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What to Do if Your Workers Compensation Claim is Denied

What to Do if Your Workers Compensation Claim is Denied

There are several reasons that workers’ compensation claims are denied. One of the most common is that the claim was not filed on time. Legally, a worker is required to report the claim as soon as possible; in some cases the window to report may be just a few days.

Another common reason for a claim to be denied is that the employer disputed it. This could be because the employer disputes that the accident actually took place at work, or that the injury or illness the claim is based on resulted from the accident. In that case, you would need to gather additional evidence to support the claim. This can be eyewitness accounts that the accident did in fact happen, or a statement from a doctor attributing the injury or illness to something that took place at work. It’s a good idea to consider contacting your employer or its workers compensation insurance carrier to discuss the claim denial. If the denial was simply a clerical error, the error could be quickly rectified and your claim approved.

The next step is to appeal the claim denial. The letter stating that the workers compensation claim was denied may also outline the appeals process. Make sure to read the letter carefully and take note any appeal deadlines. The appeals process varies from state to state. At the appeal hearing, you will be required to present evidence and documentation to support your workers compensation claim. Most importantly, be sure to file the appeal on time, and gather as much medical evidence as possible to support the claim.

In Nevada, employees who are denied a claim can file an appeal with the Nevada Department of Administrations (DOA). To begin the appeal process, the employee must request a hearing with a Hearing Officer at the DOA. A Request for Hearing form is available on the DOA website. The employee must complete the form, attach a copy of the denial letter from the insurance company, and return both to the DOA. The form must be filed within 70 days from the date of the claim denial letter. The DOA will typically schedule a short, informal hearing before a Hearing Officer within 30 days of your request. During the hearing, the Hearing Officer will hear from both sides, review evidence submitted by the parties, and make a decision.

If the employee disagrees with the Hearing Officer’s decision, he or she may request a review by an Appeals Officer. To do this, the employee must file a Request for Hearing Before Appeals Officer form with the DOA within 30 days of the Hearing Officer’s decision. The Appeals Officer will conduct a new and separate hearing.

GGRM has been handling workers compensation and personal injury cases for the people of Las Vegas and Nevada since 1970. We’ve accumulated a lot of experience and success since then, but our firm’s core values have remained unchanged. Our clients still matter to us, and we still provide exceptional representation on both a legal and personal level. For us, going above and beyond is business as usual. Visit us here to learn more, or give us a call at 702-388-4476.