Understanding the reason behind your denial is crucial for building a successful appeal. Here are the frequent causes that can occur:

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Missing Critical Deadlines

Nevada has strict filing deadlines that insurance companies use to deny otherwise valid claims:

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• Form C-1 (Notice of Injury): Must be filed within 7 days of your injury

• Form C-4 (Claim for Compensation): Must be completed by your doctor and filed within 90 days

• Appeal deadlines: Only 70 days to appeal a denied claim​

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Hypothetical Example: A warehouse worker injured their back but waited 95 days to file Form C-4 because they thought their injury would heal on its own. The insurer automatically denied the claim due to the late filing, even though the injury was clearly work-related.

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For detailed information about these critical deadlines, see our comprehensive guide on filing a workers' compensation claim in Nevada.

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Form C-4 Errors and Omissions

The C-4 form is the backbone of your workers' compensation claim. Even minor errors can result in denial:

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• Incomplete medical descriptions of your injury

• Vague language about work-relatedness

• Missing physician signatures or dates

• Conflicting information between forms​

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Hypothetical Example: A casino housekeeper developed carpal tunnel syndrome, but their doctor wrote "possible work-related" instead of clearly stating the condition arose from repetitive cleaning motions. The insurance company used this uncertain language to deny the claim.

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Insufficient Medical Documentation

Insurance companies scrutinize medical evidence closely. Common documentation problems include:

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• Gaps in medical treatment that raise questions about injury severity

• Lack of objective medical findings supporting your symptoms

• No clear causal relationship established between work duties and injury

• Pre-existing condition disputes without proper medical differentiation​

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Hypothetical Example: A construction worker hurt their shoulder but delayed seeing a doctor for two weeks while trying to "tough it out." The insurance company argued that other activities during those two weeks could have caused the injury.

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Employer Disputes and Investigations

Employers and their insurance companies may challenge various aspects of your claim:

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• Questioning whether injury occurred at work

• Claiming injury resulted from employee misconduct

• Arguing injury happened during non-work activities

• Disputing the timing of when the injury occurred​

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Hypothetical Example: A hotel maintenance worker slipped on a wet floor during their shift, but the employer claimed the accident happened in the employee break room during personal time, not while performing work duties.

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Work-Relatedness Challenges

Proving your injury "arose out of and during the course of employment" can be complex for certain types of injuries:

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• Repetitive stress injuries that develop gradually over time

• Occupational diseases with long latency periods

• Aggravation of pre-existing conditions

• Mental health conditions like PTSD (see our guide on workers' compensation for Culinary Union members for information about stress-related claims)