Transcript Slide 1

State of Nevada
Division of Industrial Relations
2009 Legislative Changes
W
orkers’
Compensation Section
Legal Disclaimer
• While every effort has been made to be
comprehensive, this overview is not guaranteed to
be all inclusive
• Those interested are strongly encouraged to read
the bills in their entirety at:
www.leg.state.nv.us
Select 2009 session>Bill Information
• If you need legal interpretation, please see
your attorney
2
Reminder
•
NRS 616C.425 Date of determination of
amount of compensation and benefits. Except as
otherwise provided by a specific statute:
•
1. ... compensation and benefits [are] ... determined
as of the date of the accident or injury ...
•
2. ... subsequent injury or disability that primarily
arises from a previous accident or injury,... the date of the
previous accident or injury must be used to determine the
amount of compensation and benefits to which the claimant
is entitled.
3
2009 Legislature Changes for
Workers’ Comp
AB 24
AB 521
AB 173
SB 6
AB 214
SB 195
AB 281
SB 361
AB 410
SB 363
4
Bills “Areas of Interest”
• Personnel Matters
• Claim Processing Changes
• Medical
• New Insurance Plans
5
Bills “Areas of Interest”
• Other Regulatory Matters
•TPAs
•PEOs
•Collective Bargaining
• Benefits
• Fines/Penalties
6
Personnel
Matters
7
Personnel Matters
AB 173 – Occ. Disease
& Arson Investigators
Existing law establishes diseases of the lung and
heart as occupational diseases of firefighters
and police officers. (NRS 617.455, 617.457)
Sections 5 and 6 of this bill provide that such
diseases are also occupational diseases of an
arson investigator.
Sections 1-3 of this bill add arson investigators
to provisions relating to such diseases.
Effective: October 1, 2009
8
Personnel Matters
AB 214 – Expanded Definition of
‘Police Officer’ & Occ. Disease
Section 1 of this bill expands the definition of “police
officer” to make certain employees of the Department
of Public Safety and certain park rangers and division
employees of the State Department of Conservation
and Natural Resources eligible for the disability benefits
provided to police officers.
Effective: July 1, 2009
9
Personnel Matters
AB 281(4) - Omnibus
Section 4 of this bill provides that the affidavit or
declaration of a qualified laboratory director,
chemist or any other person meeting certain
qualifications may be used to prove the existence
of alcohol or controlled substances in an
employee’s system in denying, reducing or
suspending the payment of compensation for an
injury. (NRS 616C.230)
Effective: July 1, 2009
10
Personnel Matters
AB 281(5) - Omnibus
NRS 616C.232 – Employee Misconduct
Section 5 of this bill revises existing provisions
governing the denial of compensation to injured
employees who have been discharged for
misconduct by providing that only compensation
for temporary total disability (TTD) may be denied.
Effective: July 1, 2009
11
Personnel Matters
SB 195 (4) - Omnibus
Section 4 of this bill revises provisions governing the
denial of compensation due to discharge from
employment for misconduct.
NRS 616C.232 – Employee Misconduct
3. Discharge from employment for reasons other than
gross misconduct does not limit an injured
employee’s entitlement to receive benefits for
temporary total disability.
Effective: October 1, 2009
12
Personnel Matters
AB 281(7-9) - Omnibus
Sections 7 & 8 of this bill authorize certain claims
relating to certain occupational diseases of police
officers, firefighters and emergency medical
attendants to be submitted to an appeals officer,
thereby bypassing the hearing officer to whom the
contested claim would need to be submitted under
existing law. (NRS 616C.315)
13
Personnel Matters
AB 281(8-9) - Omnibus
Section 8 also requires that the appeals officer set
a hearing date within 60 days after receiving a
notice of any such contested claim. (NRS
616C.345)
Section 9 of this bill requires that the appeals
officer render a decision for any such contested
claim within 15 days after certain specific events
(NRS 616C.360).
Effective: October 1, 2009
14
Personnel Matters
AB 521 – Occ. Disease and Firefighters:
New Carcinogens
• Existing law sets forth a list of substances that
shall be deemed to be known carcinogens that are
reasonably associated with specific disabling
cancers. (NRS 617.453)
• This bill expands the list of substances which are
deemed to be known carcinogens that are
reasonably associated with specific cancers.
Effective: July 1, 2009
15
Personnel Matters
SB 6 – Occ. Disease and Firefighters over 50
• Existing law provides that, under certain circumstances,
heart disease of a volunteer firefighter constitutes an
occupational disease for purposes of chapter 617 of NRS.
(NRS 617.457)
• Section 2 of this bill removes the requirement that the
heart disease must have occurred before the volunteer
firefighter reached 55 years of age; it also revises the
frequency with which the volunteer firefighter must submit
to a physical examination to detect such heart disease and
makes the benefits of NRS 617.457 contingent upon
submission to the physical examinations scheduled by his
employer.
16
Personnel Matters
SB 6 – Occ. Disease and Firefighters over 50
• This bill also provides that a volunteer firefighter
applicant 50 years of age or older may be
responsible for payment of the costs of his
physical examinations but will be reimbursed for
those costs if he becomes a volunteer firefighter.
Effective: July 1, 2009
17
Claim
Processing
Changes
18
Claim Processing Changes
AB 281- Omnibus
Section 2 of this bill provides that if an insurer is
ordered by the Administrator of DIR, a hearing or
appeals officer, a district court or Supreme Court of
Nevada to make a new determination relating to a
claim for compensation, such a determination must
be made within 30 days after the order. (Prior to
this legislation, there was no specified number of
days in statute for making the new determination.)
Effective: July 1, 2009
19
Claim Processing Changes
SB 195(2) - Omnibus
Section 2 Provides that the failure of an insurer to
indicate the acceptance or denial of a claim for a
part of the body or condition does not constitute a
denial or acceptance thereof.
Effective: October 1, 2009
20
Medical
21
Medical
AB 281(3) - Omnibus
Existing law provides that an injured employee may
choose an alternative treating physician or
chiropractor after making his initial choice if the
alternative choice is made within 90 days after the
injury. (NRS 616C.090) Section 3 of this bill
clarifies existing law by providing that an injured
employee may make the alternative choice without
the insurer’s approval if the alternative choice is
made within 90 days after the injury.
22
Medical
AB 281(3)- Omnibus
This section also provides that an injured employee
may make a change in the treating physician or
chiropractor at any time, subject to the insurer’s
approval. Insurer has 10 days to act on request
after receipt or it’s deemed approved.
It further requires an insurer to provide to an
injured employee whose request for a change in
the treating physician or chiropractor has been
denied the specific reason for the denial.
23
Medical
AB 281(3) - Omnibus
NRS 616C.090 (8) – Physician Selection
8. The Administrator shall design a form that notifies
injured employees of their right pursuant to
subsections 2 , [and] 3 and 4 to select an
alternative treating physician or chiropractor and
make the form available to insurers for distribution
pursuant to subsection 2 of NRS 616C.050.
See New D-52 on WCS Forms Page:
http://dirweb.state.nv.us/forms/D-52.pdf
Effective: July 1, 2009
24
Medical
AB 281(6) - Omnibus
Section 6 of this bill revises existing law by
requiring an insurer to notify an injured employee
whose claim will be closed whether an evaluation
for a permanent partial disability (PPD) has been
scheduled or, if such an evaluation has not been
scheduled, that the reason is because the insurer
determined there is no possibility of a permanent
impairment of any kind. (NRS 616C.235)
Effective: July 1, 2009
25
Medical
SB 195(3) - Omnibus
Section 3 of this bill requires that the Fifth Edition,
rather than the most recent edition, of the
American Medical Association’s Guides to the
Evaluation of Permanent Impairment must be
applied in all examinations for a permanent partial
disability.
Effective: May 31, 2009
26
Medical
SB 195 (5 & 6) - Omnibus
Sections 5 and 6 of this bill authorize a hearing
officer or appeals officer to consider the opinion of
an examining physician or chiropractor, in addition
to the opinion of an authorized treating physician or
chiropractor, in determining the compensation
payable to the injured employee.
Effective: October 1, 2009
27
Medical
SB 195(7) - Omnibus
Section 7 of this bill revises existing law to allow
factors other than the degree of physical
impairment of the whole man to be considered in
calculating the entitlement to compensation for a
permanent partial disability involving injury or
disease caused by stress in the case of claims
accepted pursuant to NRS 616C.180.
Effective: October 1, 2009
28
New
Insurance
Plans
29
New Insurance Plans
AB 24 – Catastrophic Injury & Life Care Plans
• Introduces “Catastrophic Injury” to provisions
governing industrial insurance claims.
– Requires adjuster for claim be competent and
qualified
– Catastrophic Team will also include a designated
nurse and vocational rehabilitation counselor.
• Insurers accepting the claims must develop a “Life
Care Plan” within 90 days after the date of claim
acceptance
30
New Insurance Plans
AB 24 – Catastrophic Injury & Life Care Plans
• DIR is required to adopt regulation(s):
– Which determine the types of injuries or other factors
which would be used in deeming a claim a catastrophic
injury.
– Defines the qualifications of the adjuster
– Defines “Life Care Plan”
– Required frequency and method of required
communications with the injured employee, his family or
representative.
31
New Insurance Plans
AB 24 – Catastrophic Injury & Life Care Plans
Sec. 17. An insurer that has accepted a claim for a catastrophic
injury may thereafter rescind or revise its original
determination that the injury is a catastrophic injury if:
1. Medical evidence supports the rescission or
revision;
2. The injured employee is stable and ratable; or
3. Other circumstances warrant such a rescission or revision.
Effective:
1. Upon passage and approval for the purpose of adopting
Regulations (June 9, 2009); and
2. On October 1, 2009, for all other purposes.
32
New Insurance Plans
SB 195 - Omnibus
Continuous Care
Sections 11 and 16 of this bill define and establish
continuous care coverage as a line of insurance for
which a producer may be licensed. Such coverage
includes health insurance and may include
insurance for workers’ compensation only when
issued jointly with and supplemental to the policy
of health insurance.
Effective: July 1, 2009
33
Other
Regulatory
Matters
34
Other Regulatory Matters
SB 195(15) – Omnibus (TPAs)
Section 15 of this bill requires the Commissioner of
Insurance to obtain final approval from the DIR
before issuing a certificate of registration as an
administrator. Section 1.5 of this bill requires the
Administrator of the DIR to adopt regulation
setting forth the qualifications needed to obtain
such final approval.
Effective: October 1, 2009
35
Other Regulatory Matters
SB 361 – Employee Leasing Companies
This bill authorizes DIR to adopt regulations to allow
an employee leasing company to enter into an
agreement with an assurance organization to act on
its behalf with regard to certain regulatory
provisions.
• Section 4 of this bill provides for the ways that an employee
leasing company and its clients may satisfy the requirement
to obtain workers’ compensation coverage for their
employees.
• Sections 9 and 10 of this bill make changes consistent with
the provisions of section 4.
36
Other Regulatory Matters
SB 361 – Employee Leasing Companies
• Section 7 of this bill requires an employee leasing company to pay
a fee ($500) for the issuance or renewal of its certificate of
registration.
• Section 8 of this bill requires an employee leasing company to
provide certain financial statements along with its application for
the issuance or renewal of a certificate of registration.
• Sections 13.2-13.8 of this bill provide for the ways that an
employee of an employee leasing company may notify a supervisor
of an injury for industrial insurance purposes.
Effective: Sec. 1 – 7, 9 – 13.8, October 1, 2009
Sec. 8, January 1, 2010
For more information contact Angela Yllas, 486-9109;
[email protected]
37
Other Regulatory Matters
AB 410 – Collective Bargaining
• Amends the Nevada Industrial Insurance Act (NIIA). It
authorizes collective bargaining agreements to
supersede certain aspects of the NIIA, but prohibits
the reduction of compensation or accident benefits.
• Under this bill, employers and labor organizations can
agree to alternative dispute resolution, specify medical
providers and evaluators, joint safety committees,
modified or light-duty employment and exclusive
sources of vocational rehabilitation services.
38
Other Regulatory Matters
AB 410 – Collective Bargaining
• This bill mandates that DIR and the courts shall recognize the
union and employer agreements as valid and binding.
• Any such process for alternative dispute must provide that a
finding of fact, award, order or decision of an arbitrator or
board of arbitration:
– Has the same force and effect as a finding of fact, award,
order or decision of a hearing officer or the Administrator,
as applicable; and
– Is subject to review by an appeals officer in the same
manner, and using the same procedures.
Effective: July 1, 2009
39
Benefits
40
Benefits
AB 281 – Omnibus
(Federal Disability Offset Eliminated)
Section 11 of this bill repeals the provisions requiring
a reduction in the compensation received by an
employee for temporary disability, permanent partial
disability or permanent total disability by the amount
of federal disability insurance benefits received by
the employee. (NRS 616C.430)
Effective: July 1, 2009
41
Benefits
SB 195(9) - Omnibus
NRS 616C.505 – Death Benefits
1. In addition to any other compensation payable pursuant to
chapters 616A to 616D, inclusive, of NRS, burial expenses are
payable in an amount not to exceed [$5,000.] $10,000, plus the
cost of transporting the remains of the deceased employee. When
the remains of the deceased employee and the person
accompanying the remains are to be transported to a mortuary or
mortuaries, the charge of transportation must be borne by the
insurer.
11. In the event of the death of any dependent specified in this
section before the expiration of the time during which
compensation is payable to him, funeral expenses are payable in
an amount not to exceed [$5,000.] $10,000.
Effective: October 1, 2009
42
Benefits
SB 363 – Death Benefits
NRS 616C.505 – Remarriage penalty/two-year lumpsum option repealed
- Child’s portion (15% of 66 2/3 AMW) repealed
NRS 616C.507: Duration of compensation for
surviving spouse of police or firefighter - Repealed
43
Benefits
SB 363 – Death Benefits
Sec. 4. 1. The amendatory provisions of section 2
of this act (see [ ] below) do not apply to a
surviving spouse if the surviving spouse is
remarried before October 1, 2007.
(Sec 2. Except as otherwise provided in subsection
3, [and NRS 616C.507,] to the surviving spouse of
the deceased employee, 66 2/3 percent of the
average monthly wage is payable until his death .
[or remarriage, with 2 years’ compensation
payable in one lump sum upon remarriage.])
44
Benefits
SB 363 – Death Benefits
Section 4 – of this bill requires DIR to contact a
surviving spouse who remarried between October
1, 2007, and September 30, 2009 and states that
DIR shall calculate the amount of a payment that
the surviving spouse could make, on what date
the surviving spouse’s monthly benefits could
recommence, for what period and by what amount
the surviving spouse’s monthly benefits should be
reduced and various combinations thereof, ...
45
Benefits
SB 363 – Death Benefits
. . . so that by October 1, 2011, the surviving
spouse would be in the same position as if they
had not received a lump sum and their monthly
benefits had not ceased.
46
Benefits
SB 363 – Death Benefits
2. b. Any monthly benefits being paid to a child
pursuant to NRS 616C.505 because of the
remarriage must cease. Those monthly benefits
are not required to be repaid. Any other benefits
to which the child may be entitled must not be
reduced or adjusted to account for any monthly
benefits paid to the child pursuant to NRS
616C.505 because of the remarriage.
Effective: October 1, 2009
47
Fines/Penalties
48
Fines/Penalties
SB 195(10) - Omnibus
616A.070 “Benefit penalty” means an additional
amount of money that is payable to a claimant if
the Administrator has determined that a violation
of any of the provisions of paragraphs
(a) to (e), inclusive, [or] (h) or (i) of subsection 1
of NRS 616D.120 has occurred.
(new provision)
(h) Engaged in a pattern of untimely payments to
injured employees; or
(i) Intentionally failed to comply with any provision
of [NAC 616 – 617]
49
Fines/Penalties
SB 195(10) - Omnibus
NRS 616D.120 – Subsequent Fine Increased
. . .The fine imposed must not be greater than $375
for an initial violation, or more than [$1,500] $3,000
for any second or subsequent violation.
50
Fines/Penalties
SB 195(10) - Omnibus
NRS 616D.120 – Benefit Penalty Max Increased
3 (a) Except as otherwise provided in paragraph (b), in an
amount that is not less than $5,000 and not greater
than [$37,500;] $50,000; . . .
51
Fines/Penalties
SB 195 (10) - Omnibus
NRS 616D.120 (4) – Benefit Penalty Criteria
To determine the amount of the benefit penalty in cases of
multiple violations occurring within a certain period of time,
the Administrator shall adopt regulations which take into
consideration:
(a) The number of violations within a certain number of years
for which a benefit penalty was imposed; and
(b) The number of claims handled by the insurer, organization
for managed care, health care provider, third-party
administrator or employer in relation to the number of benefit
penalties previously imposed within the period of time
prescribed pursuant to paragraph (a).
52
Fines/Penalties
SB 195 (10) - Omnibus
NRS 616D.120 (10) – New Section
10. The Administrator may make a claim against the
bond required pursuant to NRS 683A.0857 (Bond:
Requirement; amount; conditions; cancellation.) for
the payment of any administrative fine or benefit
penalty imposed for a violation of the provisions of
this section.
Effective: October 1, 2009
53
Fines/Penalties
SB 195 (14) - Omnibus
Continuous Care
Chapter 683A of NRS is hereby amended by adding thereto a new
section to read as follows:
1. A person licensed as a producer of continuous care coverage
shall not sell, solicit or negotiate insurance for workers’
compensation unless:
(a) The person is licensed as a producer of casualty insurance; or
(b) The policy of insurance for workers’ compensation is sold jointly
with and supplemental to a policy of health insurance covering
the same individual for the same policy period.
2. A person who violates the provisions of subsection 1 is subject
to an administrative fine pursuant to subsection 3 of NRS
683A.201.
Effective: July 1, 2009
54
Questions
• Call or e-mail the Education Unit: (702)
486-9102; [email protected]
55