Gathering the necessary evidence is a critical part of successfully disputing a denied workers’ compensation claim. To receive benefits an injured worker needs to prove several things, including that the injury was work-related, that the worker was an employee of the employer at the time of the injury, and that the worker satisfied the statutory formalities of a claim.
Kinds of evidence in a workers’ compensation dispute
There are several kinds of evidence needed in any workers’ comp dispute. As a preliminary matter, the employee needs to have copies of required forms, along with evidence that they were submitted on time to the employer, insurer, and third-party administrator. Claims are often denied due to missed paperwork deadlines. At least two forms are required in any Nevada workers’ compensation claim. The Notice of Injury or Occupational Disease (Form C-1), also called an incident report, must be submitted to the employer within seven days of the injury or becoming aware of a work-related disease. The claim process itself begins with the submittal of an Employee’s Claim for Compensation/Report of Initial Treatment (Form C-4). Typically this form is furnished and submitted by the healthcare provider. It must be submitted to the insurer within three working days of treatment.
Needless to say, the facts of an injury are central to making a good claim for benefits. Medical records not only show that the injury exists, they also show that the related healthcare services should be covered or reimbursed. Bear in mind that medical records can also prove an insurer’s case, if they show that an injury was not related to work.
The employee also needs proof of employment at the time of the injury. Workers’ compensation does not cover independent contractors in many situations. For some, proving employment should be a straightforward matter of providing copies of recent pay stubs, an offer letter, or other relevant documentation. For others, such as those who are hired only by verbal agreement or get paid entirely in cash, proving an employment relationship can be a challenge.
Finally, third-party statements can be critical to supporting a claim. Witnesses to an accident can verify that the injury was work-related, as well as other details. In some cases experts are needed to establish causation between the job and the injury. For example, an expert can provide testimony about the link between workplace conditions and an employee’s cancer.
When evidence is needed
An injured Nevada worker who wants to dispute a denied claim must follow the process administered by the Department of Administration. Evidence must be presented at the initial hearing, which can take place within a fairly short period of time after the hearing request. Although the initial hearing is relatively informal, having high-quality evidence available can be the key to ending the dispute at this early stage. On the other hand, incomplete or inadequate evidence will not give the hearing officer sufficient grounds for overturning the claim denial.
GGRM can help
One reason to involve an experienced workers’ compensation attorney early in a claims process is to ensure that important evidence is gathered, preserved, and organized in a way that maximizes the likelihood of getting benefits. Employees who face claim denials can be sure that attorneys for the employer and insurer will work hard to defend their clients’ positions.
The law firm of Greenman Goldberg Raby Martinez has helped employees in the Las Vegas area pursue their workers’ compensation claims for more than 45 years. We would be happy to talk to you about strategies for getting the benefits you deserve. To speak to an attorney, please give us a call today at 702-388-4476. We can also be reached through our contacts page.