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Can An Industrial Insurance Adjuster Act In Bad Faith?

Workers compensation claims in Nevada can be frustrating for everyone. Injured workers feel that the industrial insurance adjusters can do whatever they want with no accountability. In an attempt to prevent insurer misconduct in workers compensation cases, the Nevada legislature has enacted Chapter 616D of the Nevada Revised Statutes., commonly known as a DIR complaint. This is one option for injured workers to consider. If an injured worker feels that they have been mistreated or the insurer is not administering their claim properly under Nevada law, they have the option of filing a complaint with the state (Division of Industrial Relations) against the insurance company.

Nevada law lists several actions that insurer should not engage in or they face possible fines and penalties. A few of the actions that the insurers are prevented from doing under NRS 616D.120 include, but are not limited to, the following:

1. Induced a claimant to fail to report an accidental injury or occupational disease.

2. Without justification, persuaded a claimant to:

(a) Settle for an amount which is less than reasonable;

(b) Settle for an amount which is less than reasonable while a hearing or an appeal is pending; or

(c) Accept less than the compensation found to be due the injured worker by a hearing officer or appeals officer.

3. Refused to pay or unreasonably delayed payment to an injured worker of compensation or other relief found to be due the injured worker by a hearing officer or appeals officer or a written settlement agreement, if the refusal or delay occurs:

(a) Later than 10 days after the date of the settlement agreement or stipulation;

(b) Later than 30 days after the date of the decision of a hearing officer or appeals officer or the Division, unless a stay has been granted; or

(c) Later than 10 days after a stay of the decision of a court, hearing officer, appeals officer.

4. Engaged in a pattern of untimely payments to injured employees.

It would seem that the most common is the insurer’s untimely compliance of providing benefits pursuant to the decision of a hearing officer or an appeals officer.

If the injured worker files a DIR complaint and the state, after their investigation, determines that there has been a violation, they can impose an administrative fine of $1,500 for each initial violation, or a fine of $15,000 for a second or subsequent violation. The fines is paid to the state of Nevada. In addition, the insurer is ordered to pay a benefit penalty to the injured worker in the following amounts:

1. An amount that is not less than $5,000 and not greater than $50,000; or

2. Of $3,000 if the violation involves a late payment of compensation or other relief to an injured worker in an amount which is less than $500 or which is not more than 14 days late.

The bottom line is to make sure that the complaint is done properly and well documented. This topic will be discussed in detail in a future blog.

Yet another reason that every injured worker in Nevada should seek out and retain a qualified and experienced Nevada workers compensation attorney so that things are done properly from the beginning.

I hope that this has been helpful and informative. Please read the other blogs for more free, valuable information.

Joel A. Santos, Esq., is a Nevada worker’s compensation attorney. He is certified by the State Bar of Nevada as a Worker’s Compensation Expert and Specialist.

Copyright 2020 - Joel A. Santos, Esq.

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