If you are injured at or become sick because of your work environment, the only consolation for Nevada workers is that their employers are required to take out workers’ compensation insurance. Workers’ comp insurance provides you with the means to pay medical treatment as well as helps to pay for any lost wages while you are being treated for or recovering from a workplace injury. Not every claim is accepted by an employer’s insurer. Some may be denied for a variety of reasons. If this happens to you, you may be able to still obtain compensation through an appeal with the help of a workers’ comp. attorney. Workers Compensation Law in Nevada The state agency that handles workers’ compensation and adjudicates in the event of a dispute is the Nevada Department of Administrations. In Nevada, as in many other states, there are very prescribed rules about workers’ compensation. Injured or sick employees must inform their employers within 7 days of the accident or after an illness was first noticed. Failure to do so may mean a reduction in compensation or the claim could be denied. Then there are 90 days within which time a claim for compensation can be made. Nearly every employer in Nevada is required by law to take out insurance cover for their employees’ potential injuries or illnesses. The employee is able to obtain compensation for disabilities caused by an injury or industrial illness. There are a range of these depending on how temporary the injury or sickness is. Compensation for permanent disability, i.e. the employee is unable to return to work at all, is also covered. Workers’ compensation in Nevada, like most states is limited to medical treatment and support as well as wage recovery only. This makes it more restricted than compensation from a personal injury lawsuit, but the onus of proof that the employer was at fault is not necessary in a workers’ comp. claim. How a WC Claim in Nevada Could be Denied There is a set procedure for workers’ compensation claims in Nevada. The insurer may not approve an insurance claim for a workplace injury or illness unless it is convinced that it took place genuinely at work. The insurer may claim that it did not, or that the injury did not warrant medical treatment, or that it was caused by a lack of attention to safety procedures. Some claims are simply denied because the employee failed to adhere to time limits. There may be a justifiable reason for this. For example, a severe brain injury may mean that an employee is unconscious for more than a week, or unable to “report” the incident to the employer. Unless the incident that caused the injury was recorded correctly at the time by someone else (which it should be) the insurer may claim that the notification was too late. Other reasons for denying a claim may be because the insurer has alleged that the employee was drunk at the time or affected by drugs. The Nevada WC Appeals Process If your claim is denied in Nevada there are basically two steps that can be taken to reverse the decision by the insurer. The first step is to request a hearing with the Nevada Department of Administrations (DOA), who will arrange a hearing to look at the claim from both sides of the dispute. It is worthwhile having a workers’ comp. attorney with you at this stage. Note the time limit here. The request for a hearing must be made within 70 days of the denial letter being received. The DOA will appoint a Hearing Officer who will review the claim and make a decision whether the denial should be reversed. If the Hearing Officer does not decide that the denial should be reversed, you can then choose to make an appeal to the DOA’s Appeals Officer. The appeal is a more formal occasion than the administrative hearing and evidence must be submitted all over again. Theoretically, you can still appeal further if the decision goes against you by appealing to the Nevada Court of Appeals. How a Workers’ Compensation Attorney Can Make a Difference Making an appeal is a complex process and it is not advisable to do this all by yourself unless you have sufficient legal knowledge and are very confident that you know what you are doing. It is preferable to discuss the claim with an experienced workers’ comp. attorney who can provide advice, ensure you have sufficient supporting evidence when you attend a hearing and represent you whenever there is a need to do so.
