difference that is much more significant, often requiring the injured worker to request a second rating from a different doctor from the approved rotating list. An attorney who is familiar with a variety of injuries may be familiar with which physicians from the list are most capable in making a fair assessment in permanent disability similar to those of the injured worker.
When determining a percentage of disability, the assessing physician takes many factors into account. However, there are many injuries that are non-ratable and unable to be used when making a determination. Not all injuries requiring some type of surgical procedure can be used in making a determination of permanent disability. Additionally, the ability of an injured employee to return to work cannot be used in making a determination of disability. While issues such as pain are relative and are not used in making such a determination, certain nerve injuries may be used in making final percentage determinations.
The Doctor’s Rating Report
The assessing physician has 14 days following the examination to make a determination and to send the report to the insurer. Once the report is received, the insurer then has 14 days to make a written offer to the injured employee. While the amount offered is typically based on the impairment percentage as determined by the rating physician, the insurer may disagree with this percentage. If the insurer disagrees with the percentage of disability determined by the assessing physician, the insurer may offer a lesser amount but must include the reasons why in writing to the injured worker. If the injured employee does not agree with the percentage of disability provided by the assessing physician or with any lesser amount provided by the insurer in writing, the injured worker may file an appeal and obtain a second assessment from another doctor found on the DIR’s rotating list.
Permanent Partial Disability Award Calculation
When calculating the PPD award the injured worker is eligible to receive, the insurer takes into account the percentage of disability determined by the assessing physician, the average monthly wage that was earned by the injured employee, and the age of the injured worker at the time of such award. Actuarial tables are often used in conjunction with the correct statutory formulas to determine the correct amount each injured employee is eligible to receive. Due to differences in earnings and age at the time of award, two injured workers with the exact same injuries may end up being awarded different amounts.
PPD Payment Options
The injured worker has a choice in how to receive their permanent partial disability award. This award may be given to the injured employee as a lump sum or in installment payments. When awards are to be given in a lump sum, this amount is reduced to reflect present value of such award. Installment payments are to be distributed to the injured worker until the age of 70 years. If a worker receives a disability percentage that is greater than 25 percent, only up to the 25 percent impairment can be received as a lump sum payment, with anything over the 25 percent being paid out in installments.
The attorneys at Morris/Anderson Law Firm can look over your Nevada workers compensation PPD award if you have received an assessment for a ratable disability to check for any obvious mistakes by the assessing physician. If you feel you have received an inaccurate percentage of disability, the attorneys can help with any appeals you may be eligible to receive to secure a second determination of permanent partial disability benefits for which you may be entitled to receive.Go to the Next Article