MINUTES OF MEETING

      ASSEMBLY COMMITTEE ON LABOR AND MANAGEMENT

 

      Sixty-seventh Session

      April 19, 1993

 

 

 

The Assembly Committee on Labor and Management was called to order by Chairman Chris Giunchigliani at 5:45 p.m., Monday, April 19, 1993, in Room 321 of the Legislative Building, Carson City, Nevada.  Exhibit A is the Meeting Agenda, Exhibit B is the Attendance Roster.

 

 

COMMITTEE MEMBERS PRESENT:

 

      Ms. Chris Giunchigliani, Chairman

      Mr. Bernie Anderson, Vice Chairman

      Mr. Douglas A. Bache

      Mr. John Carpenter

      Mr. Tom Collins, Jr.

      Mr. Peter G. Ernaut

      Mr. Lynn Hettrick

      Mrs. Erin Kenny

      Mr. John B. Regan

      Mr. Michael A. Schneider

 

 

COMMITTEE MEMBERS ABSENT:

 

      Mr. John C. Bonaventura, excused

 

GUEST LEGISLATORS PRESENT:

 

      Mr. Robert E. Price, Assemblyman District 17

 

STAFF MEMBERS PRESENT:

 

      Mr. Donald Williams, Principal Research Analyst (LCB)

      Mr. Frank Krajewski, Senior Research Analyst (LCB)

 

OTHERS PRESENT:

 

      Dr. Richard H. Rahe, Nevada Mental Health Institute; Scott       Young, SIIS; Scott Craigie, Governor's Office; Bob Gagnier,

      State of Nevada Employee Association (SNEA); Ray Badger,       Nevada Trial Lawyers Association; Arthur Busby, Horseshoe

      Hotel and Casino, Las Vegas, Nevada;  Carol Jackson, DIR.        Lynn Grandlund, Grandlund, Watson and Clark Associates    (GWC), Nevada Association of Independent Businesses (NAIB),

      American Subcontractors Association (ASA) and Employers of       Nevada (EON). 

 

 

SENATE BILL NO. 316:  Makes various changes to provisions

                      governing industrial insurance.

 

Ms. Giunchigliani opened the meeting with an apology to all committee members as well as guests who might have been inconvenienced by the last minute cancellation of the scheduled meeting in Las Vegas for April 17, 1993.  She rescheduled a tentative meeting and would verify with Mr. Price a convenient date for a Las Vegas meeting.

 

Ms. Giunchigliani began with the issue of stress, Section 91.  This section was debated quite heavily during the 66th Session in SB 7 and AB 410.  The SIIS board of directors as well as various working groups attempted to define stress.  She noted it was currently compensable through the court system.  It was agreed last session Nevada did not want to create a similar program to California's 10 percent factor.  At the end of last session, Ms. Giunchigliani had agreed to remove the definition of stress from SB 7 pending a stress study.  She found distressing the fact there was no reference to this in the Senate minutes.

 

Prepared testimony of Ms. Lynn Grandlund of Grandlund, Watson, Clark and Associates (GWA) was introduced to the record as EXHIBIT C.

 

Ms. Giunchigliani introduced Dr. Richard H. Rahe to the committee.  Dr. Rahe briefly summarized his extensive vitae, (EXHIBIT D), by  stating he was a medical doctor and had spent 20 years in the United States Navy studying stress problems, especially with frogmen, aviators, prisoners of war and American hostages.  He noted he was currently a professor of psychiatry at the University of Nevada School of Medicine, and was the medical director of Nevada Mental Health Institute.  Dr Rahe stated the best definition of stress was when life demands exceeded the ability to cope.  Every day was full of stressors or incidents which might be a challenge to adaptive capacities.  Dr. Rahe stated most people could cope using various coping mechanisms which were good for overall health.  Job stress and it's effect on health cut a wide spectrum of events and consequences and Dr. Rahe cited examples at either end of the spectrum.  In the wording for the new Section 20 Dr. Rahe felt the Senate had taken the most dramatic example of stress.  A traumatic event could have definite physiologic consequences and could lead to long-term disability which is known as Post Traumatic Stress Disorder (PTSD).  Dr. Rahe stated there was an enormous middle ground which could be missed if focus was only on either extreme.  Dr. Rahe mentioned the Air Traffic Controller study and the stresses involved in being chronically alert.   What happened to people in particular jobs in the long run was the stress ate away at their coping ability.  The physiologic effects were there well before the person became aware of them.  Dr. Rahe stated stress was a gradual, erosive effect of a job requiring in some ways inhuman amounts of concentration, attention and devotion to duty.  Further, most people could cope.  There was a vulnerable minority who tried their best yet were not doing as well as the majority.  Dr. Rahe further stated these people came down with physical and life-threatening or life-limiting diseases.   Stress did not just pick one area, for example, it did not show up at work and go home at 5:00.  People who had stressful lives, experienced stress in all areas in their lives; financial, marital, children, parents, divorces, remarriages, relocations, in addition to job stress.  This could create confusion for the employer worried about job stress compensation.  There must be an assessment made as to how much stress was related to work and how much was related to the rest of the person's life.  Outside forces might be sufficient to cause vulnerability to job stress.

Dr. Rahe related the example of an aquanaut who spent two to three months submerged and suffered a job related stress illness during the time he was commander of the submerged capsule.  The commanders illness was a product of everything in his life, including job stress.  Dr. Rahe again stated when there was job stress, there was often other stress in a person's life.  He felt California got into serious trouble when only 10 percent of stress had to be job related because people were receiving compensation for job stress when only a small percentage of their stress was actually job related.  Dr. Rahe felt a 50-50 division made sense.  He always found other life stresses in every job stress evaluation he had done.  Dr. Rahe summed up his testimony with the following statements:  Job stress was everywhere; most people cope; it was only stress in the medical sense when demands exceed ability to tolerate or cope; physiologic changes of medical consequence, citing abnormal blood pressure and cholesterol; when job stress accounts for 50 percent or more of the stress experienced.

 

Dr. Rahe asked the committee to craft a definition of job stress to include people in the middle ground.  Dr. Rahe called attention to the fact job stress was very disabling but temporarily disabling.  If unarrested or not managed, job stress could cause physiologic consequences or disease.  Stress was amenable to turning around, unlike an inherited disease.  People who underwent stress and recovered sometimes were not only back to where they were, they were better than they were.  Dr. Rahe recalled many of the American hostages held in Iran were depressed and sick while they were held hostage, yet when they came back and recovered, they were stronger than before and in many ways, better off.  The good news about stress was recovery was very positive and could even be growth enhancing.  It must be treated in the early stages like any other disease.  Dr. Rahe worried about lost time when intervention was not started immediately.  Stress interventions could prevent disability.  Early timing of rehabilitative intervention could be very positive and in many cases, provide better workers.

                                                                Mr. Schneider asked if stress could start at home and carry over into the job causing the employee to have a terrible time at work.  Dr. Rahe answered there was a situation where the job performance fell because of the rest of an employee's life stress.  He went on to express a truism, problem workers were workers with problems.  The employee might blame work because compensation was involved even though work was not the cause of the stress.  Dr. Rahe stressed the need for good investigative officers, including the patient, workmates, spouse, etc.  Mr. Schneider wondered how long it would take to work through a stress patient.  Dr. Rahe responded a person cooperative in the interview, usually only needed the interview.  An SIIS evaluation usually had the investigator go out to the workplace and get the corroboration of what the job was really like, which usually took a couple of weeks.  Mr. Schneider spoke of people who had jobs they could not handle and were stressed because of the job.  He asked Dr. Rahe if the employee who was stressed out would be told to seek employment in another field.  Dr. Rahe responded sometimes during evaluation and treatment, that could happen.  A doctor might suggest good medical advice to a patient to try something else. 

 

Mr. Regan questioned when Dr. Rahe found the stressful situations within the elite groups of the military.  Mr. Regan had trained some of these same types of groups in the military Dr. Rahe had dealt with.  Dr. Rahe answered specifically using the scenario of frogmen when they could not dive and aviators when they could not fly, basically when they could not do what they loved to do due to job reassignment.  Mr. Regan pointed out the correlation with the high degree of coping within the group and the fact when one went over the edge, there was not the circumstance of a man who would slap you or rip your eyes out, but had been trained to such a degree someone else had made him go to the extreme and he was not responsible for his actions.

Dr. Rahe agreed the elite military training was not for the average citizen due to its ferociousness, yet the results were magnificent in some cases.  Dr. Rahe again stated there should be a middle ground, not the 10 percent available in California.

 

Mr. Ernaut questioned whether there was any distinction made between inherent stress and unique stress.  For example, if a person applied for an air traffic controller position or  undercover law enforcement, was there a certain amount of discretion put on the employee to know the amount of stress that would be put on him.  Dr. Rahe responded many people who went for these high stress level jobs knew what they were getting into, loved high activity jobs and could cope with the high level of stress. It was with the most mundane or ordinary jobs when the demands exceeded the employees abilities to cope where the middle ground stress claim area appeared.  Mr. Ernaut rephrased his question to 30 similarly trained air traffic controllers, as an example, and the stress was equally distributed (same job description, same incidence on shifts).  Of the 30, three became stressed and could not cope.  Mr. Ernaut wanted to know if their stress would be compensable or because of the parameters of the job, the employer would not be liable.  Dr. Rahe did not think a person could sign away his future disability ahead of time.  Most people going into the job would think they could handle it, and it was only after they had been there a while and they had failed at the job, there was an onus on both the individual and the boss to say maybe this was not the right job.  Dr. Rahe said a person had to have a chance to prove he might be having temporary life problems.  He also stated an unresponsive boss might allow the employee to make a claim.

 

Mr. Anderson referred to Mr. Regan's earlier question about military personnel being removed from the jobs they had trained so hard for, and asked if similar stress could be caused by being fired, demoted in rank or prestige within an organization.  Dr. Rahe replied a good example was the mandatory retirement of airline pilots at age 55.  Some pilots forced to retire at 55 had put in stress claims.  Mr. Anderson queried Dr. Rahe as to stress symptoms someone might exhibit.  Dr. Rahe said the term was used frequently and this common usage had caused stress to lose its defintion.  He looked for physiologic changes related to stress, including stress hormones.  If Dr. Rahe did not see good psychological and physical symptoms, he often felt it was more of a complaint than true stress.  Mr. Anderson asked if coronary thrombosis could develop over a long stressful period.  Dr. Rahe responded coronary thrombosis was an example of stress remaining unmitigated for a number of years in people who were prone to heart disease in the first place.  Dr. Rahe stated one only got in life what one was biologically programmed to get at birth.  Heart disease was far more prevalent in middle-aged males and tended to affect people who were shorter and heavier and who might have diabetes and hypertension.  Some people could tolerate stress much better in terms of the cardiovascular system than others.  People with the propensity for heart disease could accelerate the disease with stress.  Stress did not give one a disease one would not normally be biologically destined to get, but it could accelerate the disease process.  Stress brought the disease forward in time.  Even cancer, to some degree, could be accelerated by stress. First there were symptoms, later a disease. Dr. Rahe said hopefully it would be recognized at the symptom stage before it went on to disease.

 

Mr. Hettrick questioned Dr. Rahe about the cost and the time to treat stress cases.  Dr. Rahe answered the time to treat was as early as possible with the length of treatment depending on the stress illness.  He stated 70 percent would respond quickly in job stress situations, 30 percent who went to chronicity often had extensive problems with adaptation.  This 30 percent would require specific treatment in group or individual format about coping with life, maybe changing their job and other more intensive intervening treatment.  Dr. Rahe further stated 10 percent of patients would be very expensive to treat as they might not respond well to treatment.  Dr. Rahe also said there would be a small percentage who would go on and on and incur large costs.  Mr. Hettrick asked about the large pool between the two obvious ends of the spectrum, 30 percent of that group would be chronic and 10 percent of that 30 percent would require extensive amounts of treatment.  Dr. Rahe responded these numbers pertained to any illness responding to treatment.  He mentioned Chronic Fatigue Syndrome and the 30 percent who had not recovered and 10 percent of those would go on to a long, long history of illness.  Dr. Rahe felt SIIS appeared to support chronicity rather than intervene.  He said SIIS did not pick up the non-responders early enough and get them into intensive stress coping treatment.

 

Ms. Giunchigliani stated the SIIS paper came up with three different terminologies; mental/mental, mental/physical, physical/mental.  She wondered if this was something standard to define the framework.  Dr. Rahe responded California used it, he did not like it, and the lawyers loved it.  It did "tidy it up" a bit but it was not that simple.  Dr. Rahe found people responding to stress respond all over.  Ms. Giunchigliani asked Dr. Rahe what he used in a diagnostic workup.  Dr. Rahe replied he looked for stress responsiveness--physiologic and psychological responses to the illness.  Ms. Giunchigliani questioned the difference between gradual versus traumatic.  Dr. Rahe answered with an example of traumatic stress in which a bank teller was robbed and never recovered enough to return to the bank. The insidious or gradual stress went on day after day for months and years.  This stress might be punctuated by other discreet events occurring over a considerable time span.  There were usually significant changes at work to which the person had not accommodated very well and then usually had difficulty expressing themselves to the boss.  Ms. Giunchigliani wondered if there was some kind of diagnostic tool utilized if early intervention occurred or if the system immediately sought an independent party to go through a screening test.  Dr. Rahe stated psychiatry and psychology were the two disciplines that focused on the illness along with a physician.  Ms. Giunchigliani asked Dr. Rahe if there was a larger percentage of females seen.  Dr. Rahe saw both males and females in his practice and stated literature showed females were higher in every illness.  The SIIS system study showed mental stress claimants were typically female, older, higher-paid, white-collar employees, and in Nevada, the top number of claimants were government employees.  Dr. Rahe referred back to Ms. Giunchigliani's question about a diagnostic tool and replied he had his own test, and others experienced in the field used some type of test to determine what they were dealing with.  Dr. Rahe's test focused on life changes and the recency and significance of these changes.  Ms. Giunchigliani asked what Dr. Rahe meant by the phrase "investigative officer."  Dr. Rahe said when he had done SIIS evaluations there had usually been an investigative officer who had gone to the workplace to verify complaints with the boss, coworkers and the claimant and spouse.  He said this report was extremely helpful in his evaluation.  Dr. Rahe suggested if SIIS wanted to limit claims they could have their own trained medical psychological staff to do investigative evaluations.  Ms. Giunchigliani requested Dr. Rahe to cite examples of non-compensable or not found to be stress related within SB 316.  Dr. Rahe stated the people who were often the most stressed were not very dramatic people.  He said they were the ordinary persons in an extraordinary situation.  Dr. Rahe referred to the book, The Peter Principle, with the statement people eventually reach their level of incompetence.  A good worker with a good health record could have several years on the job and then with a promotion or change of duties come down with stress disability.  It was often not an obvious change and might have results appear years later.  Police officers and firemen were good examples.  Dr. Rahe illustrated how his own department had seven nurses out on SIIS at this time.  Ms. Giunchigliani referred to the research areas of labor representation where workers had less stress because they had an outlet to air grievances, while in the private sector non-representation had given way to higher stress claims.  Dr. Rahe again stressed the importance of coping as help, the employee assistance programs and early intervention.

 

Mr. Schneider expanded on the fact 10 percent of claimants were the problem and wanted to know what the system could do for this small sector.  Dr. Rahe replied the best guess on the 10 percent would be to try to identify those people as early as possible, make some kind of adjustment and release them with their disability claim.  As a medical officer in the military, Dr. Rahe said the military did it that way, with early intervention and release.  He reiterated the best way was to find the susceptibles early, make an early adjudication and therefore, manage the expense.   

 

Ms. Giunchigliani asked Dr. Rahe if he had been consulted by SIIS regarding its study.  Dr. Rahe answered no but would be happy to be a consultant.  Ms. Giunchigliani referred to an example of gradual job stress dealing with a high school coach who became a college coach, suffered job stress, underwent counseling, experienced suicidal tendencies and attempted suicide while being transported to a mental health center by jumping out of a vehicle at 55 miles per hour.  He sustained extreme physical injuries.  The workers' compensation hearing found his stress case non-compensable.

 

Guest legislator, Mr. Price, addressed the committee.  He felt elimination or severe restriction of stress disability related to the job would be improper.  He requested his intern to put together a stress booklet, EXHIBIT E, which was passed out to each committee member.  He referred to the stress booklet's first tabbed section and to an article stating stress cost over $200 billion a year with more than half of the 550 million work days lost annually due to work related stress.  He explained 60 to 80 percent of industrial accidents were due to stress incurred by workers.  Mr. Price stated industrial insurance was once described as  probably the original no-fault insurance.  In exchange for the employer paying for insurance coverage, the employee agreed to give up the right to sue the employer.  Mr. Price wondered if the wisdom of whomever was seeking to remove or severely restrict the incidence of stress on the job was actually opening the door for employees to proceed in civil cases to sue the employer.  Mr. Price spoke of the increasing number of incidents of fired employees who had gone back to the job location and murdered people.  Death by gunfire of this nature was the third highest cause of job related death.  Mr. Price gave a brief overview of the stress booklet (EXHIBIT E).

 

Mr. Collins requested confirmation of the fact many employers went out of their way to retrain workers and spent time, money and effort to help the worker.  He felt the drafters of SB 316 missed the point entirely of employers helping their employees.

 

 

Mr. Price discussed the forming of SIIS from Nevada Insurance Commission (NIC) over the years.  He stated most states were experiencing problems with their industrial insurance systems.  He also did not agree with giving the control to the governor and felt the authority should remain with the board of directors. 

 

Mr. Hettrick asked Mr. Price how to determine a true stress claim and avoid the abuses.  Mr. Hettrick expressed a struggle with determining what was compensable and how much of this should be made compensable.  Mr. Price presumed legislative changes in California adopting the 10 percent which Dr. Rahe felt was way too low had created problems.  Mr. Hettrick expressed a quandary with how to quantify and compensate.  Mr. Price suggested SIIS be set up with an expert who could deal with each claim case by case.  Mr. Price declared there would always be people who fraudulently took advantage of systems.

 

Mr. Schneider questioned whether a psychological test given to a potential employee would indicate unsuitability for the job because of stress.   Ms. Giunchigliani indicated there were some types of screening tests available.  She thanked Mr. Price for the stress booklet.

 

Scott Young, SIIS, spoke on Section 20 which eliminated all forms of mental disability.  Mr. Young and SIIS had proposed language which would allow mental disabilities proven by clear and convincing evidence a person had indeed suffered as a result of something occurring on the job. Mr. Young stated what they were looking for was more extreme cases such as a hostage situation resulting in psychological problems or a situation in which someone received no physical injury but witnessed someone's death. (EXHIBIT F).  Ms. Giunchigliani asked Mr. Young if this provision was dealt with by the SIIS report.  Mr. Young could not recall the exact testimony.  The report reflected 127 stress cases in 1991-92.  Ms. Giunchigliani mentioned the stress claims were never separated from other claims so the true dollar amount of stress claims was unknown.  Mr. Young thought stress related cases could be pulled up on the system.  He further stated a stress claim could be hidden under a neurological classification.  Mr. Young pointed out stress related cases were now handled by special examiners and records were kept.  Ms. Giunchigliani verified stress was covered but defined by the courts.  Mr. Young responded NRS 617.440 was interpreted by the Supreme Court as a catch-all provision for occupational diseases for unscheduled diseases.  Gradual mental stress was specifically eliminated.  Mr. Young said, in reviewing other states, this area was the most difficult to determine.  Mr. Young pointed out the language in SB 316 was more restrictive than the language proposed last session, but had received the endorsement of the entire SIIS board and some indication from interested parties it was acceptable.  Ms. Giunchigliani stated, and Mr. Young agreed, women and government employees were the number one stress cases.

 

Mr. Collins queried whether SIIS had staff who could determine the authenticity of stress cases within two weeks.  Mr. Young agreed it would be clear to even a lay person whether someone was truly suffering from job related stress.  The problem was there were two tests which would have to be met:  1) Is this person faking or really suffering from stress from a medical viewpoint? and 2) Is that stress legally compensable as an industrial claim? 

 

Ms. Giunchigliani drew attention to Section 91 and language changes.  Mr. Young stated Section 91 was not really related to stress.  NRS 616.110 had prohibited coronary disease of any kind with the exception of policemen and firemen which was covered in Section 617.  Mr. Young saw Section 91 as requiring a doctor to verify medical evidence of an injury not truly related to stress.

 

Mr. Regan asked Mr. Young if prosthesis injuries were covered as work injuries.  Mr. Young answered if an industrial accident damaged a prosthesis, it would be covered.

 

Mr. Collins mentioned public service workers possibly being discriminated against in unusual circumstances.  Mr. Young stated something extraordinary would have to happen, not the normal, yet arduous doing of that job.  Mr. Collins brought up early retirements and demotions in his line of work (utility lineman) to avoid the stresses of work.  Mr. Young responded they would not be excluded as a class if it was normal for that occupation to have stressful situations but an extraordinary stressful situation would have to be legally proven.  Mr. Young emphasized am employee would need to show the stress was related to a time of danger to qualify, but normal course of work would not be covered.

 

Scott Craigie, Governor's Office, stated the AMA II Guide did not provide for stress claims.  The AMA III Guide which was being reviewed by Carol Jackson, Director DIR, would dramatically broaden stress as a compensable injury.  The AMA IV Guide which was ready to be released and would be considered by the director of DIR, would also dramatically broaden the definition of stress as a compensable injury. If, without statutory definition, one of those guides was adopted by the director, at a time of financial stress within the system, it could broadly and dramatically increase the compensable injury base within the state system.  Mr. Craigie questioned whether or not the state could afford to dramatically increase the cost of the system when in fact right now it had the largest workers' compensation debt in the country.  The state of Nevada had a debt so great, it threatened the existing coverage and benefits on board now.  The Governor's office believed if stress was added, especially to the level it could be with one of the two AMA Guides, it could actually affect the compensability of injury or death to workers in the workplace today.  The Governor was extremely concerned about the very open-ended nature of stress compensability claims.  The position the Governor took was much more restrictive than what was in the bill right now.  Governor Miller's position was Section 233, subsections 2 and 3 should remain the same. Subsection 2 stated any mental injury to an employee caused by stress was not compensable and subsection 3 stated no change in police and fire protection as it existed today.  This would protect police and firemen from any change based on the new language adopted.  The Governor's position was, according to Mr. Craigie, there was an increase from the status quo, which meant stress would not be compensable.  The Governor did agree to have sudden traumatic event language in subsection 1 of Section 20 included.  Mr. Craigie believed the language would increase the cost of the benefit package in the SIIS system.  Mr. Craigie stated the Governor's position was, bottom line, at this time, "We cannot afford it."  Mr. Craigie stated his office was worried about the impending adoption by a regulator of language from one of the two AMA Guides.  The Governor recommended the legislature be as restrictive as possible and keep it to an absolute minimum.  Ms. Giunchigliani appreciated the dilemma everybody was in regarding the funding.  She stated it was rather irresponsible to create legislation based on an alleged dollar savings rather than looking at what might truly be affecting any employee in this state.  She stated consideration must be taken into account during this debate.

 

Mr. Carpenter asked Mr. Craigie whether the savings of $154,000 was correct. Mr. Craigie believed the language as it was adopted

would show a slight overall increase in expenditures.

 

Mr. Craigie responded to Ms. Giunchigliani's statement by stating he looked forward to the day when they could talk about specific dollar amounts and solvency versus cash flow.  The concern the Governor's office had was the debt of billions of dollars and broadening the benefit base where there was very little knowledge of the impact, while reducing the benefit base in other areas.  He reiterated the fact the state could not afford to pay this demand.  Ms. Giunchigliani answered long-term mismanagement was really what had driven the system to its present status.

 

Mr. Collins asked for verification on the expense.  Mr. Craigie responded SIIS was not compensating for stress claims now.  The current language on personal injury was wide open.  The practice had been not to pay on stress claims.  Mr. Craigie stated if stress was adopted as a compensable injury, there would be a dramatic increase in cost.  Even the slight recognition of stress claims in Section 20 was a broadening of the existing practice of how the policy was enforced at SIIS.  Ms. Giunchigliani stated SIIS had paid on a limited number of stress claims due to no language currently existed.

 

Mr. Young explained SIIS presently did accept some stress claims which met both a medical and legal test. 

 

Ms. Giunchigliani remarked the main concern was what DIR would be doing with the AMA Guides. 

 

Bob Gagnier, State of Nevada Employees Association, stated his organization objected to this language because the only time an employee could get a claim was when there was a physical injury attached.  He further expounded on the nurse hostage at the prison which Mr. Young briefly mentioned in earlier testimony.  Mr. Gagnier stated hostage situations at the prison were not uncommon and other institutional situations involving staff shortages could cause job related stress and needed to be compensable.

 

Ray Badger, Nevada Trial Lawyers Association, asserted stress was hard to define especially in a legal setting.  The Nevada Trial Lawyers Association agreed to a bill last session and employers stated they did not want a bill with stress in it so the status quo remained the same.  There was precedent for leaving the stress claim to the civil justice system.  If it could not be paid for in workers' compensation, leave it to the civil justice system. The Nevada Supreme Court recently issued an opinion no psychological disability would be allowed for any injury and permanent disability in the state of Nevada by their reading of the statutes despite the fact there was an entire chapter in the AMA Guides.  Mr. Badger said if the committee was to find any of this compensable, they should add if a case was compensable and there was permanent disability, it should be allowed.  He pointed out the current AMA Guide's chapter on mental and behavioral disorders relating to permanent disability did not define what cases we compensable.  Mr. Badger did not think a stress claim should require a physical injury.

 

Ms. Kenny referred to Mr. Gagnier's prison hostage example and questioned whether the nurse, if not covered for psychological damages under SIIS, could be covered under her major medical.  Mr. Badger answered all health insurance had an exclusion for areas covered by workers' compensation.  He stated the medical bills should be covered by major medical.

 

Arthur Busby, Horseshoe Hotel and Casino, Las Vegas, told of a recent occurrence wherein a maid was the victim of an attempted rape.  They felt the stress of the situation should be covered by the workers' compensation laws because, if the exclusive remedy was removed in their behalf, it would open the Horseshoe up to civil liability.  Mr. Busby had also testified before the Senate with this same testimony.

 

Ms. Giunchigliani asked Scott Young to refer to Sections 83 and 191.  Mr. Young explained SIIS was attempting to leave DIR in charge of a fund for all self-insureds and SIIS would administer its own subsequent injury cases on behalf of its own policy- holders.  This would cut down on paper trading between SIIS and DIR and Section 83 stipulates SIIS had to use the same standard currently in NRS 427 and NRS 428.  Mr. Young stated this would speed up the process for both SIIS and self-insureds.  There was a discussion on the subsequent injury fund, SIIS and self-insureds between Ms. Giunchigliani and Mr. Young.  Mr. Young  suggested "procedures" to "regulations" in Section 83, (EXHIBIT G).

 

Mr. Carpenter requested Mr. Young briefly explain the subsequent injury fund to the committee.  Mr. Young said the subsequent injury fund protected an employer from claims if a previously injured worker re-injured himself on the job.  It gave an employer incentive to hire a previously injured worker while protecting the employer from claims.  The funds came from an assessment made by DIR on all the employers in the state. 

 

Ms. Carol Jackson, Director, DIR, commented the subsequent injury fund total cost for this year was assessed at $14.6 million.  The DIR was looking at a refund to employers of almost $6 million.  Refunds were sent out March 26th of every year.  The money must be refunded; the next year's assessment could not be decreased.

 

 

 

 

 

AB 437 was rescheduled due to lack of time.

 

There being no further business to come before committee, the meeting was adjourned at 7:59 p.m.

 

      RESPECTFULLY SUBMITTED:

 

 

                             

      JUDY HANNA

      Committee Secretary

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Assembly Committee on Labor and Management

April 19, 1993, 1993

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