Unfortunately, there is no shortage of reasons why a workers’ compensation insurance provider might choose to deny a claim outright or refuse to pay out all the benefits that the claimant needs, from minor procedural errors to major disagreements about the nature and severity of the claimant’s condition. Fortunately, you have a right to formally appeal an unfavorable decision made by the insurance company about your case, provided you follow the proper legal procedures for doing so.
Working with a Las Vegas workers’ compensation appeals lawyer may be necessary if you want the best chances of getting a positive final result from your appeal. Reach out to one of the experienced Las Vegas workers’ compensation lawyers at Shook & Stone today to get started on your appeal.
Basic Steps in the Workers’ Comp Appeals Process
Generally, one of the first interactions you will have with your workers’ comp insurance provider will be a “determination letter” sent to you through the mail. This letter details the insurer’s position on the value and validity of your claim. If you disagree with any aspect of this determination, you have 70 days after receiving the letter to start the appeals process. Alternatively, you can file an appeal 30 days after sending a letter of objection to an insurance company over a specific proposed action and receiving no reply from the insurer.
To start the process, you must submit a completed Request for Hearing form—alongside a copy of the determination letter you received from the insurance company—to the appropriate Hearing Officer for the state Department of Administration. If you are a Las Vegas resident, that would be the one located at 2200 S. Rancho Drive, Suite 210, Las Vegas, NV 89102. The Hearing Officer must then schedule an informal hearing within 30 days of receiving a valid Request.
You can choose to appear at this hearing in person, call in over the phone, or submit a position statement to be considered by the judge in your absence. Our skilled Las Vegas workers’ comp appeals attorneys could help you construct a strong, evidence-based case and present it effectively during the hearing.
What Happens If an Initial Appeal Is Unsuccessful?
If you disagree with the Hearing Officer’s decision on your initial appeal, you have 30 days to formally request a hearing before an appeals officer. This second hearing would be a more formal, on-the-record process involving both sides presenting evidence and arguments supporting their position on the workers’ comp claim in question.
Suppose the appeal officer affirms the hearing officer’s decision rather than reversing it or sending the case back to the hearing officer for further review. In that case, the next step in the workers’ comp appeals process is filing a Petition for Judicial Review requesting that a district court review the case. It is extremely difficult to get a favorable result from this stage of the process, so representation from a seasoned workers’ comp appeals lawyer in Las Vegas is especially important.
Contact a Las Vegas Workers’ Compensation Appeals Attorney for Assistance with Your Claim
While exercising your right to appeal a workers’ comp decision can be vital to enforcing your rights under state law, it is also far from a simple process. Preparing effectively for your first hearing—let alone any subsequent ones—is not something you should try to do alone, especially if you are still dealing with a serious work-related injury or illness.
Help from a dedicated Las Vegas workers’ compensation appeals lawyer at Shook & Stone is available from start to finish of the legal process. Call today for a free consultation.
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