Workers' Compensation Appeals Panel

Bulletin 00-001

April

18, 2000

WORKERS’ COMPENSATION APPEALS PANEL

NRS 686B.1772 mandates that “Every insurer shall adhere to the

uniform system of classifications of risks and uniform plan for rating

experience filed with the commissioner by the advisory organization.” In

1999, the Nevada Legislature enacted Senate Bill 417 creating an Appeals

Panel for workers compensation. This Panel will hear grievances from

employers regarding the application of the workers’ compensation rules

which appear detrimental to their business. The grievances are limited to

those related to the establishment of experience modification factors, the

assignment of classifications, the application of manual rules, and other

matters filed with the Commissioner. Carriers should refer aggrieved

employers to the NCCI Appeals Panel Manager at (800) 525-8529, ext.

25.

Specifically, the Panel is empowered to make individual risk decisions

that take into account the specific differences in businesses that might call

for some judgment to reach an equitable solution. It is not intended to

establish or change classifications or rules for similarly classified businesses

within Nevada. Rather, its purpose is to provide relief for an individual

insured due to specific circumstances that merit special treatment.

The Appeals Panel is appointed for a term of two years by the

Governor in consultation with the Commissioner. The Panel consists of

seven members with the following composition:

•

An employee of the Department of Business and Industry,

Division of Insurance;

•

An agent who is licensed by the Division of Insurance and a

member of

a nationally

recognized

association

for

the

profession

of

insurance

agents;

•

Two representatives of the general public, one of whom must be

ssioner. The Panel consists of

seven members with the following composition:

•

An employee of the Department of Business and Industry,

Division of Insurance;

•

An agent who is licensed by the Division of Insurance and a

member of

a nationally

recognized

association

for

the

profession

of

insurance

agents;

•

Two representatives of the general public, one of whom must be

Bulletin 00-001

April 21, 2000

Page 3

employed by, or the proprietor of, a business which is a member

of either a local chamber of commerce or another organization

representing the general business interests of a group of

businesses located in Nevada. Neither may be an employee or a

representative of, or an independent contractor to an insurance

company; an insurance broker, insurance agent or an insurance

solicitor; a law firm, an actuary, or a representative of, a trade

association that represents or supports interests specific to the

trade of such persons. Both must be knowledgeable in the field

and business of industrial insurance in Nevada;

•

Two representatives of private carriers; and

•

A representative of the advisory organization who administers

appeals panels for grievances of employers in Nevada and other

states.

If an employer (other than a self-insured employer) believes that

circumstances unique to his situation warrant a review, he should first

contact his agent and insurer to attempt to remedy the problem. The

insurer is bound by the rules of the manual, but in those instances where

the employer disagrees with the application of such rules for his business,

the insurer should advise the employer of the Appeals Process. He may

want to discuss the situation with more than one agent/insurer to see if

they are in agreement with the grievance.

agent and insurer to attempt to remedy the problem. The

insurer is bound by the rules of the manual, but in those instances where

the employer disagrees with the application of such rules for his business,

the insurer should advise the employer of the Appeals Process. He may

want to discuss the situation with more than one agent/insurer to see if

they are in agreement with the grievance.

Bulletin 00-001

April 21, 2000

Page 4

The Appeals Panel Manager will review the complaint to ensure that the

insurer has complied with the rules and will review the merits of the

complaint. The NCCI Appeals Manager will make a good faith effort to

resolve the complaint, but failing that, the matter will be referred to the

Appeals Panel. If the advisory organization, insurer, or employer is not

satisfied with the ruling from the Appeals Panel , a hearing may be

requested before the Commissioner. If still aggrieved, any party may

petition for judicial review in the manner provided by Chapter 233B. of

NRS.

The Appeals Panel may not hear complaints concerning the effect of

the classification of risks or rules that are applied by all insurers to all

similarly classified businesses within Nevada, or grievances concerning cases

for compensation pursuant to the provisions of Chapters 616A to 616D,

inclusive, or 617 of NRS. A separate appeals process exists for injured

workers to pursue claims for workers’ compensation.

ALICE A. MOLASKY-ARMAN

Bulletin 00-001

April 21, 2000

Page 5

Commissioner of Insurance

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