Steps to Take if Your Workers’ Compensation Claim is Denied

Posted on behalf of Henness & Haight on Jan 31, 2017 in Workers' Compensation News

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Having a workers’ compensation claim denied for a work-related injury or illness can create unnecessary difficulties and prevent an individual from fully recovering. Should your claim be denied, or if you dispute the benefits offered by the insurance provider, follow these steps to file an appeal.

Request a Hearing Officer Review

If your claim has been denied, you should request a hearing with the Nevada Department of Administration (DOA). Submit a completed Request for Hearing form and a copy of your workers’ compensation benefits denial letter from the insurance provider within 70 days of receiving your denial letter.

The form should be mailed to your nearest DOA Hearings Division, which would be:

Nevada Department of Administration
Hearings Division
2200 Rancho Drive, Ste 210
Las Vegas, NV 89102
(702) 486-2525

An informal hearing with a DOA Hearing Officer will be scheduled within 30 days. At this time, the DOA will review any information and evidence submitted by you and the insurance company that denied your claim.

A decision will then be made based on the information presented at this hearing.

Request an Appeal Officer Review

Should you wish to appeal the decision of the Hearing Officer, you may file for a hearing with an Appeals Officer. Submit the Request for Hearing Before Appeals Officer form to the DOA within 30 days of the Hearing Officer’s decision.

The hearing with the Appeals Officer is more formal and will be recorded for an official transcript. This hearing is new and separate from your previous hearing, requiring you to resubmit evidence. If you disagree with the decision made by the Appeals Officer, you may file for an appeal through the courts.

To dispute the decision made by the Appeals Officer, file a Petition for Judicial Review in District Court within 30 days of receiving the Appeals Officer’s decision.

Managed Care Organization Appeals

If your employer uses a managed care organization (MCO) that offers a network of healthcare providers, you must work with the organization to resolve the dispute before utilizing the DOA’s appeals process.

If you are unsatisfied with the MCO’s decision, submit written notice within 14 days of the dispute. They will have an additional 14 days to submit a response; if they do not, or you do not agree with the response, you may request a hearing with the Appeals Officer within 30 days and skip the step of requesting a review by the Hearing Officer.

Because complex procedures may apply to your case, it is in your best interest to hire an experienced workers’ compensation attorney who can offer you professional guidance through this process while keeping your best interests in mind.

If your workers’ compensation claim has been denied, you have legal options to dispute the insurance company’s decision. The Las Vegas workers’ compensation attorneys at Henness & Haight will provide you with professional guidance through the appeals process and work with you to recover the compensation you deserve.

Call 844.613.6275 or complete our Free Case Evaluation form today for a free, no-obligation case consultation.