Updated: Jan 7
A common statement that I have heard over the years from injured worker during their first consultation with me is,
“At first, I thought the insurance adjuster was being honest with me. I thought the adjuster was on my side. Then the adjuster would not return my calls, and when I finally talked to her, she told me I was not entitled to anything!”
In a Nevada worker’s compensation case, the adjuster is in charge of administering the claim for the worker’s compensation insurance carrier. In other words, the adjuster is supposed to review the medical reporting, apply Nevada laws and regulations, and make determinations as to what benefits the injured worker should receive or not receive. They approve or deny medical treatment. They pay or refuse to pay money for being off of work, known as temporary total disability payments. They close the claim and determine whether or not the injured worker should be scheduled for a settlement evaluation, known as a permanent partial disability evaluation.
When an insurance adjuster makes a determination, they are required to write that determination in a letter to the injured worker, known as a letter of determination. The letter should inform the injured worker if the benefits that are being requested are approved or denied. When an adjuster makes a determination, they should take into consideration the injured worker’s position. Under Nevada law, NRS 684A.165 provides, in pertinent part, as follows:
Standards of conduct.
1. An adjuster shall be honest and fair in all communications with the insured, the insurer and the public.
2. An adjuster shall give policyholders and claimants prompt, knowledgeable service and courteous, fair and objective treatment at all times.
Unfortunately, the injured worker’s position and concerns are not taken into consideration by certain adjusters a lot of the time, if not almost every time. That is why at the end of every letter of determination, the adjuster is required to inform the injured worker that they can appeal the determination and request a hearing before the Hearings Officer. This law is contained at NRS 616C.315. Remember, the insurance adjuster works for, and receives their paycheck from, the insurance company, not the injured worker. So where do you think the adjuster’s loyalty lies with?
One problem is that injured workers do not know their rights under Nevada law. Yet another reason that every injured worker in Nevada should seek out and retain a qualified and experienced Nevada worker’s 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.