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Workers’ compensation insurers in Nevada may use “utilization review boards” (UR) to look over your proposed medical treatment plan following a work injury. Depending on what the board says, the workers’ comp insurer can then either:
your treating physician’s requests for authorization (RFA).1
In practice, URs tend to either pare down your treatment plan so that it is less expensive for the insurer. Even though the physicians on the UR board have never met you in person, they can override all your doctor’s recommendations based on a quick review.
After you submit your workers’ comp claim, the insurer has 30 days to conduct a utilization review and give you a decision. You will be notified of their decision by mail or (if requested) by email.2
Yes, you have 70 days to appeal when your employer’s workers’ comp insurer denies you coverage or approves insufficient coverage. If both you and the workers’ comp insurer agree, an “independent review organization” can review your proposed treatment plan.
In Nevada, independent review organizations have five business days after a request to:
Once the organization receives all the information necessary, it has 15 days to make a decision. It must take into consideration the following three factors:
Once the board reaches a decision, it will send a copy of it to:
Note that the decisions of the independent review organization are not binding. Also note that the workers’ comp insurer pays for all costs associated with the independent review organization.3
If your workers’ compensation claim is denied, you would have to pay for any medical treatment you receive during the appeals process.
Then if you win the appeal, you could get reimbursed. But if you lose, you are responsible for the medical costs you incurred.
UR boards are typically comprised of:
Depending on your injuries and your doctor’s recommendations, you can seek workers’ compensation coverage to pay for:
A former Los Angeles prosecutor, attorney Neil Shouse graduated with honors from UC Berkeley and Harvard Law School (and completed additional graduate studies at MIT). He has been featured on CNN, Good Morning America, Dr Phil, The Today Show and Court TV. Mr Shouse has been recognized by the National Trial Lawyers as one of the Top 100 Criminal and Top 100 Civil Attorneys.