reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.138 - Billing for provision of certain supplies and services

Current through June 11, 2024
Supplies and materials provided by the provider of health
				  care over and above those usually included in a visit to his or her office or
				  in other services rendered must be billed by report under the appropriate code
				  set forth in the "Centers for Medicare and Medicaid Services, CMS Common
				  Procedures Coding System (HCPCS)," as contained in the
Relative Values
				  for Physicians
, as adopted pursuant to NAC 616C.145.
Industrial Comm'n, No.
				  14.091, eff. 6-20-82-NAC A by Dep't of Industrial Relations, 11-12-85; A by
				  Div. of Industrial Relations, 10-11-93; 3-5-96; R121-97, 12-10-97, eff. 1-1-98;
				  R118-02, 9-7-2005
NRS
					 616A.400,
					 616C.260
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.141 - Requirements for programs of treatment billed under certain codes; use of codes in billing; contents of bills for certain office visits

Current through June 11, 2024
1. If a program of treatment that is required
				to be billed under codes 97001 to 97799, inclusive, or 98925 to 98943,
				inclusive, is administered to an injured employee, the treatment, evaluation,
				manipulation, modality, mobilization procedure, testing or measurements must be
				administered by:
(a) A licensed physical
				therapist;
(b) A licensed physical
				therapist's assistant;
(c) A
				licensed occupational therapist;
(d) A licensed occupational therapy
				assistant;
(e) A licensed
				physician;
(f) A licensed
				chiropractor; or
(g) A certified
				chiropractor's assistant,
who is acting within the authorized scope of his or her
				  license or certification.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.143 - Consultation or treatment provided outside State: Prior written authorization; treatment in cases of emergency

Current through June 11, 2024
1. Except as
				otherwise provided in this section, an insurer is not financially liable for
				consultation or treatment that is provided outside this State unless the
				insurer has given prior written authorization to the provider of health care or
				the medical facility in which the consultation or treatment is provided for the
				consultation or treatment. At the time of giving the written authorization, the
				insurer shall give written notice, which must include the date on which the
				notice is given, to the injured employee and the provider of health care or the
				medical facility that:
(a) The payment for the
				consultation or treatment will be made in accordance with the schedule of
				reasonable fees and charges allowable for accident benefits adopted for this
				State pursuant to
				NRS
				616C.260, unless otherwise provided in a
				contract between the provider of health care or the medical facility and the
				insurer;
(b) The insurer is solely
				responsible for the payment of all services rendered;
(c) The injured employee is not financially
				liable for any part of the cost of the services rendered and must not be billed
				for those services; and
(d) Any
				bill must be submitted within 90 days after services are rendered.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.145 - Relative Values for Physicians : Adoption by reference; annual review by Administrator; compliance required

Current through June 11, 2024
1. Except as
				otherwise provided in this section, providers of health care who treat injured
				employees pursuant to this chapter and chapter 616C of NRS shall comply with
				the most recently published edition of or update to the
Relative Values
				for Physicians
, which the Division hereby adopts by
				reference.
2. The Administrator
				will, on or before February 1 of each year, review the most recently published
				edition of or update to the
Relative Values for Physicians
.
				Each new edition of or update to the
Relative Values for
				Physicians
shall be deemed approved by the Division for use in this
				State from February 1 through January 31, unless a notice of disapproval of the
				edition or update is posted pursuant to this subsection by the immediately
				preceding February 1. If the Administrator wishes to disapprove a new edition
				of or update to the
Relative Values for Physicians
, the
				Administrator will:
(a) Post a notice of
				disapproval at the largest public library in each county, the State Library and
				Archives, the Grant Sawyer Office Building located at 555 East Washington
				Avenue, Las Vegas, Nevada, and all offices of the Division; and
(b) Send a notice to each person included on
				the mailing list that the Division is required to maintain pursuant to
				paragraph (e) of subsection 1 of
				NRS
				233B.0603.
If the Administrator disapproves an edition of or update to
				  the
Relative Values for Physicians
the edition or update that
				  was most recently adopted by reference or deemed approved pursuant to this
				  section will continue in effect.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.146 - Relative Value Guide of the American Society of Anesthesiologists: Adoption by reference; annual review by Administrator; compliance required; use

Current through June 11, 2024
1.
				Anesthesiologists who treat injured employees pursuant to this chapter and
				chapter 616C of NRS shall comply with the most recently published edition of or
				update to the
Relative Value Guide
of the American Society of
				Anesthesiologists, which the Division hereby adopts by reference.
2. The Administrator will, on or before
				February 1 of each year, review the most recently published edition of or
				update to the
Relative Value Guide
of the American Society of
				Anesthesiologists. Each new edition of or update to the
Relative Value
				Guide
of the American Society of Anesthesiologists shall be deemed
				approved by the Division for use in this State on February 1 of each year,
				unless a notice of disapproval of the edition or update is posted pursuant to
				this subsection by the immediately preceding February 1. If the Administrator
				wishes to disapprove a new edition of or update to the
Relative Value
				Guide
of the American Society of Anesthesiologists, the Administrator
				will:
(a) Post a notice of disapproval at the
				largest public library in each county, the State Library, Archives, and Public
				Records, the Grant Sawyer Office Building located at 555 East Washington
				Avenue, Las Vegas, Nevada, and all offices of the Division; and
(b) Send a notice to each person included on
				the mailing list that the Division is required to maintain pursuant to
				paragraph (e) of subsection 1 of
				NRS
				233B.0603.
If the Administrator disapproves an edition of or update to
				  the
Relative Value Guide
of the American Society of
				  Anesthesiologists, the edition or update that was most recently adopted by
				  reference or deemed approved pursuant to this section will continue in
				  effect.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.147 - Codes for surgical centers for ambulatory patients

Current through June 11, 2024
The Division hereby adopts by reference:
1. The list of eligible codes for
				hospital-based outpatient surgery centers and Ambulatory Surgical Center (ASC)
				payment groups and procedures and the payment groups to which those codes are
				assigned as set forth in "Provider Type 10: Outpatient Surgery, Hospital Based
				and Provider Type 46: Ambulatory Surgical Centers" maintained by the Rates Unit
				- Nevada Medicaid of the Division of Health Care Financing and Policy of the
				Department of Health and Human Services and available at the Internet address:
http://dir.nv.gov/uploadedFiles/dirnvgov/content/WCS/MedicalDocs/ASCOPGroupList2016.pdf
.
2. The codes set forth in the "Healthcare
				Common Procedure Coding System (HCPCS)," as set forth in the
Relative
				Values for Physicians
adopted by reference pursuant to NAC
				616C.145.
Added to NAC by Dep't
				  of Industrial Relations, 2-28-90, eff. 3-19-90; A 1-24-92, eff. 12-31-91; A by
				  Div. of Industrial Relations, 10-11-93; 3-5-96; R121-97, 12-10-97, eff. 1-1-98;
				  R090-99, 10-28-99; R105-00, 1-18-2001, eff. 3-1-2001; R118-02,
				  9-7-2005-Substituted in revision for NAC 616C.197; A by
				  R130-14,
				  eff. 9/9/2016
NRS
					 616A.400,
					 616C.260
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.148 - Reports by rating physician or chiropractor

Current through June 11, 2024
Unless good cause is shown:
1. A rating physician or chiropractor shall
				mail a report of an evaluation of an injured employee to the insurer within 14
				days after the evaluation is completed. Unless good cause is shown, if an
				addendum is requested by the insurer, the rating physician or chiropractor
				shall mail the addendum to the insurer within 14 days after receiving the
				request.
2. If a rating evaluation
				is requested by an injured employee or a representative thereof, the rating
				physician or chiropractor shall mail a report of the evaluation to the injured
				employee or a representative within 14 days after the evaluation is completed.
				Unless good cause is shown, if an addendum is requested by the injured employee
				or a representative, the rating physician or chiropractor shall mail the
				addendum to the injured employee or a representative within 14 days after
				receiving the request.
3. A report
				of a rating evaluation performed by a rating physician or chiropractor must
				include:
(a) All the findings of the physical
				examination; and
(b) References to
				each table or figure of the American Medical Association's
Guides to
				the Evaluation of Permanent Impairment
used by the rating physician or
				chiropractor to determine the permanent impairment of the injured
				employee.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.149 - Contents of bill to insurer; adoption by reference and annual review of ICD-9-CM codes; submission to insurer of order for services rendered

Current through June 11, 2024
1. Each provider of health care and each
				medical facility shall submit a bill to the insurer which includes:
(a) The usual charge for services
				provided;
(b) The code for the
				procedure and a description of the services;
(c) The number of visits and date of each
				visit to the office of the provider of health care or to the medical facility
				and the procedures followed in any treatment administered during the
				visit;
(d) The codes for supplies
				and materials provided or administered to the injured employee that are set
				forth in the "Healthcare Common Procedures Coding System (HCPCS)," as contained
				in the
Relative Values for Physicians
adopted by reference
				pursuant to NAC
				616C.145;
(e) The name of the injured employee and his
				or her employer and the date of the injury;
(f) The tax identification number of the
				provider of health care; and
(g)
				The signature of the person who provided the service.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Reimbursement for Costs of Transportation and Meals › Section 616C.150 - Eligibility and computation

Current through June 11, 2024
1. The insurer
				shall reimburse an injured employee for the cost of transportation to and from
				the place where the injured employee receives health care if he or she is
				required to travel 20 miles or more, one way, from the injured employee's:
(a) Residence to the place where he or she
				receives health care; or
(b) Place
				of employment to the place where he or she receives health care if the care is
				required during his or her normal working hours.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Reimbursement for Costs of Transportation and Meals › Section 616C.153 - Reimbursement for airfare

Current through June 11, 2024
With the prior approval of the insurer, an injured employee
				  may be reimbursed for airfare where the time, distance, convenience or cost
				  justifies the travel by air.
Industrial Comm'n, No.
				  42 § 5, eff. 6-30-82-NAC A by Div. of Industrial Insurance Regulation,
				  10-26-83; 2-22-88; A by Div. of Industrial Relations, 10-11-93; R121-97,
				  12-10-97, eff. 1-1-98
NRS
					 616A.400,
					 616C.260
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Reimbursement for Costs of Transportation and Meals › Section 616C.156 - Limitations on reimbursements

Current through June 11, 2024
1. Unless otherwise
				directed or approved by the insurer or the injured employee's treating
				physician or chiropractor, an injured employee who chooses to obtain health
				care services at a more distant place although adequate health care is
				available at a closer place may be reimbursed under NAC 616C.150 only for
				mileage to the closer place.
2. If
				an injured employee moves outside this State or to a new location within this
				State for his or her own convenience after becoming an injured employee, the
				maximum mileage for one direction for which he or she may be reimbursed is the
				mileage allowable before the move or 40 miles, whichever is greater.
3. No reimbursement will be allowed for a
				person traveling with an injured employee unless there is a health care
				necessity that precludes the injured employee from traveling alone. The health
				care necessity must be substantiated in writing by the injured employee's
				treating physician or chiropractor.
Industrial Comm'n, No.
				  42 §§ 3 & 4, eff. 6-30-82-NAC A by Div. of Industrial Insurance
				  Regulation, 10-26-83; 2-22-88; A by Div. of Industrial Relations, 10-11-93;
				  R121-97, 12-10-97, eff. 1-1-98
NRS
					 616A.400,
					 616C.260
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.260 - Definitions

Current through June 11, 2024
As used in NAC to 616C.336, inclusive, unless the context
				  otherwise requires:
1. "Hearings
				Division" means the Hearings Division of the Department of
				Administration.
2. "Licensed
				representative" means a person who is licensed pursuant to NAC 616C.350 to
				616C.377, inclusive.
3. "Senior
				appeals officer" means the appeals officer designated by the Director of the
				Department of Administration pursuant to subsection 3 of
				NRS
				232.215 to supervise the administrative,
				technical and procedural activities of the Hearings Division.
Added to NAC by
				  Hearings Div. by R055-98, eff. 8-12-98; A by R184-07,
				  9-29-2008
NRS
					 616C.295,
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.265 - Hearing officer: Qualifications regarding education and experience

Current through June 11, 2024
A person who wishes to serve as a hearing officer pursuant to
				  chapters 616A to 616D, inclusive, or chapter 617 of NRS must:
1. Possess a bachelor's degree from an
				accredited college or university and have at least 4 years of professional
				experience in resolving disputes between opposing parties, 2 years of which
				included making determinations or adjudicating issues by interpreting statutes
				or administrative rules or regulations;
2. Possess an associate's degree from an
				accredited junior college or community college and have at least 5 years of
				professional experience in resolving disputes between opposing parties, 2 years
				of which included making determinations or adjudicating issues by interpreting
				statutes or administrative rules or regulations;
3. Have at least 2 years of experience as a
				hearing officer with an administrative agency of this State; or
4. Possess any other combination of education
				and experience which the Chief of the Hearings Division deems to be equivalent
				to the education and experience required by subsection 1, 2 or 3, and
				demonstrate to the satisfaction of the Chief of the Hearings Division that he
				or she possesses the knowledge, skills and abilities required by this section
				and NAC 616C.267. For the purposes of this subsection, 1 year of experience in
				administering claims or programs for workers' compensation or representing
				employers in contested claims for workers' compensation, or 1 year of any other
				related experience, may be substituted for 1 year of education completed after
				graduation from high school.
Added to NAC by
				  Hearings Div., eff. 9-6-96
NRS
					 616C.295
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.267 - Hearing officer: Additional qualifications

Current through June 11, 2024
1. In
				addition to possessing the qualifications required by NAC 616C.265, a hearing
				officer must:
(a) Be able to:
(1) Interact effectively with all
				participants at a hearing in a manner which ensures an impartial, orderly
				proceeding;
(2) Put the parties to
				a hearing at ease and ensure their rights of due process in a dignified
				manner;
(3) Coordinate and schedule
				various assignments by determining the time, place and sequence of actions to
				be taken and establishing priorities which accurately reflect the relative
				importance of those assignments;
(4) Work independently with a minimum amount
				of supervision;
(5) Listen to and
				analyze the evidence presented at a hearing and communicate effectively his or
				her decisions on motions and objections related to that evidence;
(6) Motivate persons to resolve their
				disputes;
(7) Provide mediation or
				other techniques for the resolution of disputes for the opposing parties to a
				hearing;
(8) Communicate
				effectively, orally and in writing, with persons from a variety of social,
				economic and educational backgrounds;
(9) Render an impartial decision based on:
(I) The evidence presented at a hearing;
				and
(II) An objective analysis of
				applicable statutes, regulations and case law; and
(10) Write decisions and opinions in a clear,
				concise and accurate manner; and
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.269 - Hearing officer: Training requirements

Current through June 11, 2024
1. To
				the extent that money is made available to the Hearings Division for the
				purpose of training hearing officers, a hearing officer must successfully
				complete annually at least 20 hours of training, which may include, without
				limitation, training in:
(a) Mediation and
				other techniques for the resolution of disputes;
(b) Industrial insurance law and practice,
				including, without limitation:
(1) The
				provisions of chapters 616A to 617, inclusive, of NRS; and
(2) The provisions of chapters 616A to 617,
				inclusive, of NAC;
(c)
				Adjudication of administrative law hearings;
(d) Recent relevant statutory and regulatory
				changes and judicial decisions;
(e)
				Writing, evidence and ethics; and
(f) Other similar topics approved by the
				senior appeals officer, including, without limitation, any training provided by
				the Hearings Division.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2691 - Hearing or appeals officer: Professional conduct

Current through June 11, 2024
A hearing or appeals officer shall:
1. Act in a manner that preserves the
				integrity, impartiality and independence of hearings in contested cases for
				compensation conducted pursuant to chapters 616A to 617, inclusive, of NRS and
				promotes public confidence in such hearings;
2. Act in a manner that avoids the appearance
				of impropriety, including, without limitation, disclosing any affiliation to a
				party in a proceeding before the officer;
3. Perform diligently all official
				duties;
4. Be faithful to the law
				and decide matters on the basis of the facts and the applicable law, including,
				without limitation, judicial decisions; and
5. Maintain order and decorum in proceedings
				before the officer.
Added to NAC by
				  Hearings Div. by R184-07, eff. 9-29-2008
NRS
					 616C.295
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2693 - Limitation on communications between hearing or appeals officer and party or representative; disclosure

Current through June 11, 2024
1. Except as
				otherwise provided in subsection 2, a hearing or appeals officer shall not
				engage in any communication or contact with a party to a proceeding before the
				hearing or appeals officer or with any attorney or other representative of a
				party outside the presence of any other party to the proceeding.
2. A hearing or appeals officer may
				communicate with a party to a proceeding before the hearing or appeals officer
				or with any attorney or other representative of a party outside the presence of
				any other party to the proceeding:
(a) If the
				parties to the proceeding or the attorneys or other representatives of the
				parties are engaged in mediation; or
(b) For scheduling or administrative purposes
				or for emergencies that do not address substantive matters or issues on the
				merits relating to the proceeding before the hearing or appeals officer and if
				the officer reasonably believes that no party or attorney or other
				representative of a party will gain a procedural or tactical advantage as a
				result of the communication.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2694 - "Conflict of interest" and "personal interest" interpreted

Current through June 11, 2024
As used in
				  NRS
				  616C.300 and
				  616C.340,
				  the Chief of the Hearings Division interprets the terms "conflict of interest"
				  and "personal interest" to include, without limitation:
1. A bias or prejudice concerning a party, an
				attorney or other representative of a party, or any other participant in the
				proceeding.
2. Knowledge obtained
				from sources outside of the proceeding of evidentiary facts that are disputed
				in the proceeding.
3. Service as an
				attorney in the matter in controversy.
4. Service of an attorney with whom the
				officer previously has been associated, during the period of association with
				the officer, as an attorney in the matter in controversy.
5. Being a material witness in the matter in
				controversy.
6. Having, as an
				individual or as a personal representative, trustee, conservator or guardian, a
				financial interest in the matter in controversy or any other interest that
				could be affected substantially by the outcome of the proceeding.
7. Being, as an individual or as a personal
				representative, trustee, conservator or guardian, a party to the
				proceeding.
8. If the spouse, a
				parent or a child of the hearing or appeals officer, regardless of residence,
				or any other person residing in the household of the officer:
(a) Has a financial interest in the matter in
				controversy or any other interest that could be affected substantially by the
				outcome of the proceeding;
(b) Is a
				party in the proceeding;
(c) Is an
				officer, director, partner or trustee of a party in the proceeding;
(d) Is acting as an attorney in the
				proceeding; or
(e) To the knowledge
				of the hearing or appeals officer, is likely to be a material witness in the
				proceeding.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.26941 - Complaint of violation; investigation

Current through June 11, 2024
1. A complaint
				alleging that a hearing or appeals officer has violated a provision of NAC
				616C.2691 to 616C.2694, inclusive, must be in writing and submitted to the
				senior appeals officer.
2. The
				senior appeals officer shall investigate any complaint submitted pursuant to
				subsection 1 and shall notify the complainant of the results of the
				investigation not more than 60 days after the complaint is received.
3. If the senior appeals officer
				substantiates the complaint, the senior appeals officer shall report the
				results of the investigation:
(a) If the
				complaint involves a hearing officer, to the Director of the Department of
				Administration.
(b) If the
				complaint involves an appeals officer, to the Governor.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.26942 - Appeals officer: Training requirements

Current through June 11, 2024
1. To
				the extent that money is made available to the Hearings Division for the
				purpose of training appeals officers, an appeals officer must successfully
				complete annually at least 20 hours of training, which may include, without
				limitation, training in:
(a) Adjudication of
				administrative law hearings;
(b)
				Industrial insurance law and practice, including, without limitation:
(1) The provisions of chapters 616A to 617,
				inclusive, of NRS; and
(2) The
				provisions of chapters 616A to 617, inclusive, of NAC;
(c) Mediation and other techniques for the
				resolution of disputes;
(d) Recent
				relevant statutory and regulatory changes and judicial decisions;
(e) Writing, evidence and ethics;
(f) Any other similar subjects approved by
				the senior appeals officer; and
(g)
				Subjects taught in courses:
(1) Offered by the
				National Judicial College or the National Association of Administrative Law
				Judiciary or attended by an appeals officer to meet the requirements of the
				State Bar of Nevada for continuing legal education; and
(2) Approved for the purposes of this section
				by the senior appeals officer, including, without limitation, any training
				provided by the Hearings Division.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2695 - Special appeals officer: Qualifications; determination of assignment

Current through June 11, 2024
1. Each special appeals officer appointed by
				the Governor pursuant to subsection 4 of
				NRS
				616C.340 must be an attorney who has been
				licensed to practice law before all the courts of this State for at least 2
				years.
2. The senior appeals
				officer shall:
(a) Create and maintain a list
				of persons who have been appointed as special appeals officers by the Governor
				pursuant to subsection 4 of
				NRS
				616C.340.
(b) Assign cases to special appeals officers
				from the list described in paragraph (a).
(c) If he or she assigns a particular case to
				a special appeals officer, provide to each party involved in that case the name
				of the special appeals officer to whom the case has been assigned.
(d) In determining the particular special
				appeals officer to whom a case will be assigned, consider:
(1) The venue in which the case will be
				heard;
(2) The relative workloads
				of the special appeals officers who are otherwise available to hear the
				case;
(3) Whether the special
				appeals officers who are otherwise available to hear the case have promptly
				settled and decided cases that have been assigned to them in the
				past;
(4) The particular expertise
				of the special appeals officers who are otherwise available to hear the case;
				and
(5) Any other factor that the
				senior appeals officer determines to be relevant.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.270 - Appeal to hearing officer

Current through June 11, 2024
Any claimant who is aggrieved by any final determination of
				  the insurer or the insurer's staff may appeal from the decision to a hearing
				  officer.
Industrial Comm'n, No.
				  4.130, eff. 6-30-82-Hearings Div.
NRS
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.273 - Explanation of right to appeal suspension of benefits

Current through June 11, 2024
If an insurer suspends benefits pursuant to
				  NRS
				  616C.140 or
				  616C.230,
				  the insurer shall provide the claimant with a written explanation of the right
				  to an appeal and the procedures he or she must follow to have the benefits
				  reinstated.
Added to NAC by Div. of
				  Industrial Insurance Regulation, eff. 2-22-88-Substituted in revision for NAC
				  616.611
NRS
					 616A.400,
					 616C.140,
					 616C.230
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.274 - Form for requesting hearing before hearing officer or for notice of appeal; information required to be provided by insurer or third-party administrator

Current through June 11, 2024
1. A request for a hearing before a hearing
				officer or a notice of appeal filed with the Hearings Division must be filed:
(a) On a form provided by an insurer, an
				organization for managed care or the Hearings Division; or
(b) On a similar form approved by the
				Department of Administration.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2745 - Hearing on decision concerning accident benefits made by organization for managed care

Current through June 11, 2024
An appeals officer shall not convene a hearing on a dispute
				  that is required to be submitted to a procedure for resolving disputes pursuant
				  to
				  NRS
				  616C.305 until a final decision is rendered
				  pursuant to that procedure or the dispute is not resolved pursuant to that
				  procedure within 14 days after it was submitted.
Added to NAC by
				  Hearings Div., eff. 5-23-96; A by R184-07,
				  9-29-2008
NRS
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.275 - Procedure for submission of contested claim directly to appeals officer

Current through June 11, 2024
1. Parties to a contested claim who wish to
				forego a hearing before a hearing officer and submit the contested claim
				directly to an appeals officer must:
(a) If a
				request for a hearing before a hearing officer has been filed, submit to the
				hearing officer a written stipulation to forego the hearing before the hearing
				officer.
(b) If a request for a
				hearing before a hearing officer has not been filed, submit to a hearing
				officer a request for a hearing and a written stipulation to forego the hearing
				before the hearing officer.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2753 - Hearing or adjudication conducted by Hearings Division at request of another agency

Current through June 11, 2024
If the Hearings Division, pursuant to chapter 277 of NRS,
				  enters into an agreement with another agency in which the Hearings Division
				  agrees to hold a hearing in a contested case or to conduct a fair hearing or
				  impartial adjudication in regard to a matter that is not a contested case
				  pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS:
1. The senior appeals officer shall assign an
				appeals officer or special appeals officer to conduct the hearing or
				adjudication.
2. The agency
				requesting the hearing or adjudication shall reimburse the Hearings Division
				for the cost of conducting the hearing or adjudication, including, without
				limitation, the cost of interpreting, recording and reporting the proceedings
				of the hearing or adjudication.
3.
				The appeals officer or special appeals officer to whom the hearing or
				adjudication is assigned shall, in conducting the hearing or adjudication,
				follow the procedures set forth in any statutes or regulations that apply
				specifically to such a hearing or adjudication. If no statutes or regulations
				set forth the procedures that apply specifically to such a hearing or
				adjudication, the appeals officer or special appeals officer to whom the
				hearing or adjudication is assigned shall, in conducting the hearing or
				adjudication, follow the procedures set forth in:
(a) Chapter 233B of NRS; and
(b) The regulations of the Hearings Division
				that are set forth in chapters 616A to 617, inclusive, of NAC.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2755 - Assistance in interpreting English language during proceedings

Current through June 11, 2024
1. A party, other than a person with a
				communications disability, who requires assistance in interpreting the English
				language during any hearing held before a hearing officer must arrange for such
				assistance, at no cost to the Hearings Division, before the scheduled
				hearing.
2. A party who requires
				assistance in interpreting the English language during any proceeding before an
				appeals officer must notify the appeals officer in writing at least 10 days
				before the hearing that such assistance is required. The appeals officer shall
				appoint an interpreter and arrange for the interpreter to attend the hearing at
				no cost to the party who requires such assistance.
3. As used in this section, "person with a
				communications disability" has the meaning ascribed to it in
				NRS
				50.050.
Added to NAC by
				  Hearings Div., eff. 5-23-96; A by R184-07,
				  9-29-2008
NRS
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.277 - Scheduling of prehearing conference by appeals officer

Current through June 11, 2024
1. An appeals officer may schedule a
				prehearing conference in any appeal filed to discuss settlement, discovery,
				scheduling, or other matters pertinent to the appeal, including, without
				limitation:
(a) Expedition of the pending
				case.
(b) Hearing
				motions.
(c) Submission of
				documentary evidence.
(d) Narrowing
				the issues.
(e) Setting a
				convenient date for the primary hearing.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.278 - Additional conferences called by appeals officer; request for assignment of matter for mediation

Current through June 11, 2024
1. In addition to a
				prehearing conference authorized pursuant to NAC 616C.277, an appeals officer
				may, in regard to any proceeding that is being heard before him or her:
(a) Call the parties to the proceeding
				together for a conference to be held before the taking of testimony;
				and
(b) Recess the proceeding to
				hold a conference,
to address any matter that, in the opinion of the appeals
				  officer, will assist in securing the just, speedy and economical determination
				  of the issues that are in question in the proceeding. If an appeals officer
				  conducts a conference pursuant to this section, the appeals officer shall
				  ensure that the official record of the proceeding contains a notation that sets
				  forth the results of such a conference.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.279 - Failure of party to appear

Current through June 11, 2024
1. If a party who
				appeals fails to appear after due notice has been given and good cause is not
				shown for the failure to appear, the hearing officer may dismiss the case with
				prejudice.
2. An appeals officer
				may dismiss with prejudice an appeal by a party who received notice of a
				hearing before a hearing officer, failed to appear at or participate in the
				hearing before the hearing officer and failed to show cause for his or her
				failure to appear at the hearing.
Hearings Div., Practice
				  Rule XI, eff. 2-26-80-NAC A 11-26-84; R184-07, 9-29-2008-Substituted in
				  revision for NAC 616.616
NRS
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.282 - Failure to comply with regulations

Current through June 11, 2024
If a party or his or her counsel or licensed representative
				  fails or refuses to comply with NAC 616C.274 to 616C.336, inclusive, the
				  hearing or appeals officer may make such orders as are necessary to direct the
				  course of the hearing, including, but not limited to, the following:
1. Continue the hearing until the party or
				counsel or licensed representative complies with the requirements.
2. Restrict or prohibit the introduction of
				evidence.
3. Dismiss the
				matter.
4. If the failure or
				refusal to comply is by a licensed representative, refer the matter to the
				senior appeals officer for appropriate action pursuant to NAC 616C.350 to
				616C.377, inclusive.
5. If the
				failure or refusal to comply is by an insurer or a third-party administrator,
				refer the matter to the Commissioner of Insurance for appropriate
				action.
6. If the failure or
				refusal to comply is by an attorney licensed in this State, refer the matter to
				the State Bar of Nevada for appropriate action.
Added to NAC by
				  Hearings Div., eff. 11-26-84; A 5-23-96; R184-07,
				  9-29-2008
NRS
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2823 - Failure to respond to request for determination

Current through June 11, 2024
1. If
				an insurer fails to respond to a written request for a determination within 30
				days after receipt of such a request, the person who made the request may:
(a) File a request for a hearing before a
				hearing officer pursuant to subsection 3 of
				NRS
				616C.315; or
(b) Resubmit the written request for a
				determination to the insurer.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2825 - Information required for appeal of a final determination

Current through June 11, 2024
1. Except as otherwise provided in subsection
				3, if a hearing officer receives an appeal of a final determination of an
				insurer that does not include, if applicable, a copy of the letter of the
				determination being appealed or, if such a copy is unavailable, the date of the
				determination and the issues stated in the determination, the hearing officer
				shall notify the claimant in writing that the claimant must, within 15 days
				after the date on which the hearing officer sends the notification, provide to
				the hearing officer:
(a) A copy of the letter
				of determination;
(b) If the letter
				of determination is unavailable, the date of the determination and the issues
				stated in the determination; or
(c)
				Proof that a letter of determination had been requested from the insurer or
				third-party administrator by the claimant.
If the hearing officer does not receive such documentation by
				  the date specified in the notice sent pursuant to this subsection, the hearing
				  officer shall dismiss the appeal without prejudice in a written order for
				  failure to pursue the appeal.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.2827 - Consolidation with pending case; request for consolidation; service; approval

Current through June 11, 2024
1. An appeal of a hearing officer's decision
				may be consolidated with a case pending before the appeals officer:
(a) At the request of a party to the appeal
				of a hearing officer's decision; and
(b) When:
(1) Both cases involve the same claim and the
				same parties;
(2) Both cases
				involve similar questions of fact or law; or
(3) Consolidation would reduce duplication
				and judicial effort.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.284 - Request for issuance of subpoena; approval or denial of request

Current through June 11, 2024
1. A party who wishes a hearing or appeals
				officer to issue a subpoena requiring the attendance of a witness or the
				production of a book, account, paper, record, or other document must submit a
				request for a subpoena to the hearing or appeals officer:
(a) At any prehearing conference held in the
				matter;
(b) At least 10 days before
				the hearing; or
(c) As otherwise
				allowed by the hearing or appeals officer.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.285 - Failure to comply with order or subpoena

Current through June 11, 2024
1. Any party
				aggrieved by a person's failure or refusal to comply with an order or subpoena
				may apply to the appeals officer or hearing officer for an order certifying the
				disobedience or refusal to comply.
2. Upon receipt of an application under
				subsection 1, the appeals officer or hearing officer shall notify the
				disobedient person to show cause why such an order should not be
				issued.
3. After the hearing, if
				the appeals officer or hearing officer determines an order is appropriate, he
				or she shall issue an order certifying disobedience or refusal to the party who
				applied for the order.
4. Upon
				receipt of such an order, the party may, on behalf of the hearing or appeals
				officer, file an application to compel obedience with the appropriate district
				court.
Added to NAC by
				  Hearings Div., eff. 11-26-84; A 5-23-96
NRS
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.291 - Filing and service of documents

Current through June 11, 2024
For the purposes of NAC 616C.282 to 616C.336,
				  inclusive:
1. Filing occurs when the
				original document is received by and is in the actual physical custody of the
				Hearings Division.
2. A document
				over five pages in length may not be filed by facsimile unless so ordered or
				approved in advance by a hearing or appeals officer. If a document which is
				five pages or less in length is received by facsimile, the document will be
				accepted and the date of receipt stamped on the document. If a document is
				received by facsimile and the original of the document is received within 3
				business days after it is received by facsimile, the original will be stamped
				with the date it is received, but shall be deemed filed on the date the
				facsimile was received.
3. A
				document may be filed by electronic mail upon prior written approval of the
				Hearings Division. A document filed by electronic mail must be:
(a) Accompanied by an acknowledgment of
				receipt.
(b) Sent to the secretary
				for the hearing or appeals officer and to each party to the
				proceeding.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.294 - Proof of service

Current through June 11, 2024
Proof of service may be made by certificate of the counsel
				  for a party or of the counsel's employee, or by written admission, affidavit,
				  or other proof satisfactory to the appeals officer. Failure to make proof of
				  service does not affect the validity of service.
Added to NAC by
				  Hearings Div., eff. 11-26-84-Substituted in revision for NAC
				  616.6186
NRS
					 616C.310
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.297 - Requirements for filing and service of information

Current through June 11, 2024
1.
				Within the times prescribed in subsection 2, all parties shall file with the
				appeals officer and serve upon all other parties:
(a) All documents to be introduced as
				evidence at the hearing;
(b) A
				statement of the issues to be raised;
(c) A list of witnesses, a brief summary of
				proposed testimony, and a statement whether any of the testimony is to be taken
				by use of the telephone; and
(d) An
				estimate of the length of time required to present the case, including rebuttal
				testimony and argument.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Contested Claims of Injured Employees › Section 616C.300 - Service of copies of documents by insurer; submission of documents to Hearings Division; provision of documents to insurer

Current through June 11, 2024
1. The
				insurer shall, within 30 days after notice of hearing before an appeals officer
				or, if a prehearing conference is scheduled in the matter, on or before the
				date of the conference, copy all documents in the claimant's file relating to
				the matter on appeal and serve the copies, appropriately indexed, upon the
				appeals officer and all other parties.
2. The insurer shall, within 2 days before a
				hearing before a hearing officer, submit the following documents, appropriately
				numbered and indexed, to the Hearings Division:
(a) Copies of forms C-3 and C-4 or any
				similar forms which have been provided to the insurer pursuant to NAC
				616A.480;
(b) A brief statement of
				the reason for the determination by the insurer; and
(c) Copies of any other documents in the
				claimant's file relating to the matter before the hearing officer.