A permanent partial disability award (PPD award) in Nevada is based on 3 factors: 1) the percentage of impairment found by the assigned rating doctor at the evaluation, 2) the average monthly wage the injured worker was earning at the time of his accident, and 3) the age of the injured worker when the award is calculated. If the adjuster has the correct age of the injured worker and the correct average monthly wage, then the only basis the injured worker has for contesting the amount of the award that is offered is the percentage of impairment.
Determine whether the rating doctor made a mistake
Rating doctors in Nevada must use a book called the AMA Guides to Evaluation of Permanent Impairment, 5th edition to determine the whole person percentage. An injured worker must be able to show that the rating doctor made a mistake in applying the criteria in the AMA Guides. Very few injured workers will have access to a copy of the AMA Guides (5th edition), and those that do may have a difficult time understanding the criteria. An injured worker who files an appeal and simply argues that the amount of money offered isn't enough will lose. The injured worker or his attorney must be able to argue that the rating doctor made a mistake in applying the Guides. It really is necessary to have an experienced attorney review the PPD evaluation report, and sometimes the medical reports, in order to determine whether there is a mistake in the report and the final percentage. Some experienced workers' compensation attorneys in Las Vegas will review a rating report for free.
If the Percentage Is Wrong, File a Timely Appeal
Unless the injured worker can convince the adjuster that the rating doctor made a mistake, and that rarely happens, the injured worker must file an appeal. The request for hearing form must be filed with the Hearings Division within 70 days of receiving the insurer's offer of the PPD award. A hearing will be scheduled in approximately 3 weeks. If the injured worker thinks that he can show an error in the rating evaluation, the injured worker might try to convince the hearings officer to order the insurer to pay for another rating exam without the injured worker having to first obtain a second rating on his own. If that happens, the insurer must pay for the second exam and must make a new offer. If, however, the hearings officer is not persuaded that there is a mistake, the hearings officer will affirm the first rating. The injured worker must then appeal to the next level of appeals.
Get a Second Rating Doctor Assigned by DIR
Most of the time, it is best to pay for a second rating exam before going to the hearings officer. That involves getting an assigned rating doctor from DIR, forwarding all medical records, scheduling the exam, and paying the current fee of $630.80 An injured worker should not pay for a second rating unless their experienced attorney thinks that the assigned second rating is likely to come up highter than the first rating physician, . Many attorneys will advance the cost of this second rating for the client. Alternatively, the attorney may ask a particular rating physician who is not assigned from the rotating list, to review the report from the first rating doctor for obvious errors in the rating. This review of a rating costs much less than an actual second rating, but the attorney must be very knowledgeable about the AMA Guides and have a strong reason for suspecting an error on the face of the rating report.
Schedule the Second Rating
After the attorney or the injured worker is assigned the name of the second rating doctor, the injured worker schedules the rating exam at the doctor's office. The injured worker, or his attorney, must send the rating doctor a complete copy of medical records, and must pay the doctor before the exam. Some attorneys routinely go with their clients to the rating exam to make sure that all pertinent records are provided, and to make sure that the exam is done correctly. The rating doctor may take up to 2 weeks to provide a report.
If the Second Rating is Higher, Give the Second Rating Report to the Hearings Officer
An injured worker is not legallyrequired to give a copy of any second rating to the insurer If the second rating doctor unexpectedly gives a lower percentage than the first rating doctor. If that happens, the injured worker should withdraw the appeal and accept the first award offered by the insurer. If the second rating is higher, then the injured worker can send a copy to the adjuster, and also submit a copy to the hearings officer. The hearing officer may find that the second rating is more correct or more accurately represents the injury. If so, then the hearing officer will order that the insurer pay the award based on the higher percentage. However, a hearings officer may instead want to have a third rating done before deciding which percentage to award. Having a higher second rating is no guarantee that the hearing officer will award it.
Request Reimbursement for the Cost of the Second Rating
Hearings officers and appeals officers have authority to order the insurer to reimburse the injured worker or his attorney the cost to obtain the second rating report if the hearings or appeals officer finds that the second rating is more accurate and awards the higher percentage. If the second rating comes back lower, the injured worker cannot be reimbursed for the second rating.
Additional resources provided by the author
More information on contesting PPD awards is found in the Information Center on Attorney Hunt's website.
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