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Frequently Asked Questions

For covered claims, Nevada Insurance Guaranty Association pays up to policy limits or $300,000.00 in property damage, whichever is less.  If you have uninsured motorists’ coverage with a solvent company, you should contact your agent to file a claim.

Yes, unless you are a very large company -- the Nevada Insurance Guaranty Association does not handle claims for insureds whose net worth equals or exceeds $25,000,000.00.  Refer to NRS 687A.33 section 2F and NRS 687A.090 for more information.

The law provides for an automatic stay of all proceedings pending in any court in Nevada for three (3) months and any time thereafter ordered by the court after the date the insolvency is determined to permit proper defense by the Association of all pending causes of action. Please refer to NRS 687A.160 and NRS 687A.033 section 2C.

It is necessary to file a Proof of Claim to assert a claim against the Nevada Insurance Guaranty Association.  However, you must file a Proof of Claim to protect your rights to share in any distribution from the receivership estate, particularly for claims that are not covered by the Nevada Insurance Guaranty Association or that exceed our “cap.”

Employers, workers' compensation insurance carriers, physicians, and other participants in the workers' compensation system are permitted to share protected health information with each other in connection with workers' compensation claims and appeals.  More information is available through the Nevada Division of Industrial Relations and hippa-faq.pdf.

AUTHORIZATION FOR TREATMENT

Nevada Insurance Guaranty Assoication authorizes reasonable and necessary medical treatment for workers who resided in Nevada when injured in the course and scope of their employment for employers with workers’ compensation policies written through insurance carriers designated as “impaired insurers” by the Nevada Commissioner of Insurance. Authorization for treatment for injured workers, non Nevada residents on the date of accident should be obtained from the guaranty fund of the state the worker lived when injured.

PAST DUE BILLS

Due to the transition of claim files from the impaired carrier or handling Third Party Administrator (TPA) to NVIGA, we do not anticipate processing the medical bills left unpaid by the carrier or TPA in less than ninety (90) days from the date of the carrier’s impairment. Payments will only be made on those bills on which we have received a claim file and have confirmed coverage and compensability.

Medical bills outstanding and unpaid from prior submissions to an impaired carrier or TPA should be re-billed to NVIGA. Requests for reconsideration should be completed, a copy of the bill as it was originally submitted, with a copy of the carrier’s EOB, must be attached.  With your request, please provide a detailed position statement explaining why additional reimbursement is needed.

Thank you for your patience and consideration while we begin to receive and process the claims in Liquidation.

 

Yes. You should advise the doctor to contact NVIGA for authorization and billing information.

NVIGA makes every effort to ensure that the payment of weekly workers' compensation benefits continues without interruption. However, our efforts are subject to the availability of claim files and necessary information from the insolvent company, and it is possible that there may be an interruption in your weekly benefits. In addition, our review of the file may result in a change in the amount or availability of benefits, in accordance with the Nevada Workers’ Compensation Act.

Starting in 2011, the federal Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) will require that we also determine whether a person receiving a payment for bodily injury is a Medicare beneficiary.  To do so, we must obtain the claimant’s social security number.  For more information on MMSEA, please visit CMS.gov.

In compliance with the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA), the TPCIGA will perform the appropriate CMS queries and serve as the Responsible Reporting Entity for any claim payments it makes that are subject to the MMSEA.

The Nevada Department of Insurance (DOI) maintains complete and current records of all insurance companies licensed to do business in Nevada.  You can look up the company at the DOI website at Nevada Division of Insurance.

Carson City Office: (775) 687-0700

Las Vegas Office:   (702) 486-4007

Toll Free:               (888) 872-3234

First, consult your agent.  Generally, it is in your best interest to replace coverage in an insolvent company as soon as possible, because the receivership court will cancel all policies, and the NVIGA will only cover claims arising within the first 30 days after the company becomes impaired.

If the lawsuit is within the coverage of the applicable policy, NVIGA will continue to defend the insured to the extent of coverage under the policy and the Guaranty Act. NVIGA may choose to retain the same attorney, or we may decide to have the case referred to a different attorney.

You should immediately contact NVIGA and send a copy of the claim and/or lawsuit to our office by facsimile and by certified mail.

Yes. Claims for statutory workers' compensation benefits must be timely filed in accordance with the procedures of the applicable workers' compensation act. For all other types of claims, the deadline is eighteen months after the date that the receivership court enters an order of liquidation. If you had already filed a claim with the insurer prior to receivership, NVIGA considers your claim to have been filed prior to the deadline.

So long as your claim appears in the company's records, NVIGA will have notice of your claim and there is no need to file it again. However, if it has been more than a month since your insurer became insolvent and you have not yet heard from NVIGA, you should contact us to be sure we have a record of your claim.

Covered claims for unearned premium are covered up to $300,000.00  NVIGA will pay unearned premium claims after the Receiver processes the policy records and sends the unearned premium records to NVIGA. Refer to NRS 687A.060 1(a) 2  This may take several weeks or several months, depending on the condition of the data at the insolvent insurance company.

You must exhaust your rights under any other policy of insurance that might be available to pay your claim before obtaining coverage from the Nevada Insurance Guaranty Association.  NVIGA is entitled to a credit for the full limits of that policy.  For example, if you were in an automobile accident and you have uninsured motorists coverage with a solvent insurer, you must contact your agent to file a claim for your UM benefits.  If you have a claim for policy benefits in excess of the amount payable by NVIGA, you may present that claim to the receiver or the liquidator of the impaired insurer. Such claims will be payable only to the extent that there are sufficient company assets remaining to pay them.

Not necessarily.  Because the guaranty association is designed to be a safety net and not a complete replacement for insurance coverage, there are limitations on the kinds and amounts of claims that NVIGA can pay.  With some exceptions, benefits are generally capped at $300,000 or the limits of the policy, whichever is less; however, NVIGA will pay the full amount of a covered claim for statutory worker’s compensation benefits.

Some delays are likely, since we must first obtain the files from the insolvent insurer and have time to review them. Oftentimes, the files are disorganized or in poor condition when we receive them. We will make every effort to quickly identify and expedite the handling of any hardship cases, such as when your auto is in the repair shop and can’t be released until your claim is paid. Be patient, and we will handle your claim as soon as practicable. We will make every effort to ensure that workers compensation periodic indemnity claims continue to be paid without interruption.

We will try to contact each person who had an open claim on file with the impaired insurer.  As soon as possible after we receive the claim files from the company's receiver, we will mail out letters detailing your rights under the Guaranty Act and letting you know how to contact us.  If you do not hear from us within a month from the date the company became impaired, feel free to contact us. However, we will be unable to give you specific information about your claim or to make any payments until we have received your claim file from the receiver.

If the company was licensed to write insurance in Nevada and otherwise qualifies for membership in the association, the Nevada Commissioner of Insurance will likely issue an order designating the company as an impaired insurer and trigger NVIGA's duty to pay covered claims.

Our responsibilities are triggered when a court issues an order stating that the insurer is insolvent and the Nevada Commissioner of Insurance issues an order designating the company as an "impaired insurer."  To be considered for coverage by the NVIGA, either the claimant or the insured must be a Nevada resident, or the claim must arise from property permanently located in Nevada.  Insureds and claimants in other states may be covered by their own state guaranty associations.

It’s similar to bankruptcy, except the process is managed by state courts and state insurance departments.  When an insurance company has been found by a court to have insufficient funds to pay all of its claims, the court orders the company into liquidation, and the insurance department in the company’s home state becomes the Receiver or Liquidator of the company in order to liquidate its assets for the benefit of policyholders and claimants.  Claims payments are usually stopped, and all of the company’s insurance policies are canceled.  Existing claims are then referred to the appropriate state guaranty association for handling.

NVIGA does not cover life, annuity, health or disability insurance - questions about those lines of insurance should be directed to the Nevada Life & Health Insurance Guaranty Association 1-775-329-8387, nlhiga@sbcglobal.net.

We also do not cover surplus lines, credit insurance, financial or mortgage guaranty, fidelty or surety bonds, or ocean marine coverage.  Please refer to §687A.020 for a more complete list of exceptions to coverage.

We cover property and casualty lines of insurance, such as auto, homeowner’s, worker’s compensation, general liability and professional liability policies.

NVIGA has been set up by the legislature to protect you if your property or casualty carrier becomes insolvent. We can pay claims and provide a defense under a liability policy, so long as those obligations are “covered claims” under the NVIGA Act.

 

 

 

The Nevada  Insurance Guaranty Association is a non-profit association created by the legislature to pay certain claims of Nevada insurance consumers in the event that a property-casualty company becomes insolvent.  NVIGA is not an insurance company; it does not issue policies, collect premiums or make a profit, or otherwise stand in the shoes of an insolvent insurance company.  We exist solely to pay claims when an insurer becomes insolvent.  All insurance companies that are licensed to sell property and casualty insurance in Nevada are required to be members of the association and to contribute to our fund.  Our governing statute is found at CHAPTER 687A - INSURANCE GUARANTY ASSOCIATION.

 



by Dr. Radut