Lawmakers plan to address SIIS methods

Dennis Christensen was working as a carpenter at McCarran International Airport in October 1996 when, while loading 300-pound bundles of tubing, he suddenly felt a razor-sharp pain shoot through his spine and legs.

An emergency room doctor initially diagnosed Christensen, 46, with a muscle strain. But three weeks later, X-rays revealed he had damaged nine vertebras.

In November 1996 the Nevada State Industrial Insurance System (SIIS) approved Christensen, an Arizona resident, for worker's compensation.

SIIS, now known as Employers Insurance Company of Nevada, is specialized insurance that employers provide for injured workers to cover medical care, disability compensation and rehabilitation.

Both Christensen and his doctor thought SIIS would quickly approve his back surgery.

Both were wrong.

Christensen's physician, who diagnosed five vertebras in the lumbar region and four in the cervical as being injured, immediately ordered a CAT scan.

That was on Jan. 2, 1997, according to the notes Christensen's doctor kept.

The doctor, who declined Christensen's request to comment for this article and did not return the Sun's phone calls, repeatedly requested in his notes that SIIS approve the scan again on Jan. 23, March 19 and April 4, 1997.

He received no reply on all three requests.

The CAT scan was finally approved, according to the doctor's notes, five months later on May 12, 1997.

Soon thereafter, SIIS caseworkers began questioning the original diagnosis on the nine vertebras. Christensen said 13 SIIS caseworkers, over a period of 19 months, demanded that he submit to a second and third opinion from physicians they selected.

At one point, Christensen said he was told by SIIS caseworkers that his back injury was a pre-existing condition and he wouldn't be covered.

SIIS eventually approved surgery on four vertebras.

In severe pain, Christensen underwent a first surgery on Dec. 3, 1997, more than a year after his back injury. His final surgery was completed in May.

"I had to take the cervical (claim) through the appeals process," Christensen said. "I won at all levels. For me, they were treating everything as fraud. You had to prove that you got hurt."

Douglas Dirks, general manager of SIIS, said the state agency is not purposely trying to delay or deny claims. It's just the state's "conservative way" to handle worker's compensation.

"When there is a surgical procedure, we do have the right to get a second opinion," Dirks said. "That's pretty standard."

SIIS has adopted a caseworker approach to processing claims, Dirks said.

"Within 24 hours of receiving a claim, we contact the medical provider, the employer and the injured worker," Dirks said. "We are re-organizing to have file clerks trained to be case managers."

Dirks said SIIS had a little more than 23,000 open and active claims by the end of May. The number of claims denied, he added, has fallen so far to 8.04 percent for the fiscal year 1998.

This is down, according to SIIS statistics, from 14.6 percent in 1994, 11.2 percent in 1995, 11.6 in 1996 and 10 percent in 1997.

But not everyone in the state thinks SIIS is doing a crackerjack job.

Assemblywoman Chris Giunchigliani, D-Las Vegas, remembers how some revisionists during the 1989, 1991, 1992 and 1993 legislative sessions radically revamped the way SIIS operates.

Senate Bill 316 from the 1993 session substantially changed the way workmen's compensation is administered by enacting 32 revisions. A key component was prohibiting payment to employees with pre-existing medical conditions and requiring injured workers to see physicians who contract with SIIS.

"The injured worker lost benefits and the right to sue," Giunchigliani said. "There are some inherent problems with the claims process. But from fighting the battles in the legislatures, we all just got worn down."

That may all change during the 1999 Legislature. Assemblyman Bob Price, D-Las Vegas, has been talking with the state AFL-CIO office to draft legislation.

"We get regular complaints from injured workers daily," Price said. "I would say we get a call at least once a week. I would be happy to sponsor some legislation, but I'm not sure what at this point."

Meanwhile a legislative committee is meeting to discuss pending three-way workmen's compensation insurance expected to come before the 1999 Legislature.

Besides SIIS and companies that self-insure, private insurance companies -- such as health maintenance organizations (HMOs) -- will be allowed to write worker's compensation policies.

Sen. Ann O'Connell, R-Las Vegas, chairs the committee that is mainly dealing with how three-way workmen's compensation will operate in the state. She said her committee is not addressing complaints of claims being denied or unduly delayed.

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