A quick look at the timeline for filing a workers’ compensation claim in Nevada. Contact me for a free consultation or case review.
A quick look at the timeline for filing a workers’ compensation claim in Nevada. Contact me for a free consultation or case review.
Frequently I am asked by potential clients and current clients whether there is a settlement at the end of their workers’ compensation case or how much their case is worth. This question is often hard or impossible to answer. Sometimes, I can estimate whether I think you are likely to have a permanent partial disability (PPD) award and ballpark what I think it might equate to. However, your PPD award or workers’ compensation settlement is a figure that is based on your rating percentage, your age, your average monthly wage, and a figure from the applicable annuity table. For purposes of this blog a PPD award and a workers’ compensation “settlement” are the same thing. Below are 3 things to check to determine if your PPD award / workers’ compensation settlement is correct.
Your average monthly wage is a figure that is determined by your workers’ compensation adjuster, which they use to calculate your temporary total, temporary partial, permanent partial, and permanent total disability benefits.
The workers’ compensation insurance adjuster will request your wage information from your employer through a D-8 form. There are two ways to calculate average monthly wage, through a 84 days and 1 year wage history. The workers’ compensation adjuster should also factor in any concurrent (second job) employment you had at the time of the injury. The adjuster must use the highest average monthly wage figure.
The higher your average monthly wage the higher your PPD award / workers’ compensation settlement.
An annuity table is a set of figures that conform to a person’s age, the inflation rate, interest rates, and life expectancy. These tables are created by an actuary and adopted by the Division of Industrial Relations (DIR) every year on July 1st. The workers’ compensation insurance company must use the table that has been adopted by the DIR at the time the injured worker accepts the PPD award. Meaning if your workers’ compensation adjuster made the PPD award offer on June 28th and you accept the award on July 2nd they must recalculate the PPD award using the new tables. The current annuity table can be found here.
At the end of all your treatment for a work-related injury your workers’ compensation doctor will state whether you have a ratable impairment. A ratable impairment means you have a lasting effect from the injury you suffered at work, otherwise known as a permanent disability. A permanent disability does not always equate to the same thing as a disability in the eyes of, for example, social security disability. In workers’ compensation this permanent disability if established using the AMA Guides to the Evaluation of Permanent Impairment. Nevada uses the 5th Edition of the AMA Guides to the Evaluation of Permanent Impairment. Your percentage of impairment can be determined by your symptoms, your range of motion, and the type of treatment you had.
Common errors made my rating doctors include incorrect apportionment (subtracting from the total impairment for possible prior injuries), not evaluating all accepted body parts, and not thoroughly examining the medical records.
The higher the impairment percentage the higher the PPD award / workers’ compensation settlement.
A lot of clients have this question. Frustration often sets in immediately after the injury, but can be made worse if the injured employee feels she is not being treated fairly at work, is not receiving TTD (pay for being out of work) benefits, receiving TTD benefits, or their employer is not following their work restriction. Many times I have heard from clients that their employer/ co-workers are harassing them about being injured, that they cannot survive on 66 and 2/3% of what they were making, or that their employer is requiring them to work beyond the restrictions given by their doctor. These problems led to the question, “can I find a new job?”
In short, my answer is usually “yes.” However, I always have to warn my clients that looking for a new job requires an understanding of three very important things: 1) if you quit your job, you are no longer entitled to TTD benefits; 2) your new job must fall within your work restrictions; and 3) you need to let the workers’ compensation insurance company know about the new job.
An injured employee is entitled to TTD benefits when their employer either has no light duty work, that complies with the doctor’s work restrictions, or when the injured employee is taken off work completely for a period of time by the doctor. TTD benefits are paid at 66 and 2/3% of the injured worker’s average monthly wage. The benefits continue to be paid until either the doctor releases the injured worker to work “full duty” or until the employer offers a light duty job position that complies with the doctor’s work restrictions.
If an injured employee voluntarily takes themselves out of the work force by either quitting or going on FMLA leave, the workers’ compensation insurance adjuster can stop TTD benefits.
Yes. If an injured worker gets a new job, while they have work restrictions from a workplace injury at another job, the injured worker cannot work outside of those work restrictions for a new employer. An injured worker must notify the new employer of any work restrictions they may have to be sure the new job will not exceed them. Working outside your work restrictions can negatively impact a workers’ compensation claim in the following ways: 1) give an adjuster reasons to deny further treatment, 2) give an adjuster a reason to issue claim closure, and 3) give an adjuster a reason to pursue a claim for workers’ compensation insurance fraud with the Attorney General’s office.
Yes. The workers’ compensation insurance company needs to know about the new job for two reasons, 1) so that they can stop TTD benefits, and 2) so they can confirm you are working within your work restrictions. An injured worker cannot both collect TTD benefits and work a new job, doing so may cause an adjuster to file a claim for fraud.
A construction worker gets hurt at work and is placed on restrictions by a doctor making him no longer able to perform his typical work duties. The injured construction worker shows his work restrictions to his employer, who then says he has no light duty work. (The injured construction worker then is eligible for TTD benefits.) The injured construction worker finds an add for a call center that pays more than his TTD benefits do. The injured construction worker interviews with the call center and informs them that he is only allowed light duty work and cannot lift more than 10lbs. The call center says that is fine. The injured construction worker then quits with the construction company and starts working for the call center. The injured “former” construction work then calls and notifies his workers’ compensation insurance adjuster that he is working a new job that falls within his work restrictions.
For Fiscal Year 2021, which began on July 1, 2020, the maximum average monthly wage used to calculate workers’ compensation benefits has increased to $6,275.73. This is applicable to injuries on claims filed after July 1, 2020. If you have a claim established already, this increase will not affect your benefits. The maximum temporary total disability benefit in Nevada is 66 2/3 of the maximum average monthly wage. That means that if the injured worker is off work due to the injury for a month, or her employer does not have light duty work within the doctor’s restrictions, she will receive $4,183.82 in compensation benefits that month. The usual 14-day payment will be $1,924.16. Each day in the pay period is counted, including Saturdays and Sundays, when calculating compensation benefits. The daily rate under the new maximum average monthly wage is $137.44
The average monthly wage used to calculate off-work benefits is also an important factor in determining how much money an injured worker will received if she has a permanent impairment, as defined by the criteria in the AMA Guides to Evaluation of Permanent Impairment. If the adjuster sends you a letter with your average monthly wage, and it seems too low, do not neglect to do something about it, even if you are not losing time from work. You could lose a significant amount of money by not making sure that the average monthly wage is as high as it should be when it is time to calculate a PPD award.
The average monthly wage at the time of the injury also controls the amount of compensation benefits if the claim is ever reopened in the future. Your original injury may have occurred ten years ago when you were making a lot more money, and you will want that average monthly wage to be used. If you need to reopen your claim now and will be out of work again for another surgery, your benefits will be based on what your income was 10 years ago.
Remember there are two ways to calculate average monthly wage: 1) 84 days wage history, and 2) an one-year’s wage history. The insurance company must use which ever is higher, when establishing your average monthly wage for workers’ compensation benefits. It does not cost anything to check with a reputable attorney about whether your compensation benefits are calculated correctly and whether you should be proceeding on a reopened claim as opposed to a new claim.
In a previous blog post I talked about SB 381, which was passed in the 2019 legislative session. SB 381 created some much-needed changes and added regulation in how the Division of Industrial Relations (DIR) compiles their treating provider list. Prior to SB 381 the DIR’s treating provider list had over 4,000 providers, 50% of which were either not practicing anymore, not seeing workers’ compensation patients anymore, or were deceased. SB 381 required the DIR to have doctors complete a new application and then develop a new master list for insurance companies to use in creating their lists. July 1st has arrived, and the new treating panel of workers’ compensation doctors is now posted! Click here to see the new DIR Treating Panel of Providers and Chiropractors list.
The race is on! Workers’ compensation insurance companies now have until October 1, 2020, to complete their provider lists using the doctors on the DIR’s list. SB 381 also requires insurance companies to have at least 12 providers/doctors per specialty. The specialties include orthopedic surgery (which has 9 subcategories all of which must have 12 providers/doctors), neurosurgery, neurology, cardiology, pulmonology, psychiatry, pain management, occupational medicine, general practice, and chiropractic. All other specialties/disciplines must contain at least 8 provider/doctors unless the DIR’s list contains less than 8.
This is a huge change for insurance companies that for years were getting away with only having 2 or 3 doctors in each specialty. Once the insurance companies make their list, which must be complete by October 1, 2020, they must then send their lists to the DIR. The DIR will then publish these lists on their website for all to see. These lists will lock the providers/doctors “in,” as insurance companies will no longer be able to remove doctors without one of six reasons laid out in SB 381. The days of insurance companies removing doctors overnight because they did not like what the doctor was saying are over!
More doctors, more choice! Injured workers will have more doctors to choose from within the first 90 days of the claim. Injured workers will be able to go online and see exactly who is on their insurance company’s provider list. NRS 616C.090 gives injured workers the right to choose their doctor for a transfer of care within the first 90 days of their claim, and now they will have at least 12 doctors to choose from for most specialties.
No. There are still excellent doctors that did not make the list and efforts are underway to try to get them added. I expect the DIR’s list will change over the next few weeks as more doctors are added. There are still a lot of the same names and doctors that I am not a huge fan of, but this is a great first step. I am excited for the future and I believe injured workers should be too!
In 2015 Attorney Virginia Hunt, along with a group of other claimant’s attorneys, determined that the Division of Industrial Relations (DIR) had been slacking on their statutory duties to update the actuarial annuity table used in the calculation of permanent partial disability (PPD) awards. It was determined that the actuary table being used had not been updated for something like over 15 years. This led to claimant’s getting much less than they deserved. After Ms. Hunt passed other attorneys continued the fight and the DIR has been updating their tables ever since. The new 2020 actuarial tables released on June 23, 2020, go into effect on July 1, 2020.
PPD awards should increase! With the interest rate dropping from 2.98% in 2019 to 1.46% in 2020, injured workers will see an increase in their awards. These actuarial tables are used in combination with an injured worker’s average monthly wage, age, and percentage of impairment to calculate the PPD award.
It is necessary to have the actuarial tables and the correct statutory formula to correctly calculate the award. (See DIR forms 9a and 9b). Injured workers with the same percentages of impairment for the exact same injury will receive different PPD awards depending on how much money they were making at the time of their accidents, and how old they are.
The PPD award needs be calculated at the time it is accepted. Meaning if you received your award offer letter on June 26, 2020, but do not accept it until July 5, 2020, then the insurer will need to recalculate the award using the July 1, 2020, actuarial tables. The day the award is accepted does not matter; it is the month in which it is accepted that is important.
The new actuarial annuity table can be found here.
An injured worker may accept a PPD award in a lump sum or may elect to receive the award in installments until she is 70 years old. Awards taken in a lump sum are reduced to present value. If the injured worker’s impairment was greater than 30%, only the equivalent of a 30% PPD can be taken in a lump sum. The percentage over 30% is paid in installments.
Although the PPD percentage is not based on an injured worker’s ability to return to work, the percentage does govern the length of a retraining program that can be offered if the injured worker is entitled to vocational rehabilitation services. (See this blog on vocational rehabilitation for more information.)
Please note that this is only a summary of how permanent partial disability awards are determined in Nevada. Pertinent statutes and regulations are: NRS 616C.100, NRS 616C.490, NRS 616C.495, NRS 616C.110, NAC 616C.1162, NAC 616C.103. Many attorneys offer a free review of a PPD rating report for signs of obvious errors.
On June 4, 2020, the Senior Appeals Officer at the Nevada Department of Administration, Appeals Division, released a statement regarding the Department of Administration’s plan to reopen. June 4, 2020, also marked the start of casino reopening, a major step in the economic recovery for Nevada. The Senior Appeals Office is putting in place a 5-phase plan to reopen the Department of Administration, that puts safety of their employees, attorneys, and injured workers to the forefront. Below is a recap of the workers’ compensation COVID-19 update issued by the Senior Appeals Officer.
Though many claimants, attorneys (on both sides), and hearing/appeals officers would like things to return to “normal,” I applaud the Senior Appeals Officer for giving some guidance and providing clearer guidelines to a reopening and “new normal.”
The Department of Administration is still behind in scheduling hearings and appeals that were filed, as there were over 1500 hearings and appeals filed during the closure. Patience and understanding is going to be necessary as we all await hearing and appeal dates.
Getting hurt anywhere can be a scary experience but can be even more frightening when it happens at work. On top of the pain associated with the injury, my clients often also express fear of losing their job and costly medical bills. It is important to remember that accidents happen, and Nevada’s workers’ compensation system is a non-fault system. A valid work injury covered by workers’ compensation insurance provides the benefit of covering your medical treatment with no out-of-pocket costs, unlike private health insurance. Here are 4 steps to take if you’ve been injured at work:
Work accidents happen in many ways and result in different forms of physical or mental injuries. Your health and safety should be your first concern. It should also be your employer’s first concern. Evaluate your injury and seek first aid or call for help depending on severity. Sometimes assessing the injury only requires taking a second to sit down and catch your breath, or sometimes it requires emergency transport to a hospital. Take a second to recognize what happened, what hurts, and what immediate treatment you might need.
Tell your employer about the accident or injury immediately or as soon as possible. NRS 616C.015 requires an injured employee to notify their employer of the injury “as soon as practicable, but within 7 days.”
Too often I have clients that come to me with a denied claim because they did not report the injury to their employer within the 7 days. Their reasoning is not that they didn’t actually get hurt at work but rather they wanted to wait to see if they got better before they “made it a big deal.” While this is completely understandable and in the “real world” a totally normal thing to do, workers’ compensation insurance companies will use this against you.
An example of this is a construction worker who is lifting something heavy, hears a pop and feels pain in his back. He takes some Tylenol and thinks he will sleep it off over the next few days. Eight days later he realizes his back is not getting better and he tells his employer about the injury.
I recommend telling your employer of the accident and injury as soon as it happens, if possible, even if you do not know the severity yet. Your employer should have you complete a C-1 Form also called a Notice of Injury or they may have their own accident report forms. Ask to complete a written accident statement if one is not automatically given to you to complete.
Although this also falls under number 1 (assess your injury), it is important to mention it again for injured employees like those in the example above. Completing a C-4 Form, also known as a Request for Compensation, is what starts initiates the workers’ compensation insurance claim. This form must be completed by a doctor within 90 days. You may not feel that your injury is severe enough to seek medical attention the instant it happens, that is why the legislature allows you 90 days to see a doctor and file a claim for compensation per NRS 616C.020.
Using the example above, let’s say the construction worker told his employer of the pop and pain in his back the day it happened but wanted to see if the pain would go away on its own in a few days. Even if the construction worker waits 2 months (I DO NOT RECOMMEND THIS), he would still fall within the statutory requirement of reporting a claim within 90 days.
Many workers’ compensation attorneys, like myself, offer free consultations and will review your case with you. Although not every workers’ compensation claim will require an attorney’s assistance, taking advantage of a free consultation is always a good idea.
I recently wrote a blog on the types of benefits offered by workers’ compensation insurance. An experienced workers’ compensation attorney will be able to ensure you are receiving all the benefits that you are owed. An experienced workers’ compensation attorney can help you gather evidence and medical records and will also be able to assist in finding the appropriate doctor or getting treatment approved.
A few weeks ago, I posted a blog regarding “5 Mistakes That Can Affect Your Nevada Workers’ Compensation Claim.” Number one on the list was missed filing deadlines. Filing deadlines refers to filing claims with the insurer, giving notice to your employer, and filing appeals to the Department of Administration. However, there are many deadlines that may affect your claim and they can expire fast. Below are some time deadlines for a Nevada workers’ compensation claim that you should keep in mind!
This is not an exhaustive list of all the rapid time deadlines for a Nevada workers’ compensation claim, but it does cover a majority of the most missed deadlines.
If you are injured at work, it is important to know what you are entitled to and what are Nevada workers’ compensation benefits. The Nevada Industrial Insurance Act (NIIA) is the act that governs Nevada’s workers’ compensation in conjunction with NRS 616 – 617 and NAC 616 – 617. In short Nevada’s workers’ compensation benefits can be broken down into “7 types of benefits injured workers may be entitled to.”
One of the main goals of the NIIA is to return an injured worker to preinjury condition/health. This entails getting them proper treatment at no cost to them. When an employee gets hurt at work one of the first steps in initiating a claim entails going to a doctor and completing a C-4 Form.
Once a claim is filed with the workers’ compensation insurance company, the insurer has 30 days to accept or deny the claim. During this time, the injured worker can treat with the physician that completed the C-4 form or any physician that doctor refers the injured worker to, if approved by the insurer.
Once the claim is accepted, insurers have providers list which the injured worker can treat with. Unlike private health insurance, there are no co-pays or out-of-pocket medical expenses for the injured worker to pay for when treating for their work injury. Workers’ compensation insurers help schedule treatment, testing and pay for prescriptions.
When an injured worker is taken out of work due to their injury for more than 5 consecutive days or is working light duty, but making less than they normally would, they may be entitled to compensation. The amount of compensation depends on the injured workers’ average monthly wage at the time of the injury. Benefits are paid at a rate of 66 and 2/3% of the injured workers’ average monthly wage.
Temporary total disability (TTD) benefits are paid when the injured worker is taken completely off work due to the doctor’s work restrictions or if the employer has no “light duty” work that falls within the doctor’s work restrictions.
Temporary partial disability (TPD) benefits are paid when the injured worker is working light duty but making less than his/her calculated daily rate (or less than 66 and 2/3% of their preinjury average monthly wage).
At the end of all the injured worker’s treatment, their treating physician will indicate that the injured worker is “stable,” at maximum medical improvement, and whether there may be a ratable impairment. If the treating physician does indicate there is a ratable impairment the insurer has 30 days to schedule a permanent partial disability (PPD) examination.
The PPD examination is done by a licensed rating physician, who uses methods prescribed by the American Medical Association Guides to the Evaluation of Permanent Impairment to determine a percentage of whole person impairment. This percentage of impairment is used to determine settlement amounts and the length of vocational rehabilitation, if an injured worker is entitled to vocational rehabilitation.
Permanent total disability (PTD) benefits come into play if an injured worker is injured so severely that he/she cannot return to any form of employment again. Injured workers’ eligible for PTD receive monthly payments for life.
If an injured worker is released from their treating physician with permanent work restrictions, meaning they can never return to their preinjury employment, their employer has to offer a permanent light duty job position. If their employer cannot offer a permanent light duty position, the injured may be entitled to vocational training. This is where the injured worker can attend schooling to learn a new skill or trade that will assist them in finding meaningful employment.
The schooling is paid for and the injured worker receives bi-weekly maintenance checks (similar to TTD benefits). If the injured worker does not want to attend schooling, they may request a lump sum buy-out in lieu of vocational rehabilitation.
In the event of an injured workers’ death which is the result of a compensable work injury, his/her dependents may be entitled to the financial benefits that the injured worker himself/herself would have been entitled to.
Nevada’s workers’ compensation system also allows for additional benefits including mileage and travel reimbursement. Mileage is paid at a current rate of 57.5 cents per mile and this amount is subject to change every year on January 1st. If an injured worker lives out of state and is required to come to Nevada for medical treatment, the injured worker may be entitled to have their hotel and food paid for while in Nevada for the medical treatment. Additionally, there may be times when prosthetics or other claim related expenses would be covered by the insurer.
Although the above list of workers’ compensation benefits is a good basic overview, I recommend consulting with an experienced workers’ compensation attorney, as eligibility to each of these benefits requires a case-by-case analysis.