Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.088 - File of employees' claims: Maintenance; contents; retention

Current through June 11, 2024
1. Each file of a claim concerning an
				industrial injury or occupational disease that is maintained by an insurer or
				third-party administrator must contain:
(a)
				The employer's report of the industrial injury or occupational
				disease.
(b) The claim for
				compensation and any medical report associated with that claim that is issued
				after the claim is filed with the insurer.
(c) All:
(1)
				Applications for a stay concerning a decision on a claim for compensation made
				to a hearing officer, appeals officer or a court of competent
				jurisdiction;
(2) Written orders or
				decisions on a claim for compensation entered by a hearing officer, appeals
				officer or a court of competent jurisdiction;
(3) Written determinations made by an
				insurer, third-party administrator or an organization for managed care
				concerning a claim for compensation and, if any determination is sent or served
				by electronic transmission, proof of a successful transmission of that
				determination and receipt thereof by the injured employee or any person acting
				on his or her behalf;
(4) Written
				settlement agreements or stipulations made between the injured employee and his
				or her employer or the insurer of the employer concerning a claim for
				compensation; and
(5) Except as
				otherwise provided in subparagraph (2) of paragraph (f), other documents which
				affect the amount, timing or denial of the payment of compensation. As used in
				this subparagraph, "payment of compensation" has the meaning ascribed to it in
				subsection 2 of NAC
				616D.305.
(d) A record of all compensation paid to the
				injured employee and all payments made to any other person in connection with
				the claim, for:
(1) Accident
				benefits;
(2) Temporary partial
				disability;
(3) Temporary total
				disability;
(4) Permanent partial
				disability;
(5) Permanent total
				disability;
(6) Death benefits;
				and
(7) Vocational rehabilitation,
				and the amount of the expected total incurred costs and the
				justification.
(e) A copy
				of any notice of termination of benefits which has been sent to the injured
				employee.
(f) Copies of all
				correspondence and other documents pertaining to the claim, including, without
				limitation, copies of:
(1) All medical bills
				incurred by the injured employee and received by the insurer; and
(2) Any notices sent to the injured employee
				to inform him or her of the right to a review or appeal, but not including
				records of any privileged communication between the insurer and its attorney or
				of any investigation conducted by or on behalf of the insurer concerning a
				possible violation of
				NRS
				616D.300.
(g) All ratings performed by any physician or
				chiropractic physician.
(h) A
				summary of conversations or oral negotiations, or both, conducted by the
				insurer or the third-party administrator with the injured employee, the legal
				counsel who represents the injured employee or any other party other than the
				physician or chiropractic physician of the injured employee, if action is
				requested or taken.
(i) After the
				claim is closed, the log of oral communications relating to the medical
				disposition of a claim that must be maintained by an insurer or third-party
				administrator pursuant to
				NRS
				616D.330.