Can I File an Appeal on My Workers Compensation Claim?

When an injured worker applies for a Nevada workers compensation claim, the worker may file an appeal on specific issues, such as the initial application or the PPD award, with or without the assistance of an attorney. When applying for a reversal of any decision that has been made by the insurer, the injured worker has a time limit that must be followed in order to request a hearing. The Hearings Division will make a decision based on information provided by both parties. If the injured worker does not agree with the decision of the Hearings Officer, the worker may ask for another hearing at the Appeals Officer level. Due to the deadline requirements and information necessary when attempting to have a decision reversed, it can be helpful for an injured worker to obtain legal representation through an attorney.

Insurance Company’s Determination

When filing for workers compensation benefits in the State of Nevada, an injured worker will receive written notice of the insurer’s decision on the claim. The adjuster has 30 days from receipt of the initial paperwork to make this decision. When the initial doctor recommends no additional medical treatment or if medical expenses are expected to be less than $300.00, the case may be closed. If additional medical treatments will not help but the doctor suspects’ permanent impairment, the case will be closed but a permanent partial disability (PPD) examination will be scheduled. If no permanent disability is expected, there will be no rating evaluation when the case is closed.

What If the Injured Worker Needs More Medical Treatment for the Injury or Illness?

The insurance adjuster bases the acceptance or denial of Nevada workers compensation benefits on information provided by the initial doctor. If the adjuster sends the injured worker a letter entitled “Notice of Intention to Close Claim”, the insurer is closing the claim and does not intend to schedule a PPD assessment because no permanent impairment is expected. If the injured worker believes that he or she needs more medical treatment, the worker can complete and submit the included appeals form within (70) days of the date of the letter. If the worker feels that additional medical treatment is necessary, additional physician reports will need to be included in order for the Hearings Officer to consider reversing the decision. Without additional medical records or reports, the Hearings Officer will most likely uphold the decision of the insurance adjuster.

What If the Insurer Refuses to Schedule a PPD Assessment?

If the injured worker receives the “Notice of Intention to Close Claim” letter, the insurance adjuster does not plan on scheduling an assessment to determine a percentage of permanent disability rating for the injured worker. If the worker believes that there will be at least some degree of permanent impairment because of the injury or illness, he or she should file for a reversal of the decision through the included form. In addition, the injured worker should obtain the necessary rating evaluation to provide the PPD rating to the Hearings Officer at the hearing.

Getting Your Own PPD Rating Assessment

In order to meet the deadlines, the injured worker should first file the necessary paperwork for an appeal within the (70) day period allowable under Nevada workers compensation guidelines. After this, the injured worker will need to obtain a rating evaluation. The worker will need to send a written request to the Division of Industrial Relations (DIR) asking to be assigned a rating physician. Once the physician has been assigned, the injured worker must send all original medical records from the injury or illness to this physician before the scheduled appointment. The injured worker must pay for this rating examination, but may receive reimbursement if the claim is ultimately accepted. If the rating physician finds impairment, this report should be given to the Hearings Officer.

Timeline to Make the Appeal

The “Request for Hearing” application that is included with any denial letter must be completed and submitted with all necessary documents within (70) days of the date of the denial. The only time that a Hearings Officer will exceed this time limit is if the injured worker can provide legitimate proof that he or she did not receive the denial letter and appropriate “Request for Hearing” form. If the injured worker does not agree with the decision set forth by the Hearings Officer, the worker may request an additional hearing at the Appeals Officer level within (30) days of the Hearings Officer’s decision.

Hearings Division and Filing Requirements

The injured worker must submit the completed “Request for Hearing” form before the deadline. The worker needs to provide complete and accurate detail as to the specific reason for the hearing request, as this is the only issue that will be addressed at the hearing. In addition, all necessary supporting documents should be included with the hearing request, including a copy of the denial letter, so that the Hearings Officer can review this information before the scheduled hearing. In order to save time, copies of all documents sent to the Hearings Officer should also be sent to the insurer.

Attending the Hearing

Because it is up to the injured worker to prove his or her case, the worker should make every effort to attend the hearing. However, the worker may send in a written position statement to the Hearings Officer if he or she cannot attend the hearing. If the injured worker wishes to attend the hearing by phone, the worker must notify the Hearings Division at least one (1) week before the scheduled hearing date. It is common for injured workers who have been denied benefits to seek the advice and representation of an attorney. If the injured worker has legal representation, the attorney should attend the hearing as well.

Appealing the Hearings Division

Nevada workers compensation guidelines allow for either the insurer or the injured worker to contest the decision of the Hearings Division by filing the appropriate requests within (30) days. Injured workers who do not have an attorney at this point in the process may be able to receive free legal assistance from the Nevada Attorney for Injured Workers (NAIW).

Attorney Who Can Appeal Your Workers Compensation Claim

An injured worker who is denied benefits might wish to consider consulting a lawyer to determine if it would be helpful to contest the decision made by the adjuster. The attorneys at Bighorn Law can provide an initial consultation to help the worker determine if further recourse may be necessary in the claim. In addition to advice provided through an initial consultation, the lawyers at Bighorn Law can provide experienced legal representation for every step of the Nevada workers compensation process, including any appeals that might be necessary.

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