You should be able to receive out-of-state medical care in your Nevada workers’ compensation case if either:
- you move from Nevada to another state;
- the medical care you need – and that the insurer covers – is not available in Nevada;
- you live near the border of another state (such as California), and medical care is closer in that state; or
- you are in another state and need necessary emergency care connected to your work injury.1
Considering how transient Nevada’s population is, workers’ compensation insurance companies are used to requests from injured workers to seek out-of-state care.
However, it is always an uphill battle to get Nevada workers’ comp insurance companies to cover out-of-state care. So you – or your attorney – must stay on top of the insurer and follow all their instructions so the adjuster cannot claim you violated any rules or regulations.
What should I do if I need medical care out of state?
If you need out-of-state medical care for your Nevada worker’s compensation case, take the following measures:
- Find a medical provider who will abide by the current Nevada fee schedule. (The workers’ comp insurer will not cover medical services above the maximum allowable cost.) You can also ask your workers’ comp insurance adjuster if they have an out-of-state network of doctors to choose from.
- Ask your workers’ comp insurance adjuster in writing for prior authorization of care by the out-of-state provider you chose. Do this as soon as possible because it can take weeks for the adjuster to get back to you.
- Ask your out-of-state provider to fill out a Physician Progress Report (D-39 Form) following every appointment. This is the same form that Nevada doctors and chiropractors complete to inform workers’ comp adjusters whether you can work with restrictions (“light duty“) or not work at all.
If you move to another state or are temporarily staying there for treatment, make sure that you give your workers’ comp insurance adjuster your out-of-state address and phone number (if there is one) so they can remain in contact with you.
If your out-of-state doctor’s final progress report claims you are permanently impaired, the workers’ comp insurance company is required to pay for you to come back to Nevada within 30 days for a rating evaluation. This is to determine whether you should receive PPD (permanent partial disability).2
Can I get vocational rehabilitation out of state?
In general, you may not receive out-of-state vocational rehabilitation in your Nevada workers’ compensation case. Though there are exceptions:
- you live within 50 miles of Nevada; or
- you were injured in Nevada while your permanent residence was in another state;
- a bordering state offers more cost-effective vocational rehabilitation than Nevada does; or
- the out-of-state vocational rehabilitation services are within 50 miles of your residence in Nevada.
Alternatively, you could be eligible to receive a lump sum of up to $20,000 to pay for out-of-state vocational rehabilitation if you are otherwise eligible for vocational rehabilitation but the above conditions do not apply to you.3
