When an injured worker wins an appeal for a denied claim with a hearing officer, an employer or insurer may file an additional appeal or motion of stay that impacts benefit payments.
The Appeals Process
A successful reversal of a denied claim does not mean that workers compensation benefits will be automatically paid, even when an insurer is ordered to pay all appropriate benefits. Typically, an injured worker must follow up with the insurer by making specific requests for benefits and filing physician progress reports that document all medical care.
In Nevada, when an injured worker successfully gets a reversal on an adjuster’s action on a claim, the worker’s employer and/or insurer has the right to file an appeal. The employer and/or insurer’s appeal must be filed with 30 days of the hearing officer’s decision. Many employers and insurers wait until the last possible day to file their appeal to delay the claim and payment of workers compensation benefits. By filing a Motion for Stay, the appeal process can be significantly extended.
Most employers and/or insurers who disagree with a hearing officer’s decision choose to file a Motion for Stay, a legal document filed with the appeals office. It asks the appeals officer to order that the insurer does not have to comply with the hearing officer’s order. If a Motion for Stay is granted, it extends the appeals process, so the insurer does not have to pay any benefits until the appeal is decided.
If the insurer files an appeal and a Motion for Stay, the insurer doesn’t have to comply with the hearing officer’s decision until 10 days after the appeals officer rules on the motion. By this time, more than 45 days may have passed since the hearing officer ruled in favor of the injured worker. If the Motion for Stay is granted, the insurer does not have to comply with the hearing officer’s order.
When a Motion for Stay is filed, an injured worker who wins an appeal for a denied claim should file an opposition to the motion. In Nevada, the law allows an automatic stay during the period of time that the Appeals Officer is contemplating to grant or deny the motion. Regardless, if retro-active compensation is at issue the benefits owed by the insurer will be paid in installments, rather than in a lump sum, until the matter is decided on its merits by the appeals officer.