What to Do If Your Workers’ Comp Claim Is Denied

Navigating the aftermath of a workplace injury is stressful enough without the added frustration of a denied workers’ compensation claim. If you’re in Nevada and have recently received a denial letter, remember that this setback is not the end of the road.

With the right approach and a clear understanding of your rights, you can challenge the decision and pursue the benefits you deserve. This guide will walk you through the necessary actions, common pitfalls, and specific Nevada regulations to consider as you move forward.

Understanding Why Workers’ Compensation Claims Get Denied

The first step after a claim is denied is to carefully review the denial letter. Nevada’s workers’ compensation system, regulated by the Nevada Department of Business and Industry, requires insurance companies to provide a written explanation for any denial. Common reasons for denial include missed deadlines, incomplete paperwork, disputes over whether the injury is work-related, or a lack of sufficient medical evidence.

Sometimes, a denial stems from simple administrative errors such as missing forms or late submissions. Other times, the insurance company may believe your injury did not occur at work or that you failed to notify your employer in time. 

According to the Nevada Revised Statutes (NRS) 616C.015 and 616C.020, employees must notify their employer of an injury within seven days and file a claim within 90 days to remain eligible for benefits. Failing to meet these deadlines can lead to an automatic denial.

Taking Immediate Action After a Denial

Upon receiving a denial, act quickly. Nevada law gives you a 70-day window from the date you receive your denial letter to file a formal appeal, known as a Request for Hearing, with the Department of Administration’s Hearings Division. Missing this deadline can forfeit your right to further pursue benefits.

Begin by gathering all documentation related to your claim, including medical records, accident reports, witness statements, and correspondence with your employer or the insurance company. This evidence will be crucial in supporting your case during the appeal process.

Appealing a Workers’ Compensation Denial in Nevada

The appeal process in Nevada is structured to give injured workers multiple opportunities to present their case. The first step is the Request for Hearing, which is generally informal and allows you to present evidence before a hearing officer. If you disagree with the outcome, you can further appeal to the Appeals Officer and, if necessary, to the district court.

Throughout this process, it’s wise to seek professional legal guidance. Our attorney has extensive experience helping Nevada workers navigate the appeals process and maximize their chances of success.

Common Mistakes to Avoid During the Appeal Process

One of the most frequent mistakes claimants make is missing important deadlines. As previously mentioned, strict time limits apply at every stage of the process. Submitting incomplete documentation or failing to obtain updated medical evaluations can also undermine your appeal.

Another common error is communicating inconsistently with doctors or employers. Any discrepancies in your account of the injury or gaps in your medical treatment can be used by insurers to challenge your credibility.

Lastly, many workers attempt to navigate the appeals process alone. While it’s possible to represent yourself, having an experienced attorney on your side can make a significant difference. Legal professionals can help you avoid costly missteps, gather necessary evidence, and represent your interests during hearings.

Nevada-Specific Regulations and Resources



Nevada’s workers’ compensation system has unique rules that differ from other states. For example, Nevada is a no-fault state, meaning you do not need to prove your employer was negligent to receive benefits. However, you must demonstrate that your injury arose out of and in the course of your employment.

Key statutes to be aware of include:

• NRS 616C.015: Outlines notification requirements and deadlines
• NRS 616C.345: Details the appeals process and time limits
• Nevada Administrative Code (NAC) 616C: Provides additional regulations and procedures

For more detailed information on these regulations, visit the Nevada Workers' Compensation Section.

Additional Steps and Support

If your appeal is successful, you may be entitled to retroactive benefits and coverage for medical expenses related to your workplace injury. If the appeal is unsuccessful, you may still have options for further review or legal action. Throughout every stage, keep detailed records and maintain open communication with your medical providers and legal representatives.

If you’re feeling overwhelmed by the process, you’re not alone. Many injured workers benefit from consulting with an attorney who understands Nevada’s specific laws and can advocate for their rights. At Ahlander Injury Law, we offer guidance and support tailored to your unique situation. Learn more about how we can help by contacting us today.