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6 Reasons Your Workers’ Compensation Claim Was Denied

Each year, millions of people across the country are injured or killed in work-related accidents. In Nevada, an employee may be entitled to workers’ compensation benefits so long as they’ve sustained an injury or illness while performing the required duties of their job. Ideally, this state-regulated insurance program protects employees by offering life-saving benefits that account for their costly medical expenses and lost wages. However, it also protects employers from lawsuits, which is why workers’ compensation is an employee’s sole means of recompense per the “exclusive remedy rule.”

According to the Nevada Revised Statutes §616C.050, an injured employee can pursue the following benefits:

  • Temporary Total Disability (TTD)
  • Temporary Partial Disability (TPD)
  • Permanent Partial Disability (PPD)
  • Permanent Total Disability (PTD)

While this program encompasses many work-related injuries and illnesses, it’s not unusual for employers and their insurance companies to deny a legitimate workers’ compensation claim. After all, insurance companies are committed to protecting their bottom-line, and employers don’t want to pay for increased premiums. For this reason, it’s critical that you contact an experienced workers’ compensation attorney before completing and filing your initial claim.

Insurance companies habitually reject workers’ compensation claims for the following reasons:

  1. The employee failed to report their injury in a timely manner. You need to report the injury or illness to your employer as soon as possible. This notification should be dated and in writing to protect your claim.  If you fail to report your condition within the appropriate time period, your employer or the insurance company may claim that your injuries aren’t serious enough to warrant benefits.  
  2. The claim wasn’t filed correctly. Per Nevada’s Workers’ Compensation law, there are certain steps that need to be completed before an employee can file a compensation claim. For instance, you have 90 days to file a claim after you’ve been injured in an accident or have become aware that you’ve incurred an occupational disease.
  3. The employee didn’t pursue medical assistance. Many employees make the mistake of forgoing medical treatment because they don’t realize the extent of their injuries after a minor or serious accident. Once an incident occurs or you’re aware of an illness, you need to seek medical assistance as quickly as possible. A trained medical professional can treat your condition and prescribe essential medications that halt the development of aggressive and life-threatening symptoms or side effects. Also, your updated medical record serves as proof that your condition is legitimate and necessitates workers’ compensation. If you fail to take this step, your employer’s insurance company may have grounds to deny your claim.
  4. The employee was goofing off or under the influence of drugs or alcohol when the injury occurred. Every insurance company will thoroughly investigate the circumstances surrounding a claim before issuing benefits to an injured employee. Your employer’s insurer has grounds to refute your claim if their investigation determines that you sustained injuries because you were fooling around or under the influence of an illegal substance during work hours.
  5. The employer disputes the claimant’s injuries. As previously stated, many employers deny workers’ compensation claims because they don’t want to pay increased premiums or deal with a potential OSHA investigation. To avoid this scenario, your employer may try to counter your claim by alleging that you weren’t clocked in or working, were running personal errands, or were involved in some form of misconduct that caused the incident. At Bernstein & Poisson, we can help you collect evidence – including witness testimonies and medical records – that support your case and secure your right to benefits.
  6. The employee files a claim after quitting a job or being fired. Insurers rarely accept workers’ compensation claims that are filed after an employee has been fired or quit their job. No matter the validity of your claim, the insurance company will likely view your request as an act of retaliation against your former employer. Of course, there are scenarios and extenuating circumstances that need to be addressed; for example, if a worker sustained an injury after giving two weeks’ notice, they may still have grounds to request benefits through a workers’ compensation claim. Sadly, it’s also not uncommon for an employer to fire a worker who pursues workers’ compensation. If you find yourself in this situation, it’s imperative that you contact an attorney immediately.

Explore Your Legal Options Today

At Bernstein & Poisson, our lawyers have a comprehensive understanding of the legalities and regulations surrounding the workers’ compensation program. We can guide you through each step of this legal process and help you secure the benefits your situation warrants. Our experienced team can investigate the incident that led to your condition, review your claim, negotiate with shrewd insurance company representatives, and even help you appeal a denial. If possible, we can also aid you in maximizing your financial benefits by pursuing third-party monetary recoveries. By filing a claim against a third-party individual or company, you may be entitled to damages that cover your existing and future medical expenses, loss of earnings, property damage, and various non-economic damages.

Discuss your case with a qualified legal representative. Contact Bernstein & Poisson at (702) 602-8869 to schedule a free, no-risk consultation. If your injuries prevent you from coming to our office, we can meet at your home or hospital room. We’re available 24/7!