Legal Procedures

WHAT IS LEGAL PROCEDURE?
(AS OPPOSED TO A TRIAL ON THE FACTS)

In order to get into court and have the judge hear the facts of your case, you must follow the proper legal procedure.  At times you must go to court not to discuss the facts of your job-related incident, but to show the court that you have complied with legal procedure.

Each appeal concerns some disagreement between yourself and the insurance company or the self-insured employer.  Each appeal is separate and must go through the same routine before a judge can rule on the facts of your case.

WHAT IS THIS ROUTINE?

If the insurer denies you what you want or informs you by letter that it will cut benefits, you are given 70 days to appeal.  You then must appeal first to the Hearing Officer:  the first hurdle you must jump in the Department of Administration.  Stage one - a hearing and decision by a hearing officer - is necessary before a trial before the Appeals Officer.  You must file timely and you must make your appearance.  If you fail to appear, or do not timely appeal, you might lose because you did not follow legal procedure.

There is a thirty (30) day time limit if you appeal the Hearing Officer's decision.  This is the second stage.  You must timely file your appeal at the Nevada Department of Administration, Appeals Office. You cannot bypass the hearing officer's level and obtain an initial hearing before the Appeals Office.

Each determination (letter from insurer) you wish to appeal means you must follow the routine of legal process.  First the hearing before the Hearing Officer, then trial before the Appeals Officer.  The Appeal's Office level hearing is formal.  Each party is usually represented by an attorney.  Evidence must be presented at this hearing.  All the evidence, witness names, and an issue statement must be filed with the Appeals Officer (your judge) two (2) weeks before the hearing.  This helps settle some cases.

MULTIPLE APPEALS

An appeal is not the same thing as a claim.  A claim is what comes about when you are injured at work.  Each appeal concerns some disagreement between yourself and the insurance company.  You can have more than one appeal since each time the insurer denies you a benefit, you can appeal this decision to a Department of Administration Hearing Officer and then on to the Appeals Officer.

Nevada Attorney for Injured Workers is a separate state agency.  Its attorneys only represent injured workers.  They prepare and present the cases of injured workers to the Appeals Officer.