Report: Nevada workers’ comp system needs to examine serious claims

The Nevada workers’ compensation system “has undergone dramatic change since 1993″ becoming more competitive and allowing private insurers to enter the market,” but it has room for improvement particularly in auditing the most serious claims, according to the Workers’ Compensation Research Institute.

Headquartered in Cambridge, Mass., WCRI recently completed its study of Nevada’s workers’ comp system and published: “Workers’ Compensation in Nevada: Administrative Inventory.”

According to the report, “in 1995, the state 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.” Since that time, the Nevada system has developed a few strengths, including “an agency active in educating system participants, minimal use of ‘dueling docs’ when rating impairment because of the mutual selection of an individual from a list of approved raters maintained by the agency, and a respected and free resource for injured workers when seeking representation — the Nevada Attorney for Injured Workers,” WCRI indicated.

However, participants are divided in their assessment of the system. There are concerns about claims management, rising medical costs, lifetime claim reopening rights and the inability to fully settle claims via compromise and release agreements, the report indicated.

According to the report, statutorily-mandated audits by the Workers’ Compensation Section “do 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.”

Nevada also lacks data to determine whether the state’s approach is accurately and promptly delivering benefits, the report said. WCS did not collect and report on measures of payor performance, nor measure the interval from the date of injury to the first temporary total disability payment for all payors.

There are “opportunities for the state agency to better measure system performance and better audit the core claims processes of insurers, self-insurer and TPAs (third-party administrators) by targeting the more serious claims and consistently poor performers,” WCRI said.

To read the full report, visit: http://www.wcrinet.org/result/wcompai_NV_result.html.