Workers’ Compensation Section

WCS Basic Orientation

State of NevadaDivision of Industrial Relations

Workers’ Compensation Section

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CHIEF ADMINISTRATIVE OFFICER

CHARLES J. VERREHENDERSON

SOUTHERN DISTRICT MANAGER OF INSURER/EMPLOYER/TPA OVERSIGHT

Angelia Yllas

HENDERSON

PROGRAMS MANAGER

DOCK WILLIAMS

CARSON CITY

NORTHERN DISTRICT MANAGER OF INSURER/EMPLOYER/TPA OVERSIGHT

DEBBIE ATKINSON

CARSON CITY

WCS Mission Statement

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Impartially serve the interests of Nevada employers and employees by providing assistance, information, and a fair and consistent regulatory structure focused on:

• Ensuring the timely and accurate delivery of workers’ compensation benefits

• Ensuring employer compliance with the mandatory coverage provisions

Nevada Statutes & Regulations

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Nevada Revised Statutes

(NRS)

Chapter 616

Industrial Insurance Act

&

Chapter 617

Occupational Diseases Act

http://dir.nv.gov/WCS/Nevada_Law/

Nevada Administrative Codes

(NAC)

Chapter 616

Industrial Insurance Act

&

Chapter 617

Occupational Diseases Act

What is Workers’ Compensation?

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No-Fault

• Benefits to Employees

• Protection for Employers

Mandatory: workers’ compensation insurance coverage with licensed NV Insurer

“Exclusive Remedy”

Types of Insurances in NV

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Self-Insured Employers (SIE)

Self-Insured Associations (SIA)

Private Carriers (PC)

Types Of Claims Administration for

Nevada Workers’ Compensation

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Private Carriers (PC)

Third Party Administrators (TPA)

Self-Administered (SA)

If an Employer/Employee relationship exits, Workers’ Compensation Policy is ALWAYS

Required!

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When is Workers’ Compensation

Required

Who Requires Coverage?

Unless excluded by statute, “…Every person, firm, voluntary association and private corporation, including any public service corporation, which has in service any person under a contract of hire” needs coverage.

(NRS 616A.230)

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The Employer Compliance Unit (ECU) is responsible for ensuring that employers comply with the mandatory coverage provisions.

The ECU conducts employer site visits and the employer must provide evidence of coverage in compliance with NRS 616A.495.

If an employer fails to provide or maintain coverage for workers’ compensation then an order to cease business operations will be issued in accordance with NRS 616D.110.

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Employer Compliance Unit

• Uninsured Employer Investigations

• Cancellation/Lapse Investigations

(National Council on Compensation Insurance, NCCI provides a monthly cancellation list)

• Affirmation of Compliance Forms – D-25

• Referrals or Complaints

• Random site visits

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Employer Compliance Unit

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(Form D-1) Pursuant to NRS 616A.400, 616A.490 & NAC 616A.460

• Must be posted in proper size (8 ½” X 17”)• Most Current poster (10/07)• Provided by Insurer/TPA

• The bottom section must be filled out completely

Form D-22

Notice to Employees

Tip Information

(NAC 616A.470)

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• Incident Report

• Completed within 7 days of accident by injured employee and signed by both employee and employer

• Furnished to employee by employer

• Furnished to employer by Insurer

• Employer to maintain sufficient supply of blank forms

• Completed forms retained by employer for 3 years

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Notice Of Injury Or Occupational Disease

(Form C-1) NRS 616C.015

Form C-4

Employee’s Claim for Compensation/

Report of Initial Treatment

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Physician/Chiropractor required to

send to correct Insurer/TPA within 3

Working Days

Injured Employee has 90 Days to

seek treatment

Initiation Document to file claim in NV

Insurer/TPA has 30 Days to

accept/deny claim

• Provided to employer by Insurer/TPA & must be completed by employer in its entirety

• Upon receipt of Form C-4, employer has 6 working days to complete and mail to Insurer/TPA

• Copy to Employee from the Employer

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Employer’s Report Of Industrial Injury Or Occupational Disease – (Form C-3) NRS 616C.045

Welcome to Subsequent Injury

Purpose: To encourage employers to hire those workers who have a condition that resulted in permanent impairment and reimburse the employer for injuries that are sustained subsequently under that employment.

How do I qualify? How do I submit for reimbursement?NRS 616B.557, 558 and 587

• All these require there be a combined effect between the pre-existing permanent physical impairment and the subsequent injury that, when combined, the costs of the subsequent injury are substantially greater due to the pre-existing permanent physical impairment.

• The pre-existing permanent physical impairment must qualify for at least 6% WPI if it were to be rated by the AMA Guides as adopted by the Division, and

• There must be written documentation of knowledge of the pre-existing permanent physical impairment by the employer at the time the person is hired or, once the employer acquires knowledge, they must retain the person in employment. Knowledge and retention must occur prior to the date of the subsequent injury.

Who decides if I get reimbursement?

• The Board (Self-Insured Employers or Associations of Self-Insured Public or Private Employers) has 120 days after receipt of the request to make a determination regarding reimbursement.

• If the claim is for a Private Carrier, the Administrator has 120 days to make a determination regarding the request.

• Notice of a possible claim under these sections was repealed on October 1, 2007. However, if the claim has a date of injury prior to October 30, 2005, notice of the possible claim is still required.

What if an employee knowingly misrepresents their physical condition?

NRS 616B.560, 581 and 590

• All of these require there be a combined effect between the pre-existing permanent physical impairment and the subsequent injury that, when combined, the costs of the subsequent injury are substantially greater due to the pre-existing impairment.

• There must be proof that the employee knowingly made a false representation related their physical condition when they were injured and that this false statement formed the basis of their employment.

• There must be a causal connection between the false representation and the subsequent disability.

• These statutes require notice be submitted no later than 60 days after the date of the subsequent injury or the date the employer learns of the false representation, whichever is later.

NAC 616B.760 to 616B.779

• These regulations govern how claims should be submitted, the hearing process for the Boards and Private Carriers and time lines for the Administrator to review requests.

• Please note, the regulations for both Boards are in front of the Legislative Counsel Bureau for final review. Once they have been approved by the LCB, there will be a hearing.

• Regulations for the Private Carriers were finalized under LCB File No. R132.14 in June 2016.

Got Questions??

Jacque Everhart

Subsequent Injury Coordinator

702-486-9089

everhart@business.nv.gov

Injured Employees Web Page

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Injured Employees’ Web Page

NAIWNevada Attorney for Injured Workers

WCS complaint forms on website

Based on location of Insurer or TPA

Nevada Attorney General

Workers’ Compensation Fraud Unit

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The Workers' Compensation Fraud Unit is responsible for the investigation of allegations related to claimant, employer, and provider fraud on behalf of the state and self-insured employers. This unit is also generally responsible for the investigation of any fraud related to the administration of workers' compensation.

Fraud Hotline 800-266-8688

http://ag.nv.gov/About/Criminal_Justice/Workers_Comp/

Nevada Attorney For Injured Workers NAIW

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1000 E. William St., Suite 208Carson City, Nevada 89701PH (775)684-7555FAX (775)684-7575

NRS 616A.435-465 empowers the Nevada Attorney For Injured Workers to represent without fee, a claimant before the appeals officer, district court, court of appeals or supreme court. Upon request by an injured worker, NAIW may be appointed by an Appeals Officer.

2200 S Rancho Dr., Suite 230Las Vegas, Nevada 89102PH (702)486-2830FAX (702)486-2844

Email: naiw@naiw.com

http://naiw.nv.gov/

• Hearing Officer (HO) / Appeals Officer (AO) Compliance

• HO (NRS 616C.315)

• AO (NRS 616C.345)

• Stay (NRS 616C.345 and 616C.375)

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Department of Administrative Hearing Division

Claim Administration

• Claim Closure NRS 616C.235

• Notice of claim closure must be mailed to claimant and claimant’s attorney, if applicable

• Notice must describe the effects of closing the claim & time limit for claimant to request dispute resolution per NRS 616C.315 (Hearing Officer)

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Claim Administration

To return the injured employee to gainful employment according to NRS 616C.530 28

Vocational Rehabilitation Objective

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Return to pre-accident employer

Return to pre-accident position

Position with another employer utilizing pre-existing skills

Provide training while working in another vocation

Provide formal training/education

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Priorities – NRS 616C.530

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Selection Process - Random within 5 years NRS 616B.003

Statutory authority to audit the following:Self-Insured EmployersAssociations of Self-Insured EmployersPrivate Carriers

Insurer/TPA Audit

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Investigate Complaints From:• Injured Employees• Attorneys• Employers• Governor’s Office• Legislators• Health Care Providers

Insurer/TPA Audit

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Benefit Penalty

Intentional Violations

Court Orders

Pattern of Untimely Payments

Maintains Panels of Treating and Rating Physicians and Chiropractors

• Monitors raters’ successful completion of Nevada Impairment Rating Skills Assessment Test 33

Medical Unit

Revises Medical Fee Schedule

Reviews Standards of Care (Occupational Medicine Practice Guidelines)

Audits Permanent Partial Disability (PPD) evaluation reports for quality assurance

Enforces medically related workers’ compensation laws

New WCS Websitehttp://dir.nv.gov/WCS/home/

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Join WCS Mailing List

All Forms

Brochures

Newsletters

Important Changes

Links to: • WCSHELP• NRS & NAC

Coverage Verification Servicehttps://www.ewccv.com/cvs/

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Don’t Forget

WCS Email Notification

• Use the form provided in your training packet; Or

• Sign up or update information online

http://dir.nv.gov/WCS/Email_Enrollment/

• Need a Certificate?

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Please fill out the Evaluation Form

WCS Email Notification

Contacting WCS

400 West King Street

Suite 400

Carson City, NV 89703

Phone (775) 684-7270

Fax (775) 687-6305

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1301 Green Valley Parkway

Suite 200

Henderson, Nevada 89074

Phone (702) 486-9080

Fax (702) 990-0364

Email: WCSHelp@business.nv.gov