Appealing a denial of a Nevada workers’ compensation claim

An injured worker in Nevada who disagrees with a decision of an insurance company can appeal that decision to a Hearing Officer at the Division of Industrial Relations.

The appeal must be made:

  • within 70 days of the insurance company’s determination; or
  • after 30 days from writing to the insurance company requesting it change its position

. The parties can:

  • attend the hearing in person
  • attend by telephone – with a one-week notice
  • submit a position statement instead of appearing

A decision by a Hearing Officer can be appealed to an Appeals Officer within 30 days of the decision. The hearing is recorded, and a transcript is made.

The Appeals Officer reads the Hearing Officer’s decision, but each side must present his or her evidence again.

For either side to appeal, the request for the hearing must include:

  • claimant information
  • employer information
  • what is being appealed
  • reason for appeal
  • attorney/representative
  • insurance company1 2

A decision of an Appeals Officer can be appealed to the district court by filing a Petition for Judicial Review within 30 days of the Appeals Officer decision. (Note that another option may be to reopen a previously closed workers compensation claim.)

In this article, our Las Vegas Nevada workplace injury attorneys will explain:

insurance agent nevada

An injured worker who disagrees with a decision of an insurance company can appeal that decision to a Hearing Officer at the Nevada Division of Industrial Relations

1. The appeal of a decision of the insurance company to a Hearing Officer

An injured worker will receive a determination letter about his or her case from the insurance company. If he or she disagrees with the determination, an appeal can be filed within 70 days of receipt of the letter from the insurance company.3

An injured worker can also file an appeal if the insurance company does not respond within 30 days to a letter from the injured worker objecting to an insurance company action.4

An injured worker who wins an appeal can get reimbursement for expenses.5

1.1. Filing the request for hearing

The Request for Hearing form includes:

  • Claimant information
  • Employer information
  • What is being appealed
  • Reason for appeal
  • Attorney/representative
  • Insurance company6 7

The appeal must include a copy of the determination letter from the insurance company of the issue being appealed.

The hearing will be set within 30 days from the receipt of the request.8

The request is sent to Northern or Southern Nevada locations, depending on the injured worker’s location:

Department of Administration, Hearing Officer
1050 E. William Street, Suite 400
Carson City, NV 89701

Or

Department of Administration, Hearing Officer
2200 S. Rancho Drive, Suite 210
Las Vegas, NV 89102

The instructions for the appeal are in the determination letter.

Example: Zack is a police officer injured on the job in Nevada. He disagrees with the rate of temporary disability payments he is to receive and sends a letter to the insurance company. He does not receive a response within 30 days.

Zack sends the Request for Hearing to the Las Vegas address on May 12th. There is a hearing date set for April 2 on the issue of his temporary disability rate.

1.2. Appeal procedure

The hearing is an informal process. The injured worker and the representative from the insurance company can:

  • attend the hearing in person
  • attend by telephone – with a one-week notice
  • submit a position statement instead of appearing

Each party should provide copies of any documents to both the hearing officer and the other side.

Appeal issues

The appeal only addresses issues raised in the appeal, so any other issues an injured worker wants to raise during the hearing will not be considered

An injured worker who wins receives interest at 9% from the date payment would have been due.9

Example: Karen appeals the insurance company’s decision regarding the low level of permanent partial disability. She is rewarded for her work injury.

At the hearing she wants to address her temporary disability. However, she cannot do this because she did not raise the issue in the initial appeal.

attorney reviewing appeal

The appeal must be made within 30 days of the Hearing Officer decision.

2. The appeal of the Hearing Officer to the Appeals Officer

If an injured worker disagrees with the decision of the Hearing Officer, it can be appealed to the Appeals Officer at the Department of Administration.10

2.1. Filing the request

The appeal must be made within 30 days of the Hearing Officer decision.11 The appeal is made by filing a Request for Hearing Before Appeals Officer. The form includes:

  • claimant information
  • employer information
  • what is being appealed
  • reason for appeal
  • attorney/representative
  • insurance company12 13

The appeal must include a copy of the Hearing Officer’s decision.

The hearing will be set within 60 days.14

It is sent to Northern or Southern Nevada locations depending on the injured worker’s location:

Department of Administration, Appeals Officer
1050 E. William Street, Suite 450
Carson City, NV 89701

Or

Department of Administration, Hearing Officer
2200 S. Rancho Drive, Suite 220
Las Vegas, NV 89102

Example: Nathaniel is a Nevada firefighter with a workers compensation claim. He receives a decision from the Hearing Officer that he is not entitled to permanent partial disability.

He appeals the decision within 30 days to the Carson City location using the Request for Hearing before Appeals Officer.

2.2. Hearing process

The appeal hearing is on the record, meaning it is recorded, and there will be a transcript of the hearing that can be used in later court hearings. The transcript can be requested by the injured worker after the hearing.

The Appeals Officer will consider the hearing officer’s decision, but the hearing is like starting over. The parties must submit evidence again and make their arguments.

A doctor may be required to testify before the Appeals Officer.15

An injured worker who requires an interpreter can request it.

The Appeal Officer can:

  • Affirm the hearing officer decision
  • Reverse the hearing officer decision
  • Send the case back to the hearing officer

The Appeals Officer will:

  • make a decision within 15 days.16
  • schedule a medical evaluation to resolve the disputed issue and issue a decision 15 days after receipt of that report17

Example: Ignacio attends his appeals hearing with his documentary evidence and two copies, one for the Appeals Officer and one for the insurance company.

Ignacio is able to clearly state his position and belief that the insurance company is incorrect.

He knows the hearing is being recorded, and if he appeals again the transcript of the hearing will be read by the court.

3. The appeal of the Appeals Officer to District Court

An injured worker who disagrees with a decision of the Appeals Officer can file a Petition for Judicial Review with the district court.18 The appeal must be made within 30 days of the Appeals Officer’s decision.

A judicial review cannot be filed unless:

  • a claim form compensation has been filed, and
  • a final decision of the Appeals Officer has been made19

The judicial review is limited to the issues addressed by the Appeals Officer.20 The standard for review is whether there is substantial evidence.21 This means there is reasonable evidence to support a conclusion.

It may be very hard to win an appeal to the district court because the judge will defer to the Appeals Officer on most issues.

After the appeal is made by filing the Petition, each party can file a document, called a brief, with the court. This explains why he or she should prevail. There may or may or may not be a hearing date set where the parties can argue their side in person.

Example: Thomas won his appeal with the Hearing Officer but lost with the Appeals Officer. Therefore, he has appealed to the district court.

Thomas files a brief and argues his case before the judge. However, the judge does not see any reason to alter the decision of the Appeals Officer.

4. Representation by an attorney

An injured worker who disagrees with a decision at any point in the process can have an attorney represent him or her.

An attorney will take a fee from the injured worker’s settlement if he or she wins.

5. An injured worker must decide how long to pursue his or her claim

An injured worker’s claim is not over when the insurance company makes a decision.

There are multiple chances for an injured worker to obtain a favorable decision.

It is up to the injured worker to decide how far to pursue his or her claim. Understanding of the dispute at issue and relevant legal concepts is important, and may affect the workers compensation settlement amount that the injured worker will receive.

Call us for help…

nevada workers compensation attorneys

If you or someone you care about was injured at work, our attorneys can help you to file a workers compensation claim here in Nevada. (For cases in California, please see our page on appealing a denial of workers’ compensation benefits in California.)

For a free consultation to discuss your case simply fill out the form below or call us.

Legal References:

  1. http://hearings.nv.gov/uploadedFiles/hearingsnvgov/Content/forms/REQUEST%20FOR%20HEARING%20FORM-FY18v2.pdf
  2. Nev. Rev. Stat. § 616C.315
  3. Nev. Rev. Stat. § 616C.315(3)(a)
  4. Nev. Rev. Stat. § 616C.315(3)(b)
  5. Nev. Rev. Stat. § 616C.365
  6. See note 1.
  7. Nev. Rev. Stat. § 616C.315
  8. Nev. Rev. Stat. § 616C.330
  9. Nev. Rev. Stat. § 616C.335
  10. Nev. Rev. Stat. § 616C.345(1)
  11. Nev. Rev. Stat. § 616C.345(2)
  12. See note 1.
  13. Nev. Rev. Stat. § 616C.315
  14. Nev. Rev. Stat. § 616C.345(12)
  15. Nev. Rev. Stat. § 616C.350
  16. Nev. Rev. Stat. §616C.360(9)(a)
  17. Nev. Rev Stat. § 616C.360(9)(b)
  18. Nev. Rev. Stat. § 616C.370
  19. Nev. Rev. Stat. § 616C.370(1)
  20. Nev. Rev. Stat. § 616C.370(2)
  21. Nev. Rev. Stat. § 233B.135

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