Appeals

Was Your Work Injury Claim Denied? We Can Help

Did the insurance company deny part or all of your claim for workers’ compensation benefits? Did you receive a determination letter that you would like to dispute? Did the insurer fail to respond to your claim by the 30-day deadline? Call our office right away so we can get started with an appeal.

Now’s the Time to Talk to a Work Injury Lawyer

If you filed your workers’ compensation claim for benefits without the assistance of a work comp lawyer and you’ve received one or more determination letters from the insurance company, it’s time for us to talk about getting you your money.

When you disagree with the decision the workers’ compensation insurer makes, you have the right to file an appeal. If you miss the deadline, fail to follow the guidelines, or your request for appeal is incomplete, however, you could lose your right to recover money for your injuries. Your medical bills will likely continue to pile up. You’ll continue to go without the income you’ve lost. And your medical treatment could even be delayed.

Don’t take any chances when it comes to your work comp appeal. Let us help make sure you get paid.

How Workers’ Comp Determination Letters and Appeals Work

When you file a workers’ compensation claim for benefits, you will likely receive a number of determination letters from the insurer. These are typically sent out throughout the claims process. When you receive letters with which you don’t agree, each one must be appealed individually. In essence, your case may have multiple appeals and numerous hearings.

For each determination letter you receive, you have 70 days to file an appeal. If you fail to file an appeal by the deadline for even one of the letters you receive, you could lose your right to recover money for your medical bills and lost wages.

Filing an Appeal

The first step in filing an appeal is to request a hearing with the Hearings Division of the Nevada Department of Administration.

We’ll help you get things in order for your hearing. We will need to review any portion of your case that you would like to have reviewed during your hearing. We’ll gather evidence, records, and statements, and we’ll make sure the necessary documents are sent to the Hearing Officer so he or she can see the big picture instead of just a glimpse of your situation. These informal hearings are usually scheduled to be held within 30 days of the division receiving your request.

If you win your appeal at this level, you will be entitled to receive interest of 9%, calculated from when the initial payment was due.

Appealing with the Appeals Officer

If you receive an unfavorable decision from the Hearing Officer, you still have options to recover money. You can appeal the decision of the Hearing Officer to the Appeals Officer at the Department of Administration. The Appeals Officer would then be tasked with addressing your appeal at another hearing.

While the Appeals Officer will review the decision made by the Hearing Officer, he or she will also conduct an additional review of the case. The Appeals Officer will base the hearing only on evidence that is submitted for the hearing at hand. Any evidence that was previously submitted will not be reviewed unless it is resubmitted.

After consideration of all evidence, the Appeals Officer will decide:

• To uphold the Hearing Officer’s decision
• To reverse the decision made by the Hearing Officer
• To remand the decision (send the case back for review by the Hearing Officer)

The Appeals Officer can also decide to enter other orders as allowed by law. Decisions will be made within 15 days of the hearing. If you receive an answer from the Appeals Officer and you still don’t agree, you have the right to appeal further. This time, your appeal would be filed with the District Court.

Appealing the Appeals Officer’s Decision

If you choose to appeal the decision made by the appeals officer, you have 30 days to file a Petition for Judicial Review with the appropriate District Court. This review is limited to the information that was provided to the Appeals Officer. Once the petition is filed, we can prepare a brief on your behalf to explain to the Judge why you should prevail.

You Need a Work Injury Attorney When Appealing a Decision

If you are considering filing a workers’ compensation appeal at any level, it is highly recommended that you work with a work comp lawyer. Our knowledge of the workers’ compensation laws in Nevada, familiarity with how appeals work, and resources to handle your case with no out-of-pocket expenses can help ensure that your bills are covered, you get the medical help you need, and you are paid for the time you’ve been unable to work.