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Common reasons Nevada workers' compensation claims get denied

Submitting a workers' compensation claim can seem fairly straightforward. However, even legitimate claims can end up denied, leaving the injured worker to deal with missed workdays, medical expenses and possible wage reductions.

Working with an experienced workers' compensation attorney can help your claim overcome many potential stumbling blocks. While no one can guarantee you the result you want, a lawyer who understands the complexities that may lurk in a seemingly simple case can increase your chances of receiving the benefits you need.

Worker conduct that may exclude coverage

One common reason for denial is the insurer's suspicion that your own behavior led to the injury. This can be a thorny point, as mere carelessness on your part, such as failing to look where you step, may not necessarily be legitimate grounds for denial.

However, some types of conduct may present a serious obstacle. For example, being intoxicated or engaging in horseplay at the time of the accident may spark a denial. You would need to show that the intoxication or horseplay did not lead to the accident. For example, being drunk could cause someone to take a fall he or she could have avoided sober; on the other hand, if a poorly secured object falls from some scaffolding and hits you, you can argue your intoxication did not affect events.

Incomplete submissions

Submitting a claim can mean completing a lot of paperwork. Leaving out information can result in denial. Even if the omitted information does not seem that relevant, insurance companies tend to be particular about receiving a complete record.

Lack of witnesses

If your claim does not show any witnesses to the accident, insurance companies may claim your injury did not happen the way you say it did. If anyone witnessed your injury, it is important to get contact information. If there are really no witnesses, you may need your doctor to specifically state that your injuries correspond with events as you have stated them.

What to do when you receive a denial notice

If the insurer denied your claim, you can still appeal that decision. Because strict deadlines apply, speak with an attorney as soon as possible after learning of the denial.

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