If you are wondering how often the hearings or appeals officer rule in favor of insurers or injured workers, here are a few statistics from the Department of Administration Hearings Division that may give you a rough idea. These statistics are for the state’s fiscal year that runs from July 1, 2011 to June 30, 2012. Statewide, there were 10,643 cases scheduled before the five hearings officers in Las Vegas and the two in Carson City. There were 4,511 cases filed before the six appeals officers in the south, and the three in the north.
Claim denial and medical benefit issues made up 73% of the issues appealed to the Hearings Officers. 34% of those cases affirmed the determination of the insurer, 11% were reversed, 16% were remanded, 22% were dismissed as settled, 8% were dismissed, 8% were bypassed to the appeals level, and 1% is designated as "other". The remanded cases could be a remand for the insurer to make a new determination based on new medical reporting or a second rating obtained by the injured worker.
According to these statistics, the hearings officers resolved 56% of the cases they scheduled for hearing. Claim denial and medical benefit issues comprise 80% of the issues on appeal. The statistics do not show how many appeals from the hearing officers decisions were filed by injured workers or by insurers. They simply show that 29% of the cases heard by the appeals officers affirmed the decision of the hearing officers, 11% reversed the underlying decision of the hearing officer, 36% were dismissed as settled, 19% were dismissed (probably for procedural reasons), and 2% were remanded.
The Nevada Attorney for Injured Workers represented just under a third of the injured workers appearing before the appeals officers, while two-thirds were represented by private attorneys, and a brave 5% represented themselves.
Only 2.3% of the appeals officers’ decisions were appealed to the District Court.
Many of the statistics pertain to compliance by the hearings officers and appeals officers with the statutory times for scheduling cases and rendering decisions. They show a high rate of compliance with the statutory time frames. These statistics are somewhat misleading however with the length of time it actually takes to have a hearing take place before an appeals officer if the parties have witnesses and don’t want to be on the appeals officer’s stacked calendar. A stacked calendar is the first scheduling of the case, and several cases are scheduled for the same appeals officer every hour. As the statistics show, a good number of cases are settled, so it is expected that on the day of the hearing, many of the cases on the stacked calendar will not go forward. However, it sometimes happens that the four cases set for 9 am with a particular appeals officer haven’t settled, and there simply isn’t time for them all to be heard before another four are scheduled to be heard with that appeals officer at 10 am.
The reality is that if you need an hour to present your case to the appeals officer, you need to remove it from the stacked calendar and obtain what is called "a time certain" for a hearing when the appeals officer can schedule an hour or more for just your case. This requires coordination with the opposing attorney who may have a very full calendar and not be available for a more lengthy hearing for two months. Additionally, the appeals officer are now scheduling these "time certain" cases several months down the road. If the injured worker has a denied claim and isn’t receiving benefits at all, this delay in obtaining a hearing can be devastating.