Getting benefits after you win your case

By Jason Weinstock on August 21, 2015

I have a lot of information on my website, blog posts, and Youtube videos for those injured workers in Nevada who want to represent themselves at hearings.  But it appears that I haven’t addressed an important topic for those of you who successfully contest a claim denial and win your case in front of a hearings officer or an appeals officer.  I have already addressed what to do if an insurer or employer files their own appeal of a hearings officer’s decision that is favorable to you in by blog post that discusses motions for stay orders in “When Is a Win Not a Win”.

Now let me tell you what you must do in order to get compensation benefits paid to you after you get a decision that reverses denial of your claim and orders the work comp insurer to “pay all appropriate benefits”.  Unrepresented injured workers usually interpret their winning decision as meaning that now they will get those hard-won lost time compensation benefits automatically.  Wrong.

What a decision that remands the claim to the insurer for “all appropriate benefits” really means is that now you must follow up with the insurer by making specific requests for compensation benefits and for medical care.  For example, if you have been unable to work since the day of your accident, now you must attach physician off work certificates (usually in the form of Physician Progress Reports) to a written request to the insurer for payment of compensation benefits.  Don’t forget to date your request and to keep a copy of what you send to the insurer.

The insurer, who didn’t want to accept your claim at the outset, is not going to offer you advice on how to extract the money that is owed to you after the insurer loses the claim denial issue.   You must therefore follow up your win with a specific request for benefits and attach the supporting physician off work slips (or physician’s work restrictions when your employer doesn’t have light duty work).

If the insurer doesn’t respond to your written request for benefits within 30 days, you can file an appeal with the Hearings Division on the insurer’s failure to respond (called a de facto denial).  You could also file a complaint with the Division of Industrial Relations that the insurer violated the law by not responding to your request for benefits within 30 days.

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