What to Do If Your Workers' Compensation Claim Is Denied in Nevada

Learn about typical reasons for rejecting workers’ comp claims, and how to appeal insurance company’s decisions.

You have the right to receive benefits through Nevada’s workers’ compensation system when you’ve been hurt on the job or got sick because of your work. But what are your options if your employer’s insurance company rejects your claim, either fully or partially? This article explains common reasons workers’ comp claims are denied and how to appeal an insurer’s decision.

Common Reasons for Denying Workers’ Comp Claims

At the outset, your workers’ comp claim can be derailed if you don’t meet the deadline for reporting your injury and filing your claim. In Nevada, employees must notify their employer within seven days after they’re injured on the job. They must then file a claim form with the employer’s insurance company within 90 days after the injury. In the case of occupational diseases, the time period for these deadlines starts when an employee finds out about the illness and its relationship to the job. (For more details on the filing process, see How to File a Workers’ Compensation Claim in Nevada.)

Even if you’ve followed all the filing requirements, the insurance company could deny your claim if it decides that you don’t have a work-related injury or illness. Workers’ comp covers occupational diseases or injuries “arising out of or in the course of employment.” This means that in order to get compensation, you need to show that work activities or conditions caused your injury or illness, and that you were actually working when you were hurt. For example, the insurance company will probably deny your claim if you were hurt during you commute, but you might still get coverage if you can prove that you were doing work errands on the way home.

Nevada law also specifically rules out workers’ comp coverage for certain kinds of injuries, including:

  • heart conditions
  • injuries that happen when employees purposefully hurt themselves or others
  • injuries that take place while employees are participating in unpaid athletic or social events sponsored by their employers
  • injuries that happen because employees were drunk or under the influence of controlled substances, and
  • work-related injuries that were aggravated because the employees refused to get necessary medical treatment or did something else that hindered their recovery.

(See Denied Workers Compensation Claims to learn more about reasons workers’ comp claims are often denied.)

Administrative Workers’ Comp Appeals

You can appeal an insurance company’s decision with the Nevada Division of Industrial Relations (DIR). The administrative appeals process has two stages, but you’re allowed to skip the first step:

  • Hearing with DRI hearing officer. You may request a hearing with a DIR hearing officer. Make your request in writing within 70 days after the insurance company’s decision. Include the claim number, your name and the names of your employer and its insurer, and a copy of the decision that you’re appealing. (If you can’t get a copy, include the date of the insurer’s decision and the issues it discussed.) The hearing officer may require that you go to an independent medical examination. After the hearing, you’ll receive a copy of the officer’s decision in the mail, along with information on how to file another appeal.
  • Hearing with appeals officer. If you don’t like the hearing officer’s decision, you have 30 days to file a notice of appeal with an appeals officer. You may also skip directly to the appeals officer by filing this notice within 70 days of the insurance company’s decision. The appeals officer will review the evidence and may also order an independent medical examination. You will be notified once the officer makes a decision.

Court Appeals

If you’re unhappy with the final decision of the DIR appeals officer, you may then file a petition with a Nevada district court within 30 days. From there, you can work your way through the Nevada court system.

Reach Out to a Lawyer

The workers’ comp appeals process can be complicated and requires detailed knowledge of both the laws and procedural rules in Nevada. If you haven’t already done so, you should strongly consider speaking with a workers’ comp lawyer as soon as your employer’s insurance company denies your claim. An attorney who’s experienced in this area can help you understand why your claim was turned out, explain the legal procedures involved, help you gather evidence to support your claim, and protect your rights while guiding you through the appeals process. To learn more about the role of workers’ comp attorneys and how they charge for their services, see What a Good Workers’ Comp Lawyer Should Do and How Much Workers’ Comp Lawyers Cost in Nevada.

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