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What To Do When an Insurer Denies Workers Comp Benefits

What To Do When an Insurer Denies Workers Comp Benefits

Getting injured or sick while on the job can have lasting personal and financial consequences. Nevada’s workers’ compensation laws are designed to protect injured workers from financial ruin. But sometimes an insurer will deny a worker’s legitimate claim. Fortunately, the law provides workers recourse in the event that an insurer refuses to pay.

When a workers’ compensation claim can be denied

An insurer can deny a workers’ compensation claim if the employee has not complied with statutory process for filing a claim. After suffering an injury or contracting an illness, an employee must submit a claim within 90 days. Claims are made by filing an Employee’s Claim for Compensation/Report of Initial Treatment (Form C-4) with the employer, insurer, and any third-party administrator. The worker’s healthcare provider will furnish and submit the form.

An insurer may also deny coverage if it is not convinced that the worker suffered the injury or contracted the illness while on the job. This can be especially problematic for workers who develop cancer or other diseases that are slow to develop.

Requesting a hearing with the Nevada Department of Administrations

An injured worker begins the process of contesting a denial of coverage by requesting a hearing before the Nevada Department of Administration (DOA). The request must be filed within 70 days of the claim being denied or the date the worker sent a written request that the insurer has not responded to. Along with the request for hearing the worker must submit a copy of the notice of denied coverage.

If the request for hearing is properly submitted, the DOA will schedule an initial hearing, to be held within 30 days. At the initial hearing a Hearing Officer will consider the arguments of both the injured worker and the insurer, review evidence, and issue a decision.

A worker who disagrees with the outcome of the initial hearing may file an appeal within 30 days of the Hearing Officer’s decision. A DOA Appeals Officer will conduct a new, detailed hearing, where once again both sides will present arguments and evidence in support of their respective positions. If at the end of the DOA appeals process the worker still feels that something isn’t right about the claim process, the next step is to file a lawsuit in state court.

Working with an attorney is the best approach

Resolving a workers’ compensation dispute can be complicated. Even at the early stages, an untrained individual may have difficulty knowing how to collect and handle evidence and how to best frame arguments. That is why consulting with an attorney at the earliest possible stage is important. Ideally disputes are resolved at the initial DOA hearing, when processes are relatively informal. But the stakes quickly rise in an appeal or civil lawsuit. Making mistakes, such as not asserting a major legal argument, can delay coverage and cost an injured worker money.

The experienced workers’ compensation attorneys at GGRM are proud of their long history of helping Las Vegas workers get the benefits to which they are entitled. If you have been injured at work and would like to speak to an attorney, our team is available for free consultations. Call us today at 702-388-4476, or request that we call you by leaving us a message through our contact page.