The Nevada workers’ compensation system has undergone dramatic change since 1993. Legislation passed in 1993 made major changes, the most notable of which were focused on cutting costs. Then, in 1995, the Nevada system evolved from an exclusive state fund to a competitive system: the state fund became a domestic mutual insurance company and private insurers were allowed to enter the market in July 1999.
System participants in Nevada were divided in their assessment of the performance of the system. Most workers’ representatives expressed discontent with the current system, raising concerns about the management of claims under the managed care strictures. They also expressed concern that some claims were being unjustly denied, noted that some workers were prematurely released for return to work, and advocated for a shorter window (currently at 30 days) for the insurer or self-insurer to accept or deny a claim.
Most insurers and self-insurer representatives in Nevada were generally satisfied with how the system operated, but raised concerns about rapidly rising medical costs, lifetime claim reopening rights, and their inability to fully settle claims via compromise and release agreements.
The Workers' Compensation Section (WCS) was active in orienting employees, employers, insurers, third-party administrators (TPAs), health care providers and other system participants. For example, WCS conducted bi-monthly orientation sessions for all participants that provided a broad overview of workers' compensation in Nevada and what WCS regulators looked for when conducting and audit.
Statutorily-mandated audits by the WCS were seen as predictable and fair. However, as implemented, the scope of agency audits did not necessarily target many of the core claims processes of the insurers, self-insurers and TPAs that produce the outcomes for workers. When we examined the audit process, we found that while it addressed many specific aspects of claims-handling procedures, it did not target the more serious claims where deficiencies in claims handling may have serious consequences for workers, such as claims with longer wage-loss payments and/or permanent partial disability payments.
No data were available to determine whether Nevada’s approach to ensuring prompt and accurate delivery of benefits was effective. Despite specific statutory claims processing time frames, WCS did not collect and report on measures of payer performance. For example, WCS did not measure the interval from date of injury to first temporary total disability (TTD) payment for all payers.
When rating impairment, mutual selection of an individual from a list of approved raters served to minimize the use of “dueling docs.” Nevada is unusual among states WCRI has studied in that the state agency maintains a panel of physicians and chiropractors approved to rate permanent impairment. If the parties cannot agree upon a panel rater within 30 days, a WCS staff person selects a rater from the list on a rotating basis according to geographical area and area of specialization.
For some workers, the Nevada Attorney for Injured Workers (NAIW) provided a respected and free alternative to representation by private attorneys during litigation. An employer is required by law to carry workers compensation insurance. Should a Las Vegas or Nevada employee become injured or ill due to circumstances surrounding their working conditions, the employee might be entitled to benefits. These benefits could include medical expenses, lost wages, vocational rehabilitation, and death benefits for the surviving family members. Under workers compensation, an injury as a result of, and in the course of the employment may qualify the worker for a workers compensation claim.
If you suffer an injury or illness while on the job, you should immediately seek medical attention. Employers should be notified about the situation as soon as possible so that a claim process can begin. If possible, your Las Vegas workers’ compensation lawyer should be consulted before speaking with the insurance company. A workers compensation insurance company and their attorneys are obligated to the employer, not the injured worker, so consulting with your own Las Vegas workers compensation lawyer can ensure that you receive the full benefits provided by law.
Most liken the NAIW to the role of a public defender in the courts. However, some observers noted that workers may be unaware of the existence of the NAIW and that its role might be expanded to include more assistance to workers navigating the system.
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