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What Obligations Does an Employer Have to Help an Injured Employee?

Employers in Nevada have a number of obligations related to injured employees. One way to break down the obligations is to look at each of them according to when they arise. Some obligations arise as soon as the employee starts work. Others arise in the immediate response to an injury. And still others apply in the aftermath of the injury, when the employer’s assistance with the employee’s workers’ compensation claim can be the difference between an accepted or denied claim.
  1. Pre-injury obligations.
Most Nevada employers must carry workers’ compensation insurance that protects their employees in the event they are injured on the job. Not carrying insurance is a significant violation of law, subjecting the company to potential criminal prosecution, regulatory actions, and fines. Few employers want to risk losing their business over a failure to obtain workers’ compensation insurance. But from time to time an employer operates without it in hopes of saving some money, putting employees at risk. Under state and federal workplace safety laws (commonly known as OSHA) employers over a certain size have a general duty to provide a safe working environment for their employees, as well as specific obligations relating to particular hazards such as electrical or chemical work. Although OSHA rules do not provide for a private cause of action, they do provide an important baseline of safety that protects employees from working in substandard conditions.
  1. Obligations in the immediate aftermath of an injury.
When an employee suffers an injury in Nevada the employer has an obligation to assist the injured employee with obtaining emergency medical treatment. That might include calling 911, and might also include administering emergency care such as CPR, performing triage on a wound, and so forth. Many employers are taking steps to train their staff in emergency first aid, in part because such programs can help them lower workers’ compensation costs.
  1. Obligations as the employee recovers.
The recovery phase of a serious injury is where things can get quite complex. There are a range of obligations that employers have with respect to employees who have been injured on the job:
  • They may not take adverse employment actions against them based solely on their having suffered or reported an injury.
  • They must keep good records of the incident and report it to the state.
  • They are required to cooperate with any investigation that arises due to the employee’s workers’ compensation claim, such as if the insurance adjuster has questions about whether the injury was work-related.
  • They must comply with laws governing an injured employee’s options for returning to work, including offering light duty where appropriate.
  • They must make reasonable accommodations for an employee who has suffered a disability.
As one might expect, the above list only glosses over the surface of what might be involved in a given case. Quite often the injured employee can benefit from the assistance of an attorney with experience handling workers’ compensation cases. For over 45 years the law firm of Greenman Goldberg Raby Martinez has helped clients in the Las Vegas area pursue workers’ compensation claims. If you have been injured at work and you have questions about how to get the coverage you deserve, call us today for a free attorney consultation at 702-388-4476 or send us a request through our site.

Four Reasons Why a Workers’ Comp Claim Might be Denied

Having a workers’ compensation claim denied can be a shocking and frustrating experience. For many working people, workers’ comp is the best or only available resource for getting care for an injury or illness that happened on the job. When someone can’t keep working or needs long-term care, denied coverage can have profound personal consequences. Here are some of the common reasons why an insurer will deny a claim.
  • The injury or illness is not eligible for benefits.
To be eligible for workers’ compensation coverage, an individual must have been injured or contracted a disease in the course and scope of employment. Workers’ comp is a no-fault form of insurance, which means that an insurer cannot base decisions about whether to approve a claim on the degree to which the employee or someone else is responsible for the injury or disease. But insurers do look closely at the circumstances of the claim to verify that the individual who makes it was in fact working at the time of the injury. Cases involving denied claims have included employees who are injured while commuting, on a lunch break, or between shifts. But the dividing line between work and not-work is not always clear, and sometimes a dispute can arise when, for example, an employee is injured on the way to an employer-provided break room.
  • Missed deadlines and incomplete paperwork.
The insurance adjusters who evaluate the merits of claims are paid to review every detail for breaches of legal requirements. When claim paperwork is submitted late, or required pieces are missing, an insurer may have an excuse for denying an otherwise valid claim. For example, an accident at work needs to be reported to the employer within seven days.
  • Suspicious discrepancies.
Insurers are passionate about guarding against fraud. If they think that a claim is based on misinformation, they will be quick to deny it. Workers can find themselves facing a denied claim if information they provide in their paperwork doesn’t match third-party records, such as those provided by the employer or the physician who conducts the initial evaluation. Injured workers are also getting into trouble by posting contradictory information to social media accounts.
  • Evidence of drugs or alcohol use.
A workers’ compensation insurer can deny an employee’s claims if it finds evidence that the employee was drunk or under the influence of a controlled substance at the time of the workplace injury. This includes recreational marijuana use. An employee can only overcome the denial of a claim on the basis of drugs or alcohol use by showing through clear and convincing evidence that the substance was not a factor in the employee’s injury. Although the facts of an injury may support the employee’s argument, the process will be significantly more complicated as a consequence of drug or alcohol use at work. For over 45 years the law firm of Greenman Goldberg Raby Martinez has represented Las Vegas clients in workers’ compensation claims disputes. We can help you resolve your questions about workers’ compensation coverage and fight back against an insurer that refuses to give you the coverage you deserve. Call us today for a free attorney consultation at 702-388-4476 or send us a request through our site.

Pregnancy and Workers’ Compensation Claims

Pregnant women have unique concerns when they are injured. Protecting the health of a developing fetus can limit treatment options, like antibiotics, that might otherwise be available. And some injuries can pose serious risks to the fetus itself. For a pregnant woman who is injured at work and is receiving benefits under a workers’ compensation program, such challenges can raise questions about coverage and employment rights.

Nevada law protects pregnant women in the workplace

The Nevada Pregnant Workers’ Fairness Act (NPWFA), NRS 613.335, limits the ways that employers can restrict a pregnant employee’s job responsibilities. Among other things, the law requires covered Nevada employers to provide pregnant employees with reasonable accommodations to allow them to continue to work during pregnancy and after childbirth. For employees who do manual work, the employer may lawfully offer light duty or a less risky role to protect the health of the employee and her fetus, and to manage the employer’s risk with respect to potential workplace injuries. Although the NPWFA isn’t expressly a workers’ compensation law, it provides an important context for women who are injured at work while they are pregnant. A pregnant woman does not need to accept an employer’s unreasonable job restrictions that are only intended to limit the employer’s potential liability and create an unnecessary burden upon the employee.

Workers’ comp applies to all job-related injuries

Nevada’s workers’ compensation law requires all employers to insure their employees against all injuries and illnesses that arise out of or in the course of employment. The fact that an employee was pregnant at the time of an injury has no bearing on coverage. So long as the injury happened during working hours, or while the employee was performing work-related duties, coverage will apply. This is true regardless of the specific cause of the injury. A pregnant employee whose injuries also cause pregnancy-related complications should expect those complications to be included as a component of coverage. It’s important to bear in mind that coverage may not be approved for conditions that cannot be traced to the job-related injury. Records of the employee’s obstetric treatment will be important to show that a condition did not exist prior to the work injury.

GGRM represents clients in complex workers’ compensation cases

For over 45 years the law firm of Greenman Goldberg Raby Martinez has represented Las Vegas clients in workers’ compensation claims disputes. We are happy to help women who are facing challenges involving pregnancy and workers’ comp claims to seek better outcomes for themselves and their children. For a free attorney consultation call us at 702-388-4476 or send us a request through our site.

When Should Injured Workers Hire an Attorney?

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.

Workers’ Comp for Employees of Temporary Staffing Firms

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.

How Medical History Can Shape a Workers’ Comp Claim

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.

What Out-of-Pocket Costs Can a Workers’ Comp Claimant Face?

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.

Proving Causation of Work-Related Cancers

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:
  1. 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.
  2. 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.
  3. 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.

Can a Nevada Workers’ Comp Claim be Reopened?

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:
  1. Medical evidence demonstrates that an objective change in the claimant’s medical condition has taken place.
  2. 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:
  1. A change of circumstances (complications during recovery, discovery of previously undiagnosed problems, and so on) warrants an increase or rearrangement of compensation.
  2. The primary cause of the change of circumstances was the injury covered by the original claim.
  3. 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.

Common Construction Site Injuries

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.