A catastrophic injury is a major injury that includes the loss of sight or hearing, amputation, severe burns, head injury, or another significant injury. If an employee suffers a catastrophic injury, the insurance company is required to develop a life care plan and assign a:
- qualified claims adjuster
- nurse
- vocational rehabilitation counselor
A claim does not have to be categorized originally as a catastrophic injury in order later to be changed to one.
An insurance company can also rescind a catastrophic injury categorization if:
- medical evidence supports the rescission or revision;
- the injured employee is stable and ratable as less than catastrophic; or
- other circumstances warrant such a rescission or revision
A life care plan should be developed within 120 days of when an injured worker’s condition stabilizes. The life care plan includes:
- what medical treatment that the injured worker needs
- the worker’s life expectancy
- rehabilitation services
- the effect of pre-existing medical conditions
- any special medical devices needed
- periodic meetings with the injured worker
In this article, our Las Vegas Nevada workers’ comp attorneys will explain:
- 1. What is a catastrophic injury?
- 2. What does the insurance company have to do for a catastrophic injury?
- 3. Developing a life care plan for catastrophic injuries
- 4. A Nevada catastrophic injury and injured worker benefits
A catastrophic injury is a major injury that includes the loss of sight or hearing, amputation, severe burns, head injury, or other significant injury.
1. What is a catastrophic injury?
A Nevada catastrophic injury in workers’ compensation law is a significant injury and requires the insurance company to treat the claim differently than they would other injuries.
Specifically, a catastrophic injury is:
- the total loss of sight in one or both eyes
- the total loss of hearing in one or both ears
- amputation of an arm or leg
- an injury to the head or spine which results in paralysis of the legs, the arms or both the legs and arms
- an injury to the head which results in severe cognitive impairment, as determined by a nationally recognized method of objective psychological testing
- an injury consisting of second or third-degree burns on 50 percent or more of:
- the body
- both hands; or
- the face
- the total loss of or significant and permanent impairment of speech
- a coma or vegetative state
- the loss or significant impairment of function of one or more vital internal organs or organ systems
- the mangling, crushing or amputation of a major portion of an extremity
- an injury that the insurer and the injured employee agree should be administered as a claim for a catastrophic injury
- any other category of injury deemed to be catastrophic 1
An injured worker can also request that the insurance company treat his or her injury as a catastrophic injury.2 Any injured worker can have a catastrophic injury, including police officers, firefighters, and undocumented workers.
Example: Jose is severely injured in a grease fire in a restaurant kitchen. He has second-degree burns on both hands.
The insurance company classifies his injury as a catastrophic injury.
1.1. Change of circumstances
A claim does not have to originally be categorized as a catastrophic injury to later be changed to one.3
Example: Paul injures his arm in a Las vegas construction accident and is treated for his work injury. Later he develops a severe infection and the arm has to be amputated.
Paul’s injury goes from a regular workers’ compensation injury to a catastrophic injury due to the amputation.
An insurance company can also rescind a catastrophic injury categorization if:
- medical evidence supports the rescission or revision;
- the injured employee is stable and ratable as less than catastrophic; or
- other circumstances warrant such a rescission or revision4
Example: Joanne is in a coma after a fall at work. The injury is deemed a catastrophic injury.
She wakes up a week later and doctors expect her to recover completely. Her injury is no longer a catastrophic injury.
An injured worker with a catastrophic injury gets all workers’ compensation benefits, including temporary disability, permanent disability, and mileage reimbursement plus additional services.
2. What does the insurance company have to do for a catastrophic injury?
When there is a Nevada catastrophic injury, the insurance company must assign a:
- qualified claims adjuster
- nurse
- vocational rehabilitation counselor5
The insurance company must also develop a life care plan (see below).
An injured worker with a catastrophic injury gets all workers’ compensation benefits, including
- temporary disability,
- permanent disability, and
- mileage reimbursement plus additional services.
2.1. Qualified Claims Adjuster requirements
The insurance company must have an adjuster that has more experience than the average workers’ compensation claims adjuster, specifically he or she must have:
- at least four years of experience in adjusting workers’ compensation claims for lost time; or
- at least two years of experience in adjusting workers’ compensation claims for lost time and work under the direct supervision of an adjuster who has at least four years of experience in adjusting such claims6
3. Developing a life care plan for catastrophic injuries
Within 120 days from when the treating doctor finds the injured worker’s condition has stabilized, it must develop a life care plan.7
A Nevada insurance company also has to provide all benefits during the development of the life care plan.8
3.1. Life care assessment
The life care plan should assess:
- the number of home or hospital visits determined to be necessary or appropriate by the registered nurse and vocational rehabilitation counselor;
- the life expectancy of the injured employee;
- the medical needs of the injured employee, including, without limitation:
- surgery;
- prescription medication;
- physical therapy; and
- maintenance therapy;
- the effect, if any, of any Nevada preexisting medical condition; and
- the potential of the injured employee for rehabilitation, taking into account:
- the injured employee’s medical condition, age, educational level, work experience and motivation; and
- any other relevant factors9
3.2. Life care schedule
The life care plan must include a schedule for the adjuster, nurse, and vocational counselor to discuss:
- special medical attention or treatment;
- psychological counseling or testing; and
- any medical device, including, without limitation:
- a wheelchair;
- a prosthesis; and
- a specially equipped or designed motor vehicle10
The life care plan must include vocational rehabilitation or permanent total disability.11 The injured worker will either need to be retrained or will be unable to work due to the injury.
The insurance adjuster should attempt to schedule a personal meeting once a month with the injured worker or his or her representative.12 If that is not always possible, the claims adjuster should prepare a written report and mail it to the injured worker.13
The life care plan can be amended if the injured worker’s condition changes.14
4. A Nevada catastrophic injury and injured worker benefits
A catastrophic injury is a serious injury that affects an injured worker’s ability to work for the rest of his or her life. Fortunately, catastrophic injury benefits help to cover medical expenses and lost wages.
No one would want such an injury, but an injured worker needs to be aware of his or her rights at this difficult time so that he or she receives the best possible care and most comfortable future.
Call us for help…
If you or someone you care about is a police officer injured in the line of work, our legal team can help to file a Nevada workers compensation claim.
For a free consultation to discuss your case simply fill out the form below or call us.
Legal References:
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- Nev. Rev. Stat. § 616A.077
- Nev. Rev. Stat. § 616C.703
- Nev. Rev. Stat. § 616C.707
- Nev. Rev. Stat. § 616C.710
- Nev. Rev. Stat. § 616C.700(1)(a)
- Nev. Rev. Stat. § 616C.720
- Nev. Rev. Stat. § 616C.700(1)(b)
- Nev. Rev. Stat. § 616C.700(1)(c)
- Nev. Rev. Stat. § 616C.700(3)
- Nev. Rev. Stat. § 616C.700(4)
- Nev. Rev. Stat. § 616C.700(5)
- Nev. Rev. Stat. § 616C.700(6)(a)
- Nev. Rev. Stat. § 616C.700(6)(b)
- Nev. Rev. Stat. § 616C.700(7)