Even though virtually every employee in Nevada is required by law to provide workers’ compensation coverage to all their employees, that does not mean the insurers must automatically accept every claim filed under it. In fact, it is fairly common for first-time claimants to have their claims partially or even entirely rejected by their employer’s workers’ comp insurance provider, especially if those claimants try to file their claims alone.
If you recently had a workers’ comp claim denied for any reason, assistance from a Summerlin workers’ compensation denial lawyer at Shook & Stone could be vital to addressing the issue proactively and effectively. Beyond just helping you identify the problem with your application and correcting it to the satisfaction of your workers’ comp provider, our dedicated workers’ comp attorneys could also guide you through the formal appeals process, if necessary, to get you the benefits you need.
Common Reasons for Workers’ Comp Claim Denials
Many workers’ comp denials in Summerlin, Rhodes Ranch, Sovana, and throughout the state of Nevada occur because the insurance company does not believe they should be liable for the injuries a claimant wants to have covered. Depending on the circumstances, this could either be because:
- The insurance company does not believe the injuries in question occurred under circumstances which workers’ comp should apply to
- The claimant did not provide sufficient medical documentation to establish the severity of their injury
- A combination of both
Other workers’ comp denials stem primarily from procedural errors, some of which are easier to correct than others. When there is a minor omission or error in how a particular form was filled out, for example, our Summerlin workers’ compensation denial attorneys could help quickly identify the problem and resubmit a corrected application for further review.
However, if the insurance company’s stated reason for a denial is that the claimant waited too long to notify their employer about their accident or formally file their workers’ comp claim, contesting the denial can be a bit more complicated. Guidance from seasoned legal counsel can be especially key to achieving a positive outcome in this scenario.
Options for Resolving Workers’ Comp Rejections
Anyone who receives a denial letter for a workers’ comp claim at any stage of the claims process has 70 days after receipt of that letter to file an appeal with the Hearings Division of the Nevada Department of Business & Industry. There is a specific form to fill out, which must be included alongside a copy of the original denial letter. Our experienced workers’ comp denial lawyers in Summerlin could help a claimant properly file and submit an appeal.
The Department will generally schedule a hearing 30 days after receiving an appeal form, at which both the claimant and the insurance company can send representatives to speak in person or submit position statements to be reviewed in their absence. Unfavorable decisions from the Hearing Officer overseeing this procedure can then be appealed to the Appeals Officer within the Department of Administration and then to a district court if the Appeals Officer also rules against the claimant.
Contact a Summerlin Workers’ Compensation Denial Attorney for Assistance
Being denied at any stage of the workers’ comp claims process can be devastating professionally and personally. Fortunately, you have help from well-practiced legal professionals who know how to handle situations like yours and could work tirelessly to ensure your case has a favorable final result.
A conversation with a Summerlin workers’ compensation denial lawyer at Shook & Stone could provide you with clarity about your options and confidence regarding the next steps. Call today to set up an initial meeting.