While most workers compensation (WC) claims in Nevada are handled appropriately, there are times when a complaint might need to be filed with the Division of Industrial Relations (DIR) against an insurer or a Third Party Administrator (TPA) for negligence or bad faith practices. These negative practices may include denial or delay in providing necessary medical treatment or in providing compensation benefits for which the injured worker is eligible to receive. In the past, an injured worker could hire the services of a knowledgeable attorney to file suit against these WC workers. However, the law has changed to prevent the injured worker from taking any type of legal action against an insurer or Third Party Administrator who violates the law regarding approval or distribution of workers compensation benefits in the State of Nevada. The only option that an injured worker now has is to file a complaint in writing to the Division of Industrial Relations.
There are special rules that govern workers compensation. These are called the Nevada Revised Statutes (NRS). NRS 616D.030 was passed into the State law in 1995 to no longer allow injured workers to bring any type of legal action against the insurer or the Third Party Administrator involved in their WC claim. Even if the actions, or lack of action, taken by the individual involved in the WC claim results in harm to the injured worker, the “exclusive remedy” left to injured workers against insurers or Third Party Administrators who act in negligence or bad faith is to file a formal, written complaint to the DIR against the WC worker handling the claim.
Filing a Complaint with the DIR
When an injured worker is denied benefits or is delayed financial compensation or necessary medical treatment because an insurer or TPA violates the law regarding WC, the worker can file an official type of grievance with the Division of Industrial Relations. The allegations against the insurer or TPA handling the WC claim should be sent to the DIR in writing. While it is not required that a special form be used when filing a grievance against a WC insurer or a TPA, there is a special complaint form that may be used. The injured worker should be thorough and detailed when reporting a problem with the insurer or the TPA. The injured worker’s attorney may help with this form or the worker may contact the Nevada Attorney for Injured Workers for more information or legal advice.
What Does This Accomplish?
Once the Division of Industrial Relations has received the written grievance, an investigation can take place. An investigator will contact the WC worker that is accused of not handling the claim according to workers compensation laws, will be questioned regarding the issues. If the insurer or Third Party Administrator is found to be at fault, fines may be imposed. These fines may consist of an administrative fine and a benefit penalty. As of 2013, the administrative fine is to be set in the amount of $1,500.00 for the initial offense, and $15,000.00 for the second or any subsequent violations. The benefit penalty is based on the harm that resulted to the injured worker based on the insurer’s or the TPA’s violations, and may range from $5,000.00 to $50,000.00. Administrative fines are paid to the DIR, while any benefit penalty is paid to the injured worker in the claim. Not every official complaint filed will result in administrative fines or benefit penalties being imposed against the negligent insurer or TPA involved in the claim. In addition, the insurer or TPA may file an appeal regarding the DIR findings and any fines imposed. However, repeated violations may result in license suspensions or revocations if the insurer or the TPA continues to disregard WC laws.
Does a Complaint Filed with the DIR Help Me Recover My Benefits?
When an injured worker files a grievance against an insurer or a TPA due to violations of WC law, the subsequent investigation remains limited to the specific matter of the WC worker’s legal negligence. This investigation does not concern reversal of any decisions made by the insurer or TPA. Injured workers who wish to appeal any decisions made by the adjuster in their claim must follow the appeals process as set forth in the WC guidelines.
Experienced Workers Compensation Attorney
Injured workers who need assistance with their WC claim can contact an experienced attorney with the Morris/Anderson Law Firm. From assistance in filing documents in a timely manner to assisting with appeals or complaints, the Morris/Anderson Law Firm can help injured workers to receive the compensation and medical care that they are eligible to receive.Go to the Next Article