Nevada Administrative Code › Chapter 616D - Industrial Insurance: Administrative Proceedings and Enforcement › ENFORCEMENT › Penalties › Section 616D.413 - Determination of pattern of untimely payments to injured workers

Current through June 11, 2024
1. For the purposes of paragraph (h) 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 engaged in a pattern of untimely payments to
				injured workers, the Administrator will consider:
(a) The reasons given by the insurer,
				organization for managed care, health care provider, third-party administrator,
				employer or employee leasing company for making the payments after the time set
				forth in the applicable statute or regulation;
(b) The efforts made by the insurer,
				organization for managed care, health care provider, third-party administrator,
				employer or employee leasing company to make the payments within the time set
				forth in the applicable statute or regulation;
(c) The date the payments were
				made;
(d) The number of injured
				employees who have received untimely payments;
(e) The number of untimely
				payments;
(f) The length of the
				time period in which the untimely payments occurred;
(g) Whether the amount of any payments due,
				or any portion of that amount, was unknown, 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 determine the unknown amounts or to clarify the
				uncertainty or ambiguity and to make the payments due within the time set forth
				in the applicable statute or regulation or at any time thereafter;
(h) Whether the insurer, organization for
				managed care, health care provider, third-party administrator, employer or
				employee leasing company was advised, in writing, by the affected injured
				employee or a representative thereof that payments could be delayed pending the
				outcome of any further negotiations relating to the compensation that was
				due;
(i) Whether successive or
				numerous untimely payments have been made to a single injured
				employee;
(j) Whether the untimely
				payments involved the same form of compensation, such as temporary total
				disability;
(k) Whether the
				insurer, organization for managed care, health care provider, third-party
				administrator, employer or employee leasing company knew or reasonably should
				have known of the circumstances resulting in or likely to result in multiple
				untimely payments to one or more injured employees;
(l) 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;
(m)
				Whether the untimely payments were 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
(n) Any other circumstance which the
				Administrator deems relevant to determine whether untimely payments to one or
				more injured employees constitute a pattern of untimely payments that warrants
				awarding a benefit penalty to an injured employee.