Someone who gets injured at work and needs to file a workers’ compensation claim hopefully can rely on the system working smoothly to provide complete care and other benefits. One hopes that injured workers have access to good advice through their employers or a third-party claims administrator, and that everyone involved will try hard to ensure that the worker receives all the benefits that are owed under state law. Unfortunately, this isn’t always how things go. Like every kind of insurance, workers’ compensation often raises conflicts of interest, disputes about medical diagnoses or treatment plans, and other problems that a worker who isn’t represented by an attorney may struggle to overcome.
How an attorney facilitates workers’ comp claims
The role of a workers’ compensation attorney is to protect the client’s interests and ensure that all the benefits to which the worker is entitled are properly paid. Within the scope of that work there are a number of important things an attorney can do for the client:
- Ensure that claims paperwork is completed correctly and on time.
- Monitor the medical evaluation process to verify that the client isn’t railroaded into accepting an incorrect or incomplete diagnosis.
- Raise and resolve concerns with how coverage is being provided.
- Keep track of important records that may be vital if the claims process needs to be taken into a dispute resolution proceeding or litigation.
- Advise the client on when and how to dispute insurer decisions.
When should you hire an attorney?
Whether an individual needs the help of an attorney is really a question that needs to be answered after taking stock of all the facts of the individual’s case. It never hurts to reach out to an attorney who offers free consultations to determine if representation is necessary. Broadly speaking, the help of an attorney is more important if complicating factors are present. Some examples of these include:
- Severe injuries. An attorney’s help can make a huge difference for someone who has suffered a serious injury that will involve significant health care expenses, long periods off work, or some form of disability. Such injuries cost workers a lot of time, money, and stress. Ensuring that workers’ compensation benefits cover everything the worker needs takes planning and close oversight. In part this is because high-cost claims often end up in disputes as insurers look for ways to limit their financial exposure.
- Wrongfully denied claims. Someone who feels they’ve had their claim wrongfully turned down may need to file an appeal. Although an attorney isn’t necessarily required to make an appeal, the chances of an appeal succeeding gets significantly better if an attorney is involved, especially if the attorney has been involved from early in the process.
- Medical disputes. Many types of injury are subject to a wide variety of medical diagnoses. A strained back could be diagnosed as a muscular problem or as a slipped disc. A headache might be diagnosed as a concussion or as a more severe type of head trauma. Insurers know this and will use the medical examination process to find ways to restrict their exposure. An attorney can make sure the client knows how to exercise important rights like the option for seeking a second opinion.
The law firm of Greenman Goldberg Raby Martinez has represented clients in workers’ compensation cases for over 45 years. We provide personal, caring service to each and every client. For a free attorney consultation about your case call us at 702-388-4476 or through our contacts page.
The number of temporary staffing firms is constantly growing as businesses look for ways to manage employee costs by outsourcing work to temporary staff. Temporary workers are found in virtually every industry, including dangerous professions like construction, transportation, and health care. Like other employers in Nevada, a temporary staffing firm is required to carry workers’ compensation insurance that protects its staff members in the event that they are injured while working at a client site.
Understanding when workers’ compensation applies
Nevada’s workers’ compensation system provides that employees are insured against injuries that arise out of or in the course of employment. Generally speaking “the course of employment” captures any time for which an employee is compensated. A worker often is also covered during times when they are doing something that the employer has asked them to do. Personal time is not within the scope of workers’ compensation. Critically, a normal commute usually is not covered. However, because a temporary worker is often asked to commute to a location other than their firm’s office, those trips may be covered for some workers.
Workers’ compensation is a kind of no-fault insurance. This means that the insurer is not allowed to base its coverage decisions on who was responsible for causing the worker’s injury. It’s important to remember that a temporary worker is employed by the staffing firm, not the client at whose site the work is done. The temp worker therefore falls under the staffing firm’s workers’ compensation coverage.
Staffing firms often face workers’ compensation challenges
The inherent complexity of a staffing firm’s risk profile means they can have a hard time finding insurance. Many firms get insured through a professional employer organization, or PEO. A PEO is essentially a service company that takes on components of an employer’s human resources functions, such as payroll and insurance administration. A PEO may offer temporary staffing firms with a way to secure workers’ compensation coverage under a plan that groups together all of the PEO’s clients.
The presence of a PEO in the chain of authority can add a layer of administrative challenges to a worker who is injured on the job. Ideally a claim process goes smoothly and with adequate support from the insurer to resolve technical hiccups without interrupting the injured worker’s treatment. But if administration of the claim is handled by a PEO, the worker may have no relationship with the individuals handling the claim and may need additional help to resolve problems.
The law firm of Greenman Goldberg Raby Martinez has represented clients in workers compensation cases for over 45 years. We can help temporary workers get the workers’ compensation coverage to which they are entitled. For a free attorney consultation about your claim, call us today at 702-388-4476 or through our contacts page.
Nevada’s workers’ compensation insurance system is designed to ensure that everyone who works for an employer in the state is protected in the event of an injury on the job. Benefits are provided to qualified workers without regard to fault: an injury is covered regardless of whether the worker, the employer, or someone else can be blamed for causing it. The lack of a fault analysis doesn’t stop insurers from looking for ways to deny or limit an injured worker’s coverage. One way they may try to do that is by arguing that the injury existed prior to the work-related event that gave rise to the claim.
To be covered by workers’ compensation insurance an injury must “arise out of or in the course of employment.” Generally speaking this means that if a worker is injured while doing work-related activities, especially if the worker is “on the clock” and getting paid for the time that covers the injury event, the injury will be covered. In some types of injury, the cause may have arisen at work, but the scope of the injury only became clear later. Cancer arising after exposure to carcinogens at the workplace is a good example of a work-related illness that may be slow to develop and that would require the worker to establish a causal link to the employer in order to receive coverage.
Causation can become a barrier to coverage if the source of a particular injury can be traced to something that is not work-related. If a claim is for an injury that could be described as a “pre-existing condition” the insurer may refuse to cover it. For example, a worker who hurt his knee while skiing may have a more difficult time getting coverage for an injury to the same knee while on the job. The insurer’s argument will be that the injury did not “arise out of or in the course of employment” but was in fact the personal problem of the worker.
For a worker in such a circumstance the important thing is to document the ways in which an existing condition was made worse by the accident at work. Being clear with doctors about the details of the injury is important at every stage. So is keeping a record. In the case of the skier, if a doctor was consulted after the skiing accident the doctor will have records related to the scope and severity of the injury at that time. The accident at work may have worsened the condition in ways that can be medically measured, and to that extent the worker may be entitled to coverage.
If an insurer denies a claim that has a legitimate basis in a work-related injury the worker may need to consult with an attorney to make a successful appeal. An attorney can help the client organize facts, complete paperwork, and anticipate common insurer arguments. The attorney can also help the client navigate the medical examination process that will be used to determine the scope of coverage.
The law firm of Greenman Goldberg Raby Martinez has represented clients in workers’ compensation cases for over 45 years. We can help you understand how your preexisting conditions may affect your coverage for a work-related injury. For a free attorney consultation about your case call us at 702-388-4476 or through our contacts page.
Getting injured while on the job in Nevada entitles workers to insurance coverage under their insurers’ workers’ compensation program. Once a valid claim is started, the insurer will pay for a range of important expenses associated with the worker’s medical care. In some cases, though, an injured worker may need to pay some costs.
Nevada’s workers’ compensation system provides a broad basket of benefits to covered workers:
- Medical bills for treatment that is reasonable, necessary, and authorized.
- Wage replacement (up to defined maximums).
- Mileage reimbursement for travel to and from doctors’ appointments.
- Vocational rehabilitation for workers who can no longer continue their prior profession.
- Benefits such as funeral expenses and special payments to heirs in the event that the worker dies as a result of work-related injuries.
All of these benefits are subject to important limitations. Each have caps limiting how much an insurer will pay. Each may also come with strings attached. For example, by accepting certain fringe benefits the worker may sign away his or her right to reopen a claim. On top of these limits, insurers work hard to find ways to limit their financial exposure for each claim.
The potential for disputes with the insurer is perhaps the most important source of potential out-of-pocket costs for an employee. The “bargain” of the workers’ compensation system is that in exchange for obligatory, no-fault insurance coverage an employee cannot sue the employer except in rare cases of gross negligence or intentional injury. This limitation can put the employee in a difficult position if the insurer or employer doesn’t provide the kind of coverage that the worker is entitled to.
As a consequence, injured workers may need to hire an independent attorney to assist them with their case. An ethical attorney will examine a potential client’s case and provide an analysis of the kind of value the attorney can add to the client’s claim. By hiring an attorney the client may be able to greatly improve the outcome of the workers’ compensation process.
Of course, once coverage limits are reached any further costs must be borne by the injured worker. One goal of a workers’ compensation attorney is to ensure that only relevant costs are allocated to a particular category under a policy, so coverage limits aren’t reached in an artificial manner. There are other, rarer kinds of out-of-pocket expenses that may be necessary to resolve disputes with insurers. A dispute may require payment of administrative fees to obtain hearings. There may be costs associated with elective medical exams that are necessary to refute a questionable diagnosis by an insurer-designated physician.
The law firm of Greenman Goldberg Raby Martinez has represented clients in workers’ compensation cases for over 45 years. For a free attorney consultation about your case call us at 702-388-4476 or through our contacts page.
Cancer affects much more than just a patient’s physical health. It also can have profound consequences for the sufferer’s financial wellbeing. One hopes that cancer victims always have the benefit of thorough insurance coverage, but that isn’t always the case. When cancer can be traced to a cause that was work-related, a patient can sometimes seek benefits under the workers’ compensation insurance policy of the employer responsible.
For cancer to be covered by an employer’s workers’ compensation insurance the patient must be ready to prove that the disease arose “out of or in the course of employment.” For most types of injury the link between an injury and employment is established early in the process, usually at the first visit to a doctor. But unlike a broken arm suffered at a work site, cancer can be slow to develop and its cause may be difficult to trace.
There are three threshold matters that the patient must establish (or be prepared to establish) to ensure that coverage will not be denied:
- Exposure to a carcinogen at work. Proving exposure to a carcinogenic material at work can be easier in some situations than in others. If the patient worked at a chemical plant and was routinely exposed to substances that are well known to cause cancer, the case will be relatively easy to build. But if the patient’s exposure was in an isolated event, where the presence of carcinogens wasn’t known, proving the link may be more difficult. The passage of time can complicate proof as well.
- A causal relationship between the carcinogen and the patient’s specific cancer type. The patient’s doctor can help draw a connection between the work-related exposure to a carcinogen and the patient’s cancer. If a dispute arises with the workers’ compensation insurance provider, additional expert testimony and other scientific evidence might be required to prove causation.
- No intervening cause. Although a patient doesn’t need to prove that his or her cancer didn’t come from a source other than work, the insurer will almost certainly argue that it might have. This has been the insurer’s argument in cases involving secondhand smoke exposure at casinos. Because casino workers can be exposed to cigarette smoke other than at work, insurers have successfully denied coverage for their lung cancers.
Another potential problem for slow-developing cancers can be employers who have since gone out of business. Patients in this situation shouldn’t entirely give up hope. Even though the business may no longer exist under its old name, it may still exist under another, been merged with another business, or been bought out. A crucial question will be whether the current legal entity that owns the business has responsibility for lingering obligations to former employees.
Nevada provides a special benefit for firefighters who contract cancer, even after retirement. NRS 617.453 can simplify the process of seeking benefits for firefighters who are exposed to carcinogens during their careers. The law provides a specific list of carcinogens and their known related cancer types. Provided the firefighter can show exposure to a carcinogen that the statutory list links to the firefighter’s cancer, there will be a presumption that the cancer is work-related.
For over 45 years the law firm of Greenman Goldberg Raby Martinez has served clients with challenging workers’ compensation cases. If you think your cancer may be work-related but you aren’t sure how to go about making a claim against your employer, please reach out to us today for a free attorney consultation. Call us at 702-388-4476 or send us a request through our site.
In an ideal world every injury would have a predictable, consistent path to recovery, or at the very least a clearly defined range of potential harms. Of course, we don’t live in a perfect world. An injury can be misdiagnosed or underdiagnosed at preliminary medical appointments, or its treatment can lead to unexpected complications that require additional medical care or expensive drugs that weren’t part of the original plan. For someone who is receiving care under a workers’ compensation claim, these kinds of complications can require a claim to be reopened.
“Reopening” a workers’ compensation claim can be necessary if an insurer has formally indicated that its financial obligations with respect to it have been fulfilled—that is, the claim has been closed. Closing claims is one of the ways insurers manage the predictability of their costs: by closing a claim, the insurer knows with certainty how much it had to pay, and how much it needs to pass on to the employer. Reopening a claim therefore necessarily involves a degree of paperwork.
Nevada law sets out specific procedures for when and how a workers’ compensation claim may be reopened. The specific procedure depends on how long the claim has been closed. For claims that have been closed less than one year, the insurer is only required to reopen the claim if:
- Medical evidence demonstrates that an objective change in the claimant’s medical condition has taken place.
- There is clear and convincing evidence that the claimant’s change in circumstances was primarily caused by the injury covered by the original claim.
A claim must be reopened within one year of being closed if the claimant wasn’t forced off of work for at least five days, and didn’t receive benefits for permanent partial disability. In other words, for relatively minor injuries workers have a shorter timeframe to reopen their claims.
To reopen a claim that has been closed for a year or more, the claimant must show three things:
- A change of circumstances (complications during recovery, discovery of previously undiagnosed problems, and so on) warrants an increase or rearrangement of compensation.
- The primary cause of the change of circumstances was the injury covered by the original claim.
- The claimant’s doctor has provided a certificate attesting to the change of circumstances.
Any effort to reopen a claim must be grounded in an assertion that the reopened claim remains completely related to the original claim. That is to say, the ongoing circumstances of the worker’s condition must relate to a job-related injury. If circumstances that were unrelated to the original claim have since intervened, the insurer will deny the request to reopen the claim.
If an insurer denies a request to reopen a claim it may be necessary to sue. It is always a good idea to consult with an attorney before starting the process of reopening a claim to reduce the likelihood that a request will be denied and to have a plan for contesting a denial. The law firm of Greenman Goldberg Raby Martinez has represented clients in workers’ compensation cases for over 45 years. For a free attorney consultation about your case call us at 702-388-4476 or through our contacts page.
Construction workers have some of the most dangerous jobs in the country. They and their employers need to take safety very seriously to keep injuries to a minimum. Ideally a safety program has a flawless record, but accidents can and do still happen. Some of the common sources of injury at construction sites include:
- Injuries from equipment. Because of the powerful forces involved, accidents involving tools and heavy machinery can cause particularly serious injuries, like amputations. The risk of injury is greater if equipment isn’t properly maintained, or is modified to remove safety features.
- Trip hazards are commonplace at construction sites. So are projects that are high off the ground. Falls from scaffolding, or into holes, are frequent events.
- Injuries from vehicles. With heavy trucks, bulldozers, and other large vehicles moving around a job site, there’s always a risk that someone could be struck, run over, or crushed. A worker wearing hearing protection might not hear the warning signal of a backing truck. Vehicles might slip on loose or muddy ground.
- Falling objects. Even a relatively small item dropped from significant height can pose a serious danger to people below. Hard hats help, but a hammer dropped on an unprotected shoulder can cause long-term problems.
- Heat-related injuries. In Nevada we often experience weather that is hot enough to pose a significant health danger to people who are doing strenuous work outdoors. Heat exhaustion, heat stroke, and other serious complications can result if workers aren’t provided with adequate hydration and opportunities to cool down.
- Long-term diseases. Illnesses caused by exposure to dust, toxic substances, and carcinogens can be slow to develop and difficult to tie back to a particular job. For example, workers may be exposed to materials like asbestos during a demolition job. The consequence could be respiratory disease or even cancer.
A worker who is injured while on the job at a construction site is entitled to workers’ compensation coverage. Workers’ compensation is a no-fault system, meaning that coverage applies regardless of who was responsible for the injury. In most circumstances, an employer that has legally required workers’ compensation coverage is shielded from being sued for personal injuries. That doesn’t mean, however, that an injured worker doesn’t need the help of an attorney. A workers’ compensation claim can involve complicated nuances. Insurers often try to limit the scope of the coverage they will provide.
A workers’ compensation attorney acts as the workers’ advocate, protecting the worker’s interests in the face of potentially adversarial insurance adjusters. The law firm of Greenman Goldberg Raby Martinez has represented clients in personal injury and workers’ compensation cases for over 45 years. We are standing by to help workers who have been injured at construction sites in Las Vegas and surrounding areas. For a free attorney consultation about your case, call us today at 702-388-4476 or through our contacts page.
Highrise window washers quite literally step into thin air to do their work. Hanging from the side of buildings, often hundreds of feet in the air, they help to keep Las Vegas sparkling for its visitors. The approach to safety varies from company to company and building to building, depending on the sort of infrastructure incorporated into the building and the approach taken by the window washer. Everything from a scaffold to harness points built into the side of buildings may be used to keep washers safe.
Working at such heights involves significant risk of serious injury or death. People who work in the window washing business need to have a clear understanding of their legal rights so that if they are injured they can take the right course of action to protect themselves. Here are some principles to consider:
- Make sure your employer has workers’ compensation coverage. Every employer in Nevada is required to cover its employees with workers’ compensation coverage. People who are hired as “independent contractors” generally also have access to their employer’s workers’ compensation coverage. A Nevada employer’s coverage can be verified online. A key question is whether the employer’s coverage is adequate for the sort of risks that employees must face. It’s best to understand these questions before heading up to the top of a skyscraper.
- Be mindful of safety. All employers are required to maintain their workplaces in safe condition for employees under state and federal occupational safety and health rules (the familiar OSHA standards). These laws are enforced by regulatory agencies at the state and federal level. An employee who has safety concerns that aren’t being addressed by the employer should consider reporting them to authorities. This is especially true of professions like window washing, where inadequate safety measures can turn an otherwise low-risk job into something highly perilous.
- Understand who is responsible. Window washers often rely on the safety equipment already present at project sites. Things like hydraulic systems, winches, ropes, harnesses, and scaffolds may all be provided by the owner of the building that is being cleaned. When an equipment failure leads to injury it’s important to know if the building owner or operator may have some share of the blame.
- Be prepared to refuse the job. Working in high winds or with defective equipment dramatically increases the risks window washers face .A scrupulous employer should take such risks very seriously and keep workers off the job until conditions improve. If a manager is insisting that workers should ignore the risks and work anyway, the correct course may be to refuse to work. Under OSHA rules an employer cannot force an employee to continue to work under conditions that are known to be unreasonably dangerous.
Window washers who feel that they are faced with abnormally dangerous working conditions or who have suffered injuries and need help navigating their workers’ compensation claims should consider talking to an attorney about their legal options. For more than 45 years the law firm of Greenman Goldberg Raby Martinez has represented clients in personal injury and workers’ compensation cases. Call us today for a free attorney consultation at 702-388-4476 or reach us through our contact page.
After being injured at work it’s important to follow the steps for filing a workers’ compensation claim. Ideally an employer’s workers’ comp insurer will pick up the costs of the employee’s medical care from the first visit to a doctor until the injury has healed. In reality, though, insurers work hard to limit their exposure to costs related to covered injuries. One way they try to do this is by arguing that the injury is not as significant as the employee claims. This risk can be mitigated by having an attorney present during medical exams.
After receiving a claim for benefits an insurer has the right to require the injured worker to submit to an independent medical examination, or IME. The formal purpose of the IME is to ensure that the insurer is basing its coverage decisions on a reliable and supposedly neutral diagnosis by a physician other than one with which the patient may already have a relationship. In reality insurers often request an IME because they disagree with an initial diagnosis, or have doubts about whether an injury is related to the worker’s job.
The state maintains an official list of physicians who are authorized to perform examinations of work-related injuries. Insurers are very familiar with the doctors on this list. They know who has a history of providing insurer-favorable diagnoses and will steer unwary patients to those doctors whenever possible. When a worker is told to attend an IME, the insurer may provide a limited list of doctors to choose from for the examination. The worker is required to attend the IME, but has the right to request a second opinion from another state-approved doctor if the outcome of that initial exam is not satisfactory.
The IME is potentially one of many “independent” examinations that the patient will undergo over the course of a workers’ comp claim. For example, if the injury results in a permanent partial disability the extent of the disability will need to be evaluated by a physician who is specifically trained in how to do this.
The extent to which a patient needs to have an attorney present at a medical exam will depend on the nature of the injury and the extent to which facts about the injury are in dispute. An attorney can help the patient decide whether having an attorney or other witness on-hand is advisable, but as a general rule it is better to have a witness along than to go alone. The witness can take notes about the examination and may provide important testimony in the event that the results of the exam need to be disputed in a later proceeding. Note that some physicians may claim to have a rule prohibiting others from attending these exams. This should raise concerns that the exam may not be fair, and should be disputed.
For more than 45 years the law firm of Greenman Goldberg Raby Martinez has helped injured workers get the coverage they deserve. If you have been injured at work, our experienced injury attorneys are standing by to offer advice about your case. Call us today for a free attorney consultation at 702-388-4476 or reach us through our contact page.
Some jobs are inherently dangerous. Firefighting, heavy construction, and police work are just a few examples of high-risk professions. Employers in these professions take steps to mitigate the dangers their employees face. Beyond the clear importance of protecting their valued employees from harm, employers also want to avoid the expense of an injured employee (in terms of lost time, insurance, disability accommodations, and so on) and the potential regulatory and media attention that can come from serious accidents. But at what point can employees sue employers for dangerous conditions at work?
State and federal safety laws and regulations provide broad guidelines for workplace safety. Enforced by the federal and state Occupational Safety and Health Administrations (OSHA), these rules cover most types of high-risk conditions at work. Specific rules address things like workplace air quality, use of ladders, design and use of heavy equipment, and electrical work. In addition to specific rules, state and federal laws also feature what is called the “general duty clause.” This clause requires employers to provide workplaces that are “free from recognized hazards that are causing or likely to cause death or serious physical harm.” 29 U.S.C. § 654(a)(1), NRS 618.375(1).
The primary means of addressing workplace safety concerns is to submit a complaint to the Nevada Department of Business and Industry. If the agency determines that a complaint has merit it will arrange for an inspection of the workplace. Findings from the inspection will be reported to the employer, which has a certain amount of time to resolve the dangerous conditions. If the employer fails to adequately address the problem the agency may take enforcement action against the employer to ensure that noncompliant conditions are resolved.
It’s important to note that employees can’t sue to enforce OSHA rules on their own. Instead, workers who file OSHA complaints or who refuse to work in unreasonably dangerous conditions are protected against retaliation by their employers. If an employer fires an employee under such circumstances it may be liable in a lawsuit for wrongful termination. An employee considering these steps should consult with an attorney to craft a sound strategy.
What about workers who are injured at work by unaddressed safety conditions? Even in these situations a worker’s ability to sue the employer may be limited. Workplace injuries are covered by Nevada’s workers’ compensation system, which has two critical features for this analysis. First, workers’ compensation is a no-fault system, meaning that the worker’s injuries are covered without consideration for who or what is responsible for the injury. Second, an employer that purchases workers’ compensation insurance ordinarily cannot be sued for personal injury unless the employer deliberately caused the injury or doesn’t carry enough insurance to cover the kinds of risks that its employees face.
For more than 45 years the law firm of Greenman Goldberg Raby Martinez has helped clients in the Las Vegas area with workplace injuries. If you are concerned about dangerous conditions at your job and you’d like to understand how your legal rights may be affected by taking action to resolve them, call us today for a free attorney consultation. We can be reached at 702-388-4476, or ask us to call you through our contact page.