Your Claim is Now Accepted, so why is the Insurance Company Refusing to Pay Your Back Wages?

By: Kevin Kampschror, Esq.

An all-too common scenario is where an injured worker files a claim, is denied, and then the injured worker is forced to go to court to fight the claim denial. This could be months from the actual date of injury. Once a Hearing Officer reverses the claim denial (you win), the Insurer must then accept the claim. If there is not motion for stay filed, the Insurer must accept the claim and comply with the Hearing Officer’s Decision & Order within thirty (30) days.

Once the claim is accepted, you (or your attorney if you hire one) will request Temporary Total Disability (“TTD”) pursuant to NRS 616C.475. That law states that if you are off work five (5) days in a row or five (5) days in a twenty (20) day period, you will receive 66 2/3% of your average monthly wage. Because your claim is now accepted (and you were off the entire time), why would the Insurer then deny those benefits?

Often times what happens is when the claim is originally denied, the injured worker is not able to see a doctor under the claim. If the injured worker does not have health care, they have no option but to wait out the process. What that means is that there is no doctor that would give the injured worker restrictions during the time the claim is denied. There would only be the initial restrictions given when the person was injured (likely at a place like Concentra). Once the claim denial is reversed by the Hearing Officer and the insurer must administer the claim, the injured worker sees a doctor under the claim and is given restrictions again. This presents a gap between the original restrictions and restrictions given a few months later. Insurers often deny any request for TTD during this time frame, citing that there are no off-work slips from a doctor during this time. Of course there aren’t, and the insurer knows this! Moreover, the very reason there are no off-work slips during this time frame is because the insurer denied the claim and the injured worker was not able to see a doctor under the claim. If this happens to you, you will have no option but to go to court to fight for the retro TTD benefits.

This is a very complex area of workers’ compensation law. As always, it is advised you seek an experienced attorney who is able to assist in obtaining all benefits that you are entitled to under Nevada law.