The workers’ compensation system in Nevada often favors employers over the legitimate claims of injured workers. Established procedures and guidelines often result in bureaucratic red tape that strangles legitimate claims and prevents workers from receiving fair compensation for injuries sustained on the job. It is a growing problem and workers and lawmakers are starting to fight back.
Common Reasons for Claims Denials
There are numerous reasons a workers’ compensation claim may be denied. Missed deadlines are a common reason for denial. In Nevada, workers must file a notice of injury within seven days of the incident. Similarly, workers and their physicians must file a claim for compensation within three business days of treatment. These are very tight deadlines and missing any of them can result in an insurer denying a claim.
Claims are also commonly disputed by employers and their insurance providers. Many argue that the injury is not work-related even when there is clear evidence establishing the cause of the injury and the effect it has on the individual’s ability to work. It is especially problematic when long-term exposures to chemicals, repetitive stresses, etc. create cumulative injuries that take years, and sometimes decades to manifest.
Finally, claims are frequently denied when workers are fired, laid-off, or quit as a result of their injuries. While it is against the law, it is not uncommon for employers to terminate workers who report unsafe working conditions or file a claim for a work-related injury.
Fighting Back Against Unfair Denials
Survivors are fighting back against a system that often favors employer positions over employee rights. Several high-profile lawsuits have been filed in recent years that highlight how significant the problem is in Nevada.
One example is the case of Russell Anthony Tracy who died in September 2017. Tracy was employed by Olson Precast Concrete and he died when he fell 20 feet through an open manhole cover. The manhole was not properly guarded at the construction site where he was working and the Nevada Occupational Safety and Health Administration fined his employer $82,000 for their negligence. In all, OSHA cited the company for 14 different safety violations that contributed to causing Tracy’s death.
However, even though the employer’s negligence was clearly the cause of Tracy’s death, Olson Precast Concrete denied his widow’s workers’ compensation claim. This forced her to appeal the decision which may take years to resolve. Her situation is not unique and there are many thousands more that are similar.
Recovering compensation after a work injury can be a long process and employers know how to game the system. It starts with a denial which can then be appealed to the Department of Administration Hearings Division. At this point, the hearing officer will hold an informal hearing and issue a decision via the mail. This can be appealed at which point an appeals officer will hold another hearing and then issue a final decision.
If this is appealed by either the employer or employee, it goes before the Clark County District Court to make a decision. But, that’s not the end of it. Either side can appeal to the Nevada Supreme Court. This process can take years to complete. In the interim, injured workers have to bear the costs and burdens associated with medical expenses, rehabilitative care, diminished income, reduced quality of life, etc.
Lawmakers Seek Reforms
Over the past few years, delays and denials have become increasingly common. A pattern of deliberate delays and stonewalling of legitimate claims have created considerable hardships for injured workers in Nevada. While the law requires a decision within 30 days of filing a claim, claims adjudicators often flagrantly ignore this deadline or rush claims through without giving them proper consideration.
This raised the attention of state lawmakers including Nevada Assemblyman Mike Sprinkle who are currently investigating the issue. Of chief importance to the legislative body is determining where the breakdowns are occurring and identifying ways to streamline the claims process and provide stronger protections for claimants whose claims are improperly dismissed.
The Importance of Determination & Documentation
Fighting a claims denial requires dogged determination of the injured party and their work injury lawyer as well as thorough documentation of all aspects of the case. The current system favors employers who deliberately deny legitimate claims hoping that the processes and procedures of the appeals process will deter claimants from pursuing compensation. Countering this requires strict adherence to deadlines, thorough documentation of the injury including the cause of the injury and the impact the injury has on the individual’s health, ability to work, and quality of life. The stronger the documentation, the less likely an employer will be able to deny the claim and prevail at the worker’s expense.