Celebrating 75 Years of Serving Nevada’s Legal, Business, Government, and Civic Communities

Workers’ Compensation Update: New Senior Appeals Officer and New Local Rules

The Hearings Division of the Nevada Department of Administration has a new Senior Appeals Officer, Dean Hardy, Esq. Following are highlights of changes he is implementing:

  • Website Statistics: The Department of Administration will be posting statistics regarding hearings/appeals on their website at this link: https://hearings.nv.gov/reports/Reports_Stats_Main/
  • E-Filing: The Department of Administration is working on implementing e-filing.  
  • De Facto Denials: The Department of Administration will be focusing on de facto denials and expects insurers/TPAs to respond to requests from claimants within 30 days. The failure to do so could result in being reported to DIR. However, if a de facto denial hearing is improperly requested by a claimant when a written determination has been issued timely within 30 days, it is expected that claimant’s counsel will dismiss the de facto hearing or consolidate the matter with the hearing on the written determination in response to claimant’s request. This should reduce the time spent on litigating improper de facto hearings requested by claimants.
  • Local Rules of Practice: The Department of Administration has implemented new local rules for the Carson City and Las Vegas Appeals Offices, these rule can be found at https://hearings.nv.gov/appeals/Rules_Of_Practice/. Notably, the Appeals Officers will be requiring continuances of hearings to be requested at least 5 days in advance. Also, evidence must be filed by appellants 14 days in advance of the appeal hearing and by respondents 7 days in advance of the hearing.  It is important to ensure continuances are timely requested and update claim files in advance to ensure timely filing of evidence so no evidence is stricken due to a late filing.
  • Calendaring/courtroom management: The Senior Appeals Officer indicated they will be less accommodating with conflicts and will be focusing on pushing hearings to resolution and he expects all parties to be responsive and to communicate. The Hearing Officers and Appeals Officers will be taking a more assertive approach in courtroom management and late submissions. Last minute continuances and late-filed evidence will not be allowed. 
  • Implications of the new Gilman case: The Senior Appeals Officer has focused on the new Gilman case, Gilman v. CCSD, 139 Nev. Adv. Op. 7 (Court of Appeals, Mar. 16, 2023), linked here. This case provides that unless treatment, coverage, a body part, or something else has been denied in a written determination by an insurer/TPA, the claimant is not aggrieved and being aggrieved is a perquisite by statute to filing an appeal as set forth in NRS 616C.220(10) and NRS 616C.315(3). Denial of coverage must be explicitly indicated in writing pursuant to NRS 616C.065(5), (7). A hearing on a written determination that accepts or approves a request from the claimant is considered not appealable as nothing has been denied. It is anticipated that these types of hearings will be dismissed by both the Hearings Officers and Appeals Officers and there should be a decrease in hearing/appeal filings by claimants due to this change. The Gilman case also significantly changes how claim acceptance works. Now, under Gilman, anything not explicitly denied as to coverage or treatment in writing will be fair game under a claim. Meaning, if a claimant seeks to reopen a claim on a new body part, claim reopening cannot be denied because that body part was not accepted under the claim under Gilman.  This means insurers/TPAs should increase their focus on what is accepted or denied.

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