DI 52120: State Specific Workers' Compensation (WC) Procedures
A. Important Dates
Unless otherwise noted, the instructions in this section are based on Nevada’s current WC statutes. Beginning in the 1980s, the Nevada WC program evolved from a monopolistic State-run program to a fully competitive market. This shift not only affected the types of WC payers SSA must contact, but also resulted in significant changes to the statutes affecting the amount or duration of WC payments. The changes with the most significant impact on SSA offset or development are listed below.
07/01/1973 – Permanent Partial (PP) payments extended to age 65
07/01/1981 – State enacts reverse offset plan. NOTE: SSA does not recognize reverse offset (RJ) plans in effect after 02/18/1981.
07/01/1982 – State Industrial Insurance System (SIIS) created as State-run WC
01/01/1991 - PP payments extended to age 70
01/01/2000 - SIIS privatized into Employers Insurance Company of Nevada (EICON)
- Private carriers allowed to offer WC insurance
- PTD reduced by prior PPD lump sum
- Substantial benefit penalty payments added
01/01/2004 – Annual cost-of-living adjustment (COLA) added for Permanent Total (PT) based on injuries on or after 01/01/2004 and annual payment for PT based on injuries prior to 01/01/2004
Note also that, between 1973 and 2004, the state Legislature enacted several increases in PT benefits.
07/2009 – Nevada repealed its own reverse offset plan. Not significant, since SSA did not recognize Nevada’s RJ plan, which went into effect after 02/18/1981.
B. Types of WC payments
Temporary Total (TT) – maximum period is duration of the disability
Temporary Partial (TP) – maximum period is for life
Permanent Total (PT) – maximum period is duration of the disability; may be reduced by 10 percent to recover a prior PP LS (see DI 52120.155F below)
Permanent Partial (PP)
maximum period is duration of the disability
may be paid in a LS (see DI 52120.155F below)
may be paid annually if monthly rate is under $100.00
If the date of the injury that resulted in permanent partial payments is prior to 07/01/1973, no offset will apply.
For injury dates of 07/01/1973 or later, develop proofs as with any other WC case and impose offset as appropriate.
Effective 01/01/1991, the State law extended PP payments to age 70. This extension to age 70 resulted in a small monthly payment, which often precludes offset.
Vocational Rehabilitation (VR) - maintenance payments are paid at the TT rate in lieu of periodic TT and are therefore offsettable; VR is also offsettable if paid in a LS in lieu of VR services. For more information, see DI 52110.005B - When to Apply Offset to VR Payments.
A worker receiving permanent disability cannot be entitled to PP while receiving PT. A worker receiving TT or TP cannot be entitled to PP during the same period.
C. Cost-of-living adjustments (COLAs)
Permanent total (PT) cost-of-living increases:
Payable for disabilities occurring on or after 01/01/2004
Annual increase of 2.4 percent effective January 1 immediately after the year in which the worker becomes entitled to receive PT
Subsequent COLA increases are effective January 1 of each successive year
Workers not eligible for the COLA (i.e. injured prior to 01/01/2004) are entitled to an annual payment not to exceed $1,200.00. Divide the annual payment by 12 to obtain a monthly amount for offset purposes; prorate over the specified 12-month period, or if not specified, beginning with the month the increase is due.
D. Attorney fees
There are no special provisions regarding attorney fees.
E. Retirement insurance benefit (RIB) considerations
Nevada does not offset for SSA retirement benefits.
F. WC settlements
Use the monthly WC amount upon which the LS award is based for offset proration purposes. This amount is usually specified on the election form, Form D-10a (07/99) the worker signs. Form D-11 is required to verify the worker reaffirmed lump sum election.
If D-10a (07/99) shows an annual rate, divide the annual rate by 12 and use the resulting monthly rate for offset proration purposes.
More recent D-10a (07/99) forms shows “monthly/annual”. The employer’s attorney or other person completing the form circles the appropriate word.
Often the payer initially issues a small additional payment for the first permanent partial amount. That is to be included in the total lump sum amount.
If a worker elects to receive PP payments in a lump sum, all compensation terminates and the LS constitutes a final settlement of all factual and legal issues in the case. For more information, see DI 52150.060 - Prorating a WC/PDB Lump Sum Settlement.
Workers injured on or after 07/01/1981 with a greater than 25 percent disability may only elect a PP LS equal to a 25 percent award. The employer will pay the portion of the disability in excess of 25 percent in installments. Process the LS per DI 52150.060. Allocate the installment payments over the time periods the award states the payments will be made.
If a PP lump sum was awarded and the worker later becomes entitled to PT payments, the PT payments are reduced by 10 percent until the LS is recovered unless the worker refunds the PP lump sum. Use the full PT payment amount that should have been paid for offset purposes. For more information, see DI 52150.035A.4. - WC/PDB Benefit Rate Adjustments.
G. Reverse offset plan enacted after 02/18/1981
The State of Nevada enacted a reverse offset plan after 02/18/1981. Reverse offset plans or expansion of prior plans put into effect after 02/18/1981 are not recognized as reverse offset plans and DIB benefits are still subject to WC/PDB offset. For more information, see DI 52105.001 - Reverse Offset Plans.
The chart outlines actions needed in the following two situations:
|If Social Security disability insurance benefit (DIB) onset is prior to 03/01/1981 or the month of entitlement (MOET) is prior to 09/1981||If DIB onset is 03/01/1981 or later and the MOE is 09/1981 or later|
For example, if the month of adjudication is 06/1983, SSA's offset would be removed 08/1983.
H. Benefit penalty
Nevada pays a worker a benefit penalty of $5,000.00 to $37,000.00 if the State finds that an insurer violated any of several statutory provisions related to payment of WC benefits. The penalty is limited to $3,000.00 if the payment in question is less than $500.00 or not more than 14 days late. Penalty payments are not offsettable if based only on the employer’s failure to provide WC. For a list of payments not considered WC, see DI 52105.015.
The following are forms used by State WC agency.
A worker may elect to receive a workers’ compensation award in a lump sum or in monthly installment payments.
Then the worker has 20 days after the mailing or personal delivery of From D-10 a. to reaffirm or retract that request.
A worker also has the right to reopen a closed claim based on a change in medical condition.