In theory, obtaining workers’ compensation benefits after getting seriously hurt or sick on the job should be as simple as notifying your employer of your condition and following through with medical treatment from appropriate healthcare providers. In practice, though, it is far from uncommon for workers’ comp insurance providers to refuse to provide certain benefits to seemingly qualifying claimants, or even to reject claims entirely for any number of procedural or evidentiary reasons.
If you recently received a determination you disagree with from your workers’ comp insurance provider, you have a right to appeal that decision with help from a capable Summerlin workers’ compensation lawyer. By retaining and working closely with a Summerlin workers’ compensation appeals lawyer from Shook & Stone, you could give yourself the best chance of getting the positive outcome you want from this often complex legal process.
How to Appeal an Insurer Determination
Once you receive written notice of an insurance company’s decision regarding your workers’ compensation claim, you have 70 days from the moment that notice arrives to begin the formal appeals process. Typically, this entails sending a copy of the insurer’s decision or denial letter to the Hearings Division of the Nevada Department of Administration along with a completed Hearing Request Form, something which a Summerlin workers’ compensation appeals attorney could provide vital assistance with.
Upon receiving a valid Hearing Request Form, the Hearings Division will schedule an informal hearing before a Hearing Officer. During this hearing, both sides—the injured claimant and a representative from their insurance provider or employer—will have a chance to explain why they disagree with or support the determination in question. The Hearing Officer will then inform the involved parties of their decision on the matter in writing through the mail.
Further Steps in the Workers’ Comp Appeals Process
If you disagree with the decision about your claim made by the Hearings Office, you have 30 days after receiving notice of that decision to file a “Notice of Appeal and Request for Hearings Before the Appeals Officer” form. The Appeals Officer will only review evidence submitted specifically to them and separately from the preceding Hearing Officer’s hearing, and the hearing is generally more in-depth and allows more time for each side to present arguments and evidence compared to the Hearing Officer’s hearing.
If you receive an unfavorable decision from the Appeals Officer, the process doesn’t necessarily end there. You have the option to appeal further to the nearest Nevada District Court. If the District Court ruling is also not in your favor, you can take your case all the way to the state Supreme Court. It’s important to note that cases that reach this stage can be costly, time-consuming, and have relatively low success rates. Therefore, having a seasoned workers’ comp appeals lawyer in Summerlin, Rhodes Ranch, Sovana, and Sun City is almost essential to achieving a positive final result.
Contact a Summerlin Workers’ Compensation Appeals Attorney for Assistance
Having your workers’ comp claim denied or not being offered the benefits you believe you need is not the end of the road for your claim. You may have a right to appeal the unfavorable decision on your claim to multiple levels of the Nevada state government, each of which may end up ruling in your favor even if other levels below them did not.
No matter the reason for your appeal or how far you intend to take it, you should think twice before trying to pursue it without a dependable Summerlin workers’ compensation appeals lawyer from Shook & Stone by your side. Call today to discuss your options.
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