If you are injured at work in Nevada and get denied workers’ compensation, you have 70 days to appeal to the Nevada Department of Administrations (DOA). You would send a Request for Hearing form as well as the denial letter to the DOA office.
You can:
- attend the hearing in person
- attend by telephone – with a one-week notice
- submit a position statement instead of appearing
You can then appeal a decision by a Hearing Officer to an Appeals Officer within 30 days of the decision. Finally, you can appeal a decision of an Appeals Officer to the district court by filing a Petition for Judicial Review within 30 days of the Appeals Officer’s decision. (Note that another option may be to reopen a previously closed workers’ compensation claim.)
In this article, our Las Vegas Nevada workers’ compensation attorneys will explain:
- 1. The appeal of a decision of the insurance company to a Hearing Officer
- 2. The appeal of the Hearing Officer to the Appeals Officer
- 3. The appeal of the Appeals Officer to District Court
- 4. Representation by an attorney
- 5. You must decide how long to pursue your claim
If you disagree with a decision of an insurance company, you 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
You will receive a determination letter about your case from the insurance company. If you disagree with the determination, an appeal can be filed within 70 days of receipt of the letter from the insurance company. 1 2 3
You can also file an appeal if the insurance company does not respond within 30 days to a letter from you objecting to an insurance company action.4
If you win an appeal, you 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 your 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. You 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 you want to raise during the hearing will not be considered
If you win, you receive 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.
The appeal must be made within 30 days of the Hearing Officer’s decision.
2. The appeal of the Hearing Officer to the Appeals Officer
If you disagree 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’s decision.11 The appeal is made by filing a Request for Hearing Before Appeals Officer. The form includes:
- your information
- employer information
- what is being appealed
- reason for appeal
- your attorney/representative
- the 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 your 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 89102Example: 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. You can request the transcript 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 arguments.
A doctor may be required to testify before the Appeals Officer.15
If you need an interpreter, you can request it.
The Appeal Officer can:
- Affirm the hearing officer’s decision
- Reverse the hearing officer’s 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
If you disagree with a decision of the Appeals Officer, you 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 explaining why they should prevail. There may or may or may not be a hearing date set where the parties can argue to the judge 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
You can always have an attorney represent you. An attorney will take a fee from your settlement if you win.
5. You must decide how long to pursue your claim
Your claim is not over when the insurance company makes a decision.
There are multiple chances for you to obtain a favorable decision.
It is up to you to decide how far to pursue your claim. Understanding of the dispute at issue and relevant legal concepts is important, and may affect the workers’ compensation settlement amount that you will receive.
Call us for help…
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.) The odds of winning a workers’ comp case are much greater with an experienced attorney.
For a free consultation to discuss your case simply fill out the form below or call us.
Legal References:
- http://hearings.nv.gov/uploadedFiles/hearingsnvgov/Content/forms/REQUEST%20FOR%20HEARING%20FORM-FY18v2.pdf
- Nev. Rev. Stat. § 616C.315
- Nev. Rev. Stat. § 616C.315(3)(a). See, for example, Seino v. Emplrs Ins. Co. (2005) Elizondo v. Hood Mach., Inc. (2013)
- Nev. Rev. Stat. § 616C.315(3)(b)
- Nev. Rev. Stat. § 616C.365
- See note 1.
- Nev. Rev. Stat. § 616C.315
- Nev. Rev. Stat. § 616C.330
- Nev. Rev. Stat. § 616C.335
- Nev. Rev. Stat. § 616C.345(1)
- Nev. Rev. Stat. § 616C.345(2)
- See note 1.
- Nev. Rev. Stat. § 616C.315
- Nev. Rev. Stat. § 616C.345(12)
- Nev. Rev. Stat. § 616C.350
- Nev. Rev. Stat. §616C.360(9)(a)
- Nev. Rev Stat. § 616C.360(9)(b)
- Nev. Rev. Stat. § 616C.370
- Nev. Rev. Stat. § 616C.370(1)
- Nev. Rev. Stat. § 616C.370(2)
- Nev. Rev. Stat. § 233B.135