If Your Claim is Denied

Challenge the Denial of Your Claim

Claim Denial:

This is when the workers' compensation insurer, a self-insured employer, or an MCO writes you a letter saying that your initial request for acceptance of your workers' compensation claim is denied. It can also refer to a situation where you asked for acceptance of a claim and only part of the claim was accepted.

Appeal ASAP:

You have 70 days to appeal the letter denying your claim. Send the appeal to the Hearings Division. If the appeal is not received by the Hearing Division within the 70 days you may lose your right to appeal. (NRS 616C.315)

Documents:

There are two (2) documents you must send to the Hearings Division:

  1. A copy of the denial letter itself. 
  2. The Hearing Request Form. Fill it out, date it and sign it. 

You can get the form to request a hearing by clicking the Hearing Request Form below.

Put the letter and the completed form together and either mail or hand deliver them to the Hearings Division. Make a copy for yourself.

Appealing Other Written Insurer Decisions

When an insurer or self-insured employer makes a written decision that the injured worker does not agree with, the injured worker has 70 days to appeal the decision to a Hearing Officer at the Nevada State Hearings Division.  If the injured worker has written a request to the insurer, and the insurer fails to respond to the written request within 30 days, the injured worker may appeal to a Hearing Officer. The injured worker must appeal the failure of the insurer to respond within 70 days from the day the worker mailed the written request to the insurer(NRS 616C.315).

You can get the form to request a hearing by clicking this link: Hearing Request Form

  • You must file your appeal as soon as you are denied a benefit, even if you need more evidence.
  • Enclose a copy of the determination letter along with the "request for hearing" form, from the insurer/administrator, when you send in your appeal.
  • Your hearing is limited to the issues regarding the benefit you asked the insurer to provide.
  • Bring your evidence documents with extra copies for the Hearing Officer and opposing party.
  • If you live too far away or are housebound, contact the Hearing Office early to make arrangements to file documents or give telephone testimony instead of attending your hearing in person.

If you receive a decision against you from an MCO or a collective bargaining arbitrator, or you are a public safety worker whose special claim was denied, you have the right to appeal directly to the Appeals Office and to request free legal service from NAIW. To get the AO Appeals Form click the link below.

 

Note:
Every time the workers' compensation insurer makes a written determination that you disagree with you need to file a new separate appeal with the Hearings Division. This is the process by which you protect your rights. Your individual claims may be consolidated at the second level hearing before the Appeals Officer.