If you have suffered a work-related injury or realized you have a condition that was caused by your job as a first responder, you have the right to workers’ compensation benefits to help pay your expenses. However, to qualify for these benefits, you must take certain steps within specific timeframes to protect your rights.
Like many Nevada laws, workers’ compensation rules establish strict deadlines for each step of the process. If you miss a deadline, you may lose your right to receive benefits. To preserve your rights to the compensation you deserve, follow this general timeline but remember, each case is different so it’s wise to contact your union representative first to fully understand your specific circumstances and whether a qualified workers’ compensation attorney would be beneficial for your case.
A General Timeline for Workers’ Compensation Claims
Since each step of the workers’ compensation claim process depends on a triggering event, this guide will start with the trigger and go forward from there. Again, if you have any questions about what you have to do and when consider scheduling a no-cost consultation with an experienced lawyer.
First Trigger: a Work-Related Injury Occurs or Condition is Discovered
Day 1:
The date of your injury or the date you first discovered a medical condition that is related to your work triggers the entire workers’ compensation (work comp) process. If your injury is an emergency, obviously seek treatment immediately. Otherwise, you should get medical attention from a provider named on your employer’s list of authorized medical providers as soon as possible
Day 7 (or before):
Within the first seven days after your injury or condition appears, you must notify your employer by completing and filing a “Notice of Injury or Occupational Disease – Incident Report” also called a C-1 form. Ask your employer for this form and submit it as soon as possible. If you miss the seven-day deadline, you may be barred from work comp benefits.
Days 1-90:
Schedule your first treatment visit with an authorized care provider from the list your employer provides. At your first appointment, you must complete the “Employee’s Claim for Compensation/Report of Initial Treatment” which is also called a C-4 form together with your doctor. The doctor must submit the C-4 form to your employer and the workers’ compensation insurance carrier within 90 days of your injury.
Second Trigger – the C-4 form is submitted to the Insurer
Within the next 30 days:
The workers’ compensation insurance carrier must either accept or deny your claim in writing. If you do not receive a response within these 30 days, it is considered a denial.
If your claim is accepted, you will receive work comp benefits as determined by your injury or condition, the treatment you require, the length of time you must be off work or working at a modified job with reduced pay, and many other specific details that depend on your personal circumstances.
If your claim is denied, the carrier must tell you that you have a right to appeal the decision to a Hearing Officer and provide a Request for Hearing form that you’ll need to request for an informal hearing with a Hearing Officer.
Third Trigger – Claim is Denied, Pursue Appeal Process
Within the next 70 days:
If your claim was denied by the insurer, or if the insurer fails to respond within 30 days from when you filed, you can appeal the denial or failure to respond. You have 70 days from the date of the denial, or from the date you submitted your claim, to file a Request for Hearing with a Hearing Officer. Your request must be in writing and include a copy of your claim.
After your Request for Hearing is filed:
Your hearing will be scheduled within 5 days from when your request is received at the Hearings Division and the hearing will be held within 30 days. You and the insurer will receive a notice of the hearing date 15 days beforehand.
You must provide certain documents to the Hearing Officer and copies to the insurer. It is recommended that you attend the hearing in person, but you can ask for a teleconference or just submit your position in writing. If you don’t appear and don’t submit your position statement, your appeal will be dismissed.
Important: If you appeal and request a hearing, it is your responsibility to prove your case. You must know the relevant issues and which documentation you’ll need to win. A workers’ compensation lawyer who has handled these types of hearings can be invaluable at this point.
Fourth Trigger: You Disagree with the Hearing Officer’s decision
Within 30 days from receiving the Hearing Officer’s decision:
If you disagree with this decision, you can further appeal your case to an Appeals Officer by filing a “Notice of Appeal and Request for Hearing Before the Appeals Officer” form. This form must be filed within 30 days from the date you receive the Hearing Officer’s decision or you lose your right to appeal the decision.
Within 60 days from filing a Notice of Appeal to the Appeals Officer:
After you file your request for an appeal with an Appeals Officer, your hearing will be set within the next 60 days. This hearing will be recorded and more formal than the last hearing.
At this stage, the Appeals Officer will review the Hearing Officer’s decision, but this officer will also conduct a brand new hearing so both sides need to submit their evidence and documents directly to the Appeals Officer for fresh consideration. The Appeals Officer won’t consider any information you previously sent to the Hearing Officer unless you submit it again or specifically request the prior information be admitted into evidence at the appeal hearing.
The Appeals Officer can affirm the Hearing Officer’s decision, reverse it, or remand (return) the case to the Hearing Officer level for further consideration.
Fifth Trigger: You disagree with the Appeals Officer’s decision
Within the next 30 days:
If you disagree with the Appeals Officer’s decision, you can appeal again and request a judicial review in the Nevada District Court that has jurisdiction over your claim. This request must be made within 30 days of the Appeals Officer’s decision.
The court review does not allow a fresh look at your claim. Instead, the court is limited to looking only at the issues reviewed by the Appeals Officer. You are obligated to file a formal Petition and Brief that explains why the Appeals Officer was wrong. The court may allow a hearing to argue the case in person, or the court can decide the issues based only on the written submissions.
You must show substantial evidence to the court to overcome the Appeals Officer’s decision, and usually, the judge will defer to the Appeals Officer, so these cases are very hard to win. Once more, a tenacious workers’ compensation lawyer can be your best ally throughout the entire process you may face.
Not a Trigger, but an Important Step: Signing a Settlement Agreement
If you receive benefits at the start, or after pursuing your right to a hearing at any of the appeal levels, you may eventually be presented with a settlement offer to close your claim. Be very careful before signing any final settlement document because you cannot undo a settlement, even if your injury or condition worsens in the future. Consult with a knowledgeable workers’ compensation attorney to understand your rights and what you are signing.
The Workers’ Compensation Process is Complicated and Full of Potential Pitfalls
If you are dealing with a work-related injury or condition, it’s important you follow the proper procedures to protect your hard-earned rights. Remember, if the insurer denies your claim, you don’t have to accept the insurer’s decision. You can pursue other steps to get a favorable decision, but you have to decide how far you want to take your case if your benefits are denied.
You don’t need to make these decisions or navigate the claim process alone. Reach out at (702) 840-5555 or fill out the online contact form if you have questions or need a workers’ comp attorney referral.