Nevada Administrative Code › Chapter 616D - Industrial Insurance: Administrative Proceedings and Enforcement › ENFORCEMENT › Payment of Compensation › Section 616D.315 - Considerations for determining unreasonable delay in payment

Current through June 11, 2024
For the purposes of paragraph (c) of subsection 1 of NRS 616D.120, to determine whether an insurer, organization for managed care, health care provider, third-party administrator, employer or employee leasing company has unreasonably delayed payment to an injured employee of compensation found to be due him or her by a hearing officer, appeals officer, court of competent jurisdiction, written settlement agreement, written stipulation or the Division when carrying out its duties pursuant to chapters 616A to 617, inclusive, of NRS, the Administrator will consider:
1. The reasons given by the insurer, organization for managed care, health care provider, third-party administrator, employer or employee leasing company for making the payment after the time set forth in paragraph (c) of subsection 1 of NRS 616D.120;
2. The efforts made by the insurer, organization for managed care, health care provider, third-party administrator, employer or employee leasing company to make the payment within the time set forth in paragraph (c) of subsection 1 of NRS 616D.120, if any;
3. The date the payment was made;
4. Whether the amount of compensation due, or any portion of that amount, was unclear or ambiguous and whether the insurer, organization for managed care, health care provider, third-party administrator, employer or employee leasing company took action or exercised reasonable diligence to clarify the uncertainty or ambiguity and to pay the compensation due within the time set forth in paragraph (c) of subsection 1 of NRS 616D.120, or at any time thereafter;
5. Whether the amount of compensation due, or any portion of that amount, was unknown or could have been determined through the exercise of reasonable diligence within the time set forth in paragraph (c) of subsection 1 of NRS 616D.120, or at any time thereafter;
6. Whether the insurer, organization for managed care, health care provider, third-party administrator, employer or employee leasing company was advised, in writing, by the injured employee or a representative thereof that payment of the compensation due could be delayed pending the outcome of any further negotiations relating to the compensation that was due;
7. Whether the insurer, organization for managed care, health care provider or third-party administrator established the policies and procedures required by NAC 616D.311 and complied with those policies and procedures;
8. Whether the delay in the payment of the compensation due, or any portion thereof, was the result of error, lack of good faith or diligence, neglect or another cause within the control of the insurer, organization for managed care, health care provider, third-party administrator, employer or employee leasing company; and
9. Any other circumstance which the Administrator deems relevant to determine whether a delay in the payment of compensation due was reasonable.
Added to NAC by Div. of Industrial Relations by R010-97, eff. 11-5-97; A by R149-09, 10-23-2013
NRS 616A.400, 616D.120