Your Employer Denied Your Workers’ Comp Claim, Now What?

Injuries that happen at a workplace are covered under a specific workers’ compensation insurance. This insurance is in place to cover personal injury claims that occur from injury or illness due to a job. An employee can file Las Vegas workers’ comp to receive compensation for lost wages, medical expenses, pain and suffering, and more.

While the state of Nevada requires most employers to carry workers’ compensation, not all workers’ comp claims are approved. In some cases, an employee can be left without the financial help they need after a denial. However, if you’re facing a workers’ comp claim denial, it is not the end of the road. You still have options.

Workers’ compensation can cover a wide variety of illnesses and injuries. The only stipulation is that the illness or injury was a result of your employment. Some of the injuries that can occur on the job and lead to a claim include:

• Traumatic Injuries: Slips, trips, falls, lifting injuries, machinery accidents, cuts, punctures, lacerations, burn injuries, eye injuries.
• Repetitive Stress Injuries: Carpal tunnel syndrome, tendonitis, bursitis, herniated disks.
• Occupational Illnesses and Diseases: Exposure to harmful substances can lead to respiratory illnesses, hearing loss, skin conditions, toxic exposure illnesses.
• Psychological and Mental Health Conditions: Work-related PTSD, Severe workplace stress-related disorders.
• Aggravation of pre-existing conditions: Workers can claim if their job worsened an existing medical condition.
• Work-related death: Dependants may be eligible for death benefits if an employee dies from a workplace injury or illness.

It’s important to note that self-inflicted injuries that happen on the job are not typically covered by workers’ comp. Neither are injuries caused by drug use or fights at the job. To find out if your injury might qualify for workers’ comp, reach out to a Las Vegas personal injury attorney.

When you’re injured on the job, the next steps you take are important to file successfully. After the injury, let your employer know right away what happened. Your employer should give you a C-1 Form so you can formally document that the injury happened. It’s important to note that you will have 7 days from the injury to file this form. If your employer does not give you the form, you can find it at the Nevada Division of Industrial Relations website.

Once your employer is notified, seek medical help, but ensure the provider is an authorized medical provider who is part of the insurer’s panel of treating chiropractors & physicians. Tell your doctor the injury is work-related and obtain Form C-4. Your doctor will fill out their portion of the Employee’s Claim for Compensation. After you sign the form and send it in, the claim will officially be started.

At this point, your employer should have noticed the workers compensation insurance provider of the claim. The insurance company will have 30 days to provide an approval or a denial after a thorough review of medical records, accident reports, and the other evidence. If your claim is denied, you will have 70 days from the denial notice to appeal.

The deadlines are strict and short when it comes to filing for Las Vegas workers’ compensation. Having a lawyer by your side can help you improve your chances of success. If you face a denial, your lawyer can also help you appeal and ensure you get the compensation you deserve.

When you receive a denial letter from your workers’ compensation claim, the very first thing you must do is determine why you were denied. This is typically outlined in the letter. Depending on the circumstances, you may be able to file an appeal if you disagree with the reasons for denial. Have your personal injury lawyer in Nevada take a look at the letter to see if an appeal might be the next best course of action.

There can be many reasons an insurance company denies a claim and understanding these reasons can help you navigate your next steps. The reasons for denial can include:

• The insurance company deems the injury non work-related.
• The employer disputes that the claim happened at work.
• You did not report the injury within the allotted time frame.
• You did not provide enough information about your injury or medical care.
• You did not seek medical attention for the injury immediately.
• Inconsistencies between medical report and claim.

There are many reasons a claim can be denied. However, to ensure the most successful claim, your lawyer will make sure you report your injury with your employer immediately. Get medical care right away and start your workers’ compensation claim as soon as possible. Immediate action will prevent denials based on missed deadlines.

Denied claims can be appealed once you have determined why you were denied. Your lawyer can help you evaluate why you were denied and can walk you through the appeal process. The steps for your appeal will look similar to the following:

• Review Denial Letter: Look at your denial letter for the reason you were denied and the instructions on how to appeal. There is typically a deadline for appeals, so pay attention to this date.
• File a Request for a Hearing: You will have 70 days to submit a written appeal to the Nevada Department of Administration, Hearings Division. Include any new information that pertains to your appeal.
• Attend the Hearing: An attorney will look over your case and hear arguments from both sides. Hire a Las Vegas personal injury lawyer to make sure you have an advocate and your rights are protected. A decision will be issued within 15 days of the hearing.

If you are denied the claim after going through this process, you will have 30 days to file a second appeal with an appeals officer. If this is denied and you and your lawyer believe you still have a valid claim, you can pursue further appeals with the district court and the Nevada supreme court.

At Benson & Bingham, we have over 25 years of experience representing our clients in personal injury cases. We will walk you through your case, making sure your claim is strong, finding the evidence necessary to support it, and negotiating on your behalf. We have settled hundreds of millions of dollars for our clients and will make sure you get the compensation you deserve.

Contact our law firm anytime of day or night for a free consultation with our top-rated Las Vegas personal injury lawyers.