What are Reasons For Denying a Workers’ Compensation Claim?

In the State of Nevada, there are basically five reasons why workers’ compensation insurance claims are denied. A denial may occur if your injury was a result of horseplay at work, you applied for benefits through fraudulent requests, if your employer disputes the case, if you failed to complete the required steps when making your application, or if the injury occurred at work-related social events that occurred outside of normal work duties. If you are at first denied for benefits, this does not mean that you will not be able to receive benefits for your illness or injury. You have the opportunity to file an appeal within 70 days by following the information regarding your appeal rights that will be included with your denial letter.

Horseplay on the Job

If an injury or illness was obtained while on the job but as a result of horseplay or goofing off, you may receive a denial of your benefit application. However, Nevada law allows for some limited types of horseplay that may arise out of a direct course of your job. There have been cases that were provided benefits after an appeal in regards to horseplay issues such as messing around physically and even throwing objects that resulted in personal injury on the job. While your employer and his or her insurance provider may potentially be looking for any reason to deny your case, the law takes a broader look at the situation in an appeals case. You may choose to file an appeal within 70 days of notification that your workers’ compensation insurance claim was denied, especially if your employer typically condones such types of horseplay during the regular scope of employment. If you are unsure about a case where you were at least partly at fault for any injuries or illness, you might consider contacting an attorney for help with your appeal.

Fraudulent Claims

In order to be eligible for workers’ compensation insurance benefits in the State of Nevada, one of the requirements for receiving such compensation are that you were injured or became ill as a direct result of your job. Your application can be denied if you try to file for benefits by faking an injury or by claiming that a real injury or illness occurred on the job even if it did not. If you receive a denial for benefits that determine your application was based on fraud even though it was not, you may choose to appeal within 70 days. However, the burden of proof will be on you, and you will need to provide additional documentation from co-workers, witness statements, and medical proof that the injury or illness occurred as you stated it did on your benefits application. Many times, it will be of benefit to you to hire a qualified attorney to help you obtain such proof.

 Employer Disputes the Claim

An employer may choose to deny your allegations that any type of accident occurred or that your injury or illness was caused by an incident that occurred during your regular work-related activities. An employer dispute may occur because he or she never received written notice of your injury within the allotted time frame or nobody was around to witness the injury or incident. In addition, this may occur because an employer can decrease his or her insurance costs and liability if such applications are denied. If you receive a denial based on your employer disputing the injury or illness, you can choose to appeal the decision within 70 days. To increase your chances of a successful appeal for Nevada workers’ compensation benefits, you will need additional documentation from witnesses, co-workers, or a physician that specifically state that your injury or illness was caused at your workplace.

Failure to Follow Required Steps while Making a Claim

One of the biggest reasons workers’ compensation insurance benefits are denied in the State of Nevada is due to a problem with the application process. You may receive a denial of benefits for any of the following:

  • • Failure to file the correct forms within the specified time period
  • • Failure to fill out the required paperwork completely and accurately
  • • Failure to provide necessary documentation with your case

This is why it is especially important to turn all completed forms in as quickly as possible so there is no chance to miss any deadlines. Also, when completing the forms, it is important to provide as much detail as possible, including the date, time, and place of the incident, as well as the exact nature of the injury and which specific body parts were affected. You should include any witness statements and physicians reports that are pertinent to your case as well.

After Work Social Events

The insurance provider or your employer may dispute or deny your claim for workers’ compensation benefits if the incident that lead to the injury or illness occurred at a company-sponsored event that was held outside the normal scope of your job duties. However, Nevada law allows for compensation in many cases that involve employer-sponsored events, such as cookouts, picnics, and company sporting events.

In an appeal, additional aspects may be considered regarding your petition, so be sure to have any additional applicable information and documentation that could benefit your case. In cases such as these, you can appeal the denial within 70 days, but it may be beneficial for you to obtain the services of a qualified attorney to help prove your claim.

Nevada Workers Compensation Attorney

If you filed for benefits but were denied due to any of the reasons discussed above, you may benefit from speaking with a qualified attorney who is familiar with workers’ compensation laws and the appeals process. The attorneys at Morris / Anderson law firm have extensive experience in dealing with the application and appeals process and can work with you to protect your rights. If you feel you are entitled to compensation benefits and need help with an appeal, the Morris / Anderson law firm can discuss your options and help you to gather the necessary information to increase your chances at a successful appeal. If you have any questions regarding your claim, contact a qualified attorney to help you.

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