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Why is My Worker's Compensation Claim Closing?

A common question from injured workers who have a Nevada industrial injury is why is my claim closing? I am still in pain. I am not back to 100%. I need more medical treatment!

There comes a time in a worker’s compensation claim that the treating physician will say that you are “medically stable” or at “maximum medical improvement”. NAC 616C.103(1)(a) defines stable as:

“Stable” to include, without limitation, a written indication from a physician or chiropractor that the industrial injury or occupational disease of the injured employee:

(1) Is stationary, permanent or static; or

(2) Has reached maximum medical improvement.

Basically, this means that the doctor feels that they have exhausted all medical options and no additional medical treatment will improve your condition.

Some injured worker will agree, while other may disagree with their doctor. You should ask yourself, “What medical treatment have I received?” Have you had physical therapy? Is so, are you continuing to improve or is your condition staying the same? Did you receive any injections? Remember, many injections are just temporary in nature. Are you a surgical candidate? Are you eligible for a pain management program? These are the types of questions that an injured worker should ask their treating physician when the issue of claim closure arises. Make sure that all of your options for treatment have been offered to you prior to the claim closing.

Once the treating physician places in his medical report that the injured worker is medically stable or at maximum medical improvement, the industrial insurance adjuster will then issue a claim closure letter. It is very important to make sure that the injured worker has received all of their benefits. If not, or if the injured worker disagrees with the claim closing because they feel they need additional medical treatment, then the injured worker can appeal the letter of determination to the Hearings Officer of the Department of Administration. For a description of hearings and letters of determination, please read my other blogs on these subjects.

Another issue that goes side by side with claim closure is whether or not the injured worker will receive a settlement, known as a permanent partial disability evaluation, commonly referred to as a PPD. If the treating physician states that the injured worker is rateable, then the injured worker should be scheduled for a permanent partial disability evaluation. However, sometimes the adjuster may not schedule the appointment PPD evaluation. In addition, sometimes the treating physician may say that the injured worker is not rateable and therefore the adjuster will not schedule a PPD evaluation. I have seen this happen in many cases and it ends up that through litigation, the injured worker actually does qualify for a PPD evaluation and they eventually end up receiving a substantial settlement.

The bottom line. Make sure when claim closure arises that you are comfortable with the claim closing. Make sure that you have received all of your benefits under Nevada law. Make sure that you are being scheduled for a permanent partial disability evaluation.

Yet another reason that every injured worker in Nevada should seek out and retain a qualified and experienced Nevada workers compensation attorney so that things are done properly from the beginning.

I hope that this has been helpful and informative. Please read the other blogs for more free, valuable information.

Joel A. Santos, Esq., is a Nevada worker’s compensation attorney. He is certified by the State Bar of Nevada as a Worker’s Compensation Expert and Specialist.

Copyright 2021 - Joel A. Santos, Esq.


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