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What Medical Treatment Is Covered by Workers’ Compensation?

A Young Construction Site Worker has an Accident at Work.

Workers’ comp insurance provides compensation for the cost of reasonable and necessary medical care, as well as other compensation for workers who are injured or become ill as a direct result of their jobs. Nevada employers are required by law to carry workers’ compensation insurance. Worker’s compensation insurance protects both the worker and the employer. Employees who are injured at work can receive benefits without having to prove fault for work-related injuries. Employers benefit because they will not be held liable for work-related injuries. 

A Young Construction Site Worker has an Accident at Work.

Benefits from workers’ compensation are intended to help the injured employee recover from the injury, get back to work, and to pay for any long-term effects of the injury. Workplace injuries might include overexertion, falls, machinery accidents, exposure to toxins, or vision or hearing loss caused by the workplace. Worker’s compensation insurance should cover most all medical treatment and medical expenses for a work-related injury.

What Medical Treatment Is Covered by Workers’ Compensation After an on-the-Job Injury?

If you have been injured on the job, you will be relieved to know that necessary medical treatment for injuries that occur at work in Nevada should be covered by workers’ compensation insurance. There are several steps you should take to ensure you receive these benefits. 

First, you need to report your workplace accident as soon as possible. You can report the injury using an incident report referred to as a C-1 form in Nevada. Your employer will report your injury to the worker’s compensation insurance company. The insurance company will then review the claim and determine if you are eligible for compensation. 

After reporting the injury, the insurance company may ask you to be seen by a physician of their choosing for an independent medical examination. In some cases, the insurance company might hire an investigator to look into your claim. It is important to cooperate with the insurance company.

Two requirements must be met for an injury to be covered by workers’ compensation. First, the injured worker must be categorized as an employee. Second, the injury must have occurred as a result of the employment. If you have concerns about your workers’ comp claim being successful, a workers’ compensation lawyer can advise you on how to win a workers’ compensation claim.  

Types of Medical Treatment Covered by Workers’ Compensation

In Nevada, workers’ comp insurance will cover medical bills, as well as other injury-related medical expenses. Medical treatment may include a wide variety of things, such as emergency room visits, diagnosis of injuries, hospital stays, surgery, and doctor’s appointments.

In addition to the initial medical treatment needed after a workplace injury, workers’ comp should also cover medications and prescriptions for as long as they are needed. 

Workers’ comp insurance can even be used to cover travel expenses for trips to and from medical appointments. Transportation covered by workers’ comp might include your initial ambulance ride for emergency treatment, as well as compensation for gas mileage for post-op check-ups. After being injured in a work-related accident, your doctor may prescribe physical therapy, chiropractor visits, or other ongoing care. Workers’ comp insurance should also cover ongoing care such as physical therapy and other recovery costs.

Other Benefits Available in a Workers’ Compensation Claim

Workers’ comp insurance should cover all the expenses related to your medical treatment. In addition, workers’ comp insurance provides several other benefits. These benefits include lost wage benefits, vocational rehabilitation benefits, and death benefits. A worker’s compensation lawyer can help you determine what benefits you may qualify for based on your situation.  

Workers’ Compensation Lost Wage Benefits

The amount of compensation you can receive for lost wages is calculated based on the extent of your injury and your average weekly wages prior to being injured. For the purposes of assigning lost wage benefits, on-the-job injuries generally classified into four different categories – temporary total disability, temporary partial disability, permanent total disability, and permanent partial disability.

Temporary Total Disability (TTD) benefits are available to workers who are unable to work temporarily while they recover from their injuries. The amount you can receive for TTD benefits is calculated as two-thirds of your normal average weekly earnings. These benefits will end when a physician determines that you have reached Maximum Medical Improvement (MMI). MMI is the point when where you have recovered, or you have reached the maximum recovery you are expected to reach. TTD benefits will end when you return to work or a physician determines you have reached MMI.   

Temporary Partial Disability (TPD) benefits are available to employees who are able to return to work but cannot perform the same duties they had pre-injury. Workers with a TPD may be assigned to perform light-duty work, or they may need to work part-time while they recover from their injuries. TPD benefits are designed to help make up some of the difference between what you are able to earn while recovering from your injury and what you earned prior to being injured.

Permanent Total Disability (PTD) benefits are available to employees who are permanently unable to work. If a work-related injury causes you to lose the use of both legs, both arms, both hands, both feet, both eyes, or any combination of two of these body parts, it is considered a Permanent Total Disability. If it is determined that your injury qualifies as a PTD, you are usually eligible to receive compensation for the remainder of your life.

Permanent Partial Disability (PPD) benefits are available to employees who have suffered a work-related injury that results in permanent partial loss of use of a body part or their body as a whole. PPD benefits are designed to provide a wage differential for employees who are able to go back to work, but at a lower wage. PPD benefits can last up to five years, or until you reach the age of 67.

Workers’ Compensation Vocational Rehabilitation Benefits

If your work-related injury leaves you unable to return to work, you may be able to receive vocational rehabilitation benefits. Vocational rehabilitation benefits refer to services that are designed to help a worker return to their job or to enter a new line of work. 

If you are eligible for vocational rehabilitation benefits, you will be assigned a vocational rehabilitation counselor who will customize a rehabilitation plan based on your skills and abilities. Some of the services you may receive as part of vocation rehabilitation could include skills evaluation, job training, career counseling, job placement services, and additional educational courses.

Workers’ Compensation Death Benefits

Unlike other workers’ comp benefits, which are paid to the employee, workers’ compensation death benefits are paid to the relatives of an employee who has died in a work-related accident. Workers’ compensation death benefits in Nevada are intended to provide financial support to the family of the deceased and can also help to cover funeral and burial costs. 

Beneficiaries of workers’ comp death benefits are usually the spouse or children of the deceased worker. These next of kin may receive a portion of the deceased employee’s average weekly wages for a period of time. Beneficiaries may also receive compensation for funeral and burial expenses for the deceased worker.  

What Does Workers’ Comp Not Cover?

It is important to note that workers’ comp insurance only applies to employees. Independent contractors, freelancers, or volunteers who are injured while working will not be covered by workers’ comp.

Workers’ comp insurance also does not apply to accidents that occur while commuting to or from work. There are exceptions, however. If, for example, you are driving a work vehicle to a work site and are injured, the injury may be covered by workers’ comp insurance.

If an employee gets in a fight or is engaging in roughhousing, their injuries may not be covered by workers’ comp.

Finally, workers’ comp insurance may not cover injuries suffered by employees who are injured on the job due to being intoxicated or while engaging in illegal activities.

What to Do if Your Workers’ Compensation Claim Is Denied

Many workers’ comp claims are processed without any issues. However, there are several reasons your claim could be denied. Some of the most common reasons for a claim to be denied include:

  • Failing to report your injury in a timely manner
  • Failing to provide medical records
  • Failing to comply with doctor’s orders for treatment

If your workers’ comp claim has been denied, you will have the option to appeal to the Workers’ Compensation Appeals Board. If your claim is denied, a workers’ compensation lawyer can help you appeal the decision, understand what medical treatment is covered by workers’ compensation, and get workers’ comp benefits.

The George Bochanis Injury Law Offices was established in 1985. Before opening his office, Mr. Bochanis spent years representing major insurance companies in litigation cases and prior to that was a law clerk to a prominent local district court judge. Our offices have grown from a small one person setting to having its own well known office location on South Ninth Street in Downtown Las Vegas with 15 employees.

Years of Experience: More than 28 years
Nevada Registration Status: Active
Bar & Court Admissions: Nevada State Bar Federal Court of Nevada, 3rd Circuit

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Since opening our doors in 1985, the accident lawyers at the George Bochanis Injury Law Offices have been committed to helping injury victims get full compensation after slip and fall accidents, motor vehicle crashes, workplace injuries, and other personal injuries.

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