Shook & Stone successfully secured a $127,500 penalty award for an injured employee after a third-party administrator (TPA) failed to comply with a binding Hearing Officer’s order. This victory highlights our “Net-First Advocacy,” where we litigate beyond the initial claim to ensure insurers are held financially accountable for unreasonable delays and administrative violations of Nevada law.
The Problem: Systemic Delay and Benefit Underpayment In December 2024, our client, a professional driver, suffered a serious hand crush injury while working for an entertainment company. The insurer, Gallagher Bassett, initially issued Temporary Total Disability (TTD) benefits based on estimated wages rather than the client’s actual earnings. Despite clear evidence that the client was a “max wage earner” in Nevada, the insurer stalled for months, ignoring formal written requests to recalculate the Average Monthly Wage (AMW) and pay the resulting underpayment.
The Action: Aggressive Litigation and DIR Complaint When the insurer failed to respond, Shook & Stone moved the case into litigation. Attorney Bryan Spinelli, Esq. secured a favorable Decision and Order from the Hearing Officer, but the insurer again missed the 30-day legal deadline for compliance.
Rather than waiting for the insurer to act, we took a “Straight Talk” approach to enforcement:
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Motion for Order Certifying Disobedience: We formally moved to have the insurer’s non-compliance certified by the Appeals Division.
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DIR Investigation Request: We filed a comprehensive complaint with the Nevada Division of Industrial Relations (DIR), triggering a full audit of the insurer’s conduct.
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Proving Unreasonable Delay: We documented that the insurer mailed their compliance response late and only issued the owed benefits after the DIR investigation began.
The Result: $127,500 in Total Penalties The DIR investigation concluded that the insurer had committed multiple violations of NRS 616D.120(1), specifically for unreasonable delay and making it necessary for the claimant to initiate new proceedings just to get paid.
The Administrator awarded our client a **total benefit penalty of $127,500** ($93,500 for the delay and $34,000 for forced litigation). This result provided the client with significantly more than the initial $7,188 underpayment, serving as a powerful deterrent against insurer bad faith in Nevada.
DIRECTIONS 
