reglab/statecodes huggingface dataset:
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › PROVIDERS OF HEALTH CARE › Section 616C.018 - Panel of physicians and chiropractors: Hearing and decision on appeal of suspension or removal

Current through June 11, 2024
1. The
			 Administrator will schedule a hearing for a physician or chiropractor suspended
			 or removed from the panel of physicians and chiropractors within 15 days after
			 the receipt of the petition for a hearing.
2. The physician or chiropractor must be
			 notified of the Administrator's decision on the petition within 5 days after
			 the hearing.
Industrial Comm'n, No.
				23.060, eff. 7-1-73; renumbered as 13.060, 6-30-82; No. 23.070, eff. 7-1-73;
				renumbered as 13.070, 6-30-82-NAC A by Div. of Industrial Relations by R006-97,
				12-9-97; R105-00, 1-18-2001, eff. 3-1-2001
NRS
				  616A.400,
				  616C.090
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › PROVIDERS OF HEALTH CARE › Section 616C.021 - Rating physician or chiropractor: Designation; qualifications; maintenance of designation; authority; review of rating evaluation by Administrator

Current through June 11, 2024
1. The designation of a rating physician or
			 chiropractic physician pursuant to NRS 616C.490  must be in writing or by
			 electronic communication.
2. To
			 qualify for designation, a physician or chiropractic physician must:
(a) Possess the qualifications required of a
			 physician or chiropractic physician who is appointed to the panel of physicians
			 and chiropractic physicians established pursuant to NRS 616C.090  and NAC
			 616C.003.
(b) Demonstrate a special
			 competence and interest in industrial health by:
(1) Completing:
(I) An appropriate level of training, as
			 determined by the Administrator, related to industrial health from a nationally
			 recognized program that provides training related to industrial health;
			 or
(II) Three years or more of
			 experience concerning industrial health in private practice. The Administrator
			 shall determine whether the experience in private practice concerning
			 industrial health is sufficient to qualify for designation as a rating
			 physician or chiropractic physician on a case-by-case basis.
(2) Except as otherwise provided
			 in subsection 3, successfully completing a course on rating disabilities, in
			 accordance with the most recent edition of the Guide, that is approved by the
			 Administrator.
(3) Except as
			 otherwise provided in subsection 3, passing an examination on evaluating
			 disabilities and impairments that is administered by the American Board of
			 Independent Medical Examiners or its successor organization, or by any other
			 organization or company recognized by the Division.
(4) Except as otherwise provided in
			 subsection 3, passing the Nevada Impairment Rating Skills Assessment Test which
			 is administered by the American Academy of Expert Medical Evaluators or its
			 successor organization and which examines the practical application of the
			 rating of disabilities in accordance with the Guide with a score of 75 percent
			 or higher.
(c)
			 Demonstrate an understanding of:
(1) The
			 regulations of the Division related to the evaluation of permanent partial
			 disabilities; and
(2) The
			 Guide.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › PROVIDERS OF HEALTH CARE › Section 616C.023 - Rating physician or chiropractor: Establishment of panel to review ratings evaluations

Current through June 11, 2024
1. The
			 Administrator will establish a panel to review ratings evaluations conducted by
			 physicians and chiropractors pursuant to
			 NRS
			 616C.490. The Administrator will select
			 physicians and chiropractors who perform ratings evaluations to serve as
			 members of the panel.
2. The
			 members of the panel shall assist the Administrator in reviewing ratings
			 evaluations of permanent partial disabilities to ensure that the evaluations
			 comply with the standards set forth in the
Guide
and the
			 regulations of the Division.
Added to NAC by Div. of
				Industrial Relations by R009-97, eff. 10-27-97; A by R105-00, 1-18-2001, eff.
				3-1-2001
NRS
				  616A.400,
				  616C.490
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › PROVIDERS OF HEALTH CARE › Section 616C.024 - Rating physician or chiropractor: Disciplinary action

Current through June 11, 2024
1. The
			 Administrator will issue a warning to any physician or chiropractic physician
			 on the list of rating physicians and chiropractic physicians designated
			 pursuant to NRS 616C.490, or suspend or remove any physician or chiropractic
			 physician from the list if the physician or chiropractic physician:
(a) Fails to correct errors in subsequent
			 ratings evaluations after receiving three or more written responses from the
			 panel established by the Administrator pursuant to NAC 616C.023  which address
			 the same or similar errors identified in ratings performed by the physician or
			 chiropractic physician;
(b)
			 Violates any provision of NAC 616C.006  or commits two or more violations of any
			 of the provisions of chapters 616A to 617, inclusive, of NRS or any other
			 regulations adopted pursuant thereto;
(c) Is the subject of any disciplinary action
			 that resulted in the suspension or revocation of his or her license or the
			 limitation of his or her practice by the applicable licensing
			 authority;
(d) Is determined by the
			 Administrator to have engaged in any action detrimental to an injured employee,
			 an employer, an insurer or the program of industrial insurance;
(e) Refuses to serve as a member of the panel
			 to review ratings evaluations established pursuant to NAC 616C.023  or serves as
			 a member of the panel but does not attend the meetings of the panel;
			 or
(f) Fails to perform ratings
			 evaluations when selected pursuant to NRS 616C.490  or schedules and fails to
			 perform ratings evaluations in accordance with that section.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › PROVIDERS OF HEALTH CARE › Section 616C.027 - Review of reduction, denial or nonpayment of bill; appeal of determination upon review

Current through June 11, 2024
1. A provider of
			 health care whose bill has been denied or reduced or is not paid in a timely
			 manner may, within 60 days after receiving notice of the denial or reduction,
			 or within 60 days after the payment was due, submit a written request to the
			 Workers' Compensation Section for a review of that action. The request must
			 identify the billed item for which the review is sought and state the ground
			 upon which the request is based. The Workers' Compensation Section shall review
			 the matter, and if it determines that issuing a written determination is
			 appropriate, it shall issue a written determination and mail or deliver copies
			 of the determination to the provider of health care and the insurer. If the
			 determination is in the provider's favor, the insurer shall, within 30 days
			 after receiving notice of the determination, pay the bill, unless an appeal is
			 taken in the manner provided by subsection 2.
2. A provider of health care or insurer
			 aggrieved by the determination of the Workers' Compensation Section may file a
			 request for a hearing before an appeals officer. The request must be filed
			 within 30 days after the date of the determination.
3. The provider of health care and the
			 insurer will be the only parties to the hearing scheduled pursuant to
			 subsection 2.
Industrial Comm'n, No.
				25.040, eff. 7-1-73; A 6-24-76; renumbered as 15.040, 6-30-82-NAC A by Dep't of
				Industrial Relations, 10-26-83; A by Div. of Industrial Insurance Regulation,
				8-30-91; A by Div. of Industrial Relations by R006-97, 12-9-97; R090-99,
				10-28-99; R105-00, 1-18-2001, eff. 3-1-2001; R118-02, 9-7-2005; R108-09,
				6-30-2010
NRS
				  616A.400,
				  616C.135,
				  616C.260
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › PROVIDERS OF HEALTH CARE › Section 616C.030 - Provision of list of providers authorized to provide services to injured employee

Current through June 11, 2024
Upon the receipt of a written request from an injured employee,
				his or her representative, or his or her treating physician or chiropractor,
				the:
1. Employer;
2. Insurer;
3. Third-party administrator; or
4. Organization for managed care, shall
			 provide a list of providers of health care who are authorized to provide
			 medical and health care services to the injured employee within 3 working days
			 after the date it receives the request.
Added to NAC by Div. of
				Industrial Relations, eff. 3-5-96; A by R006-97, 12-9-97; R090-99, 10-28-99;
				R118-02, 9-7-2005
NRS
				  616A.400,
				  616C.090
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › ACCIDENT BENEFITS PROVIDED BY EMPLOYERS › Section 616C.040 - Scope

Current through June 11, 2024
The provisions of NAC to 616C.055, inclusive, apply to all
				employers who elect and have been approved by the Administrator to provide
				accident benefits for their employees pursuant to
				NRS
				616C.265.
Industrial Comm'n, No.
				33.030, eff. 10-13-77-NAC A by Div. of Industrial Insurance Regulation,
				10-26-83; A by Div. of Industrial Relations by R098-98,
				12-18-98
NRS
				  616A.400,
				  616C.265
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › ACCIDENT BENEFITS PROVIDED BY EMPLOYERS › Section 616C.043 - Requirements for employer providing benefits

Current through June 11, 2024
An employer who makes arrangements to provide accident benefits
				shall:
1. Have adequate resources to
			 ensure payment of accident benefits during any period of adverse loss
			 experience;
2. Ensure that each
			 employee is guaranteed and notified in writing of the right to select his or
			 her own physician or chiropractor for treatment pursuant to
			 NRS
			 616C.090; and
3. Provide for payment of incurred losses of
			 uninsured sole proprietors and subcontractors pursuant to chapters 616A to 617,
			 inclusive, of NRS.
Industrial Comm'n, No.
				33.100, eff. 10-13-77-NAC A by Div. of Industrial Insurance Regulation,
				2-22-88; A by Div. of Industrial Relations by R098-98,
				12-18-98
NRS
				  616A.400,
				  616C.265
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › ACCIDENT BENEFITS PROVIDED BY EMPLOYERS › Section 616C.046 - Financial qualifications

Current through June 11, 2024
1. An employer who
			 was not providing accident benefits pursuant to
			 NRS
			 616C.265 on June 30, 1977, must:
(a) Be a corporation having a net worth of at
			 least $2,500,000; or
(b) Be an
			 entity of the State or its political subdivisions with an annual operating
			 budget in excess of $5,000,000, and must have paid premiums for workers'
			 compensation to a private carrier of not less than $50,000 per year for each of
			 the preceding 2 years before the employer may seek approval from the
			 Administrator of arrangements to provide accident benefits.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › ACCIDENT BENEFITS PROVIDED BY EMPLOYERS › Section 616C.052 - Contents of arrangement by employer

Current through June 11, 2024
An arrangement by an employer to provide accident benefits must
				include, without limitation:
1.
			 Written instructions to his or her employees specifying procedures to be
			 followed for the payment of accident benefits to injured employees or employees
			 with occupational diseases;
2. A
			 written notification to his or her employees that the employees are not
			 required to accept the services of a physician or chiropractor provided by the
			 employer and may seek professional medical services from providers that the
			 employees choose pursuant to
			 NRS
			 616C.090;
3. A written explanation or a copy of
			 instructions covering the procedures to be followed in determining the amount
			 of fees charged by providers of medical care to be reimbursed by the
			 employer;
4. Identification of the
			 offices or locations in this State which are responsible for the administration
			 and payment of accident benefits;
5. A copy of any contract between the
			 employer and a provider of medical or hospital services; and
6. A written statement in which the employer,
			 as a condition precedent, agrees to assume liability for the costs of
			 transporting an injured employee to the nearest place of proper treatment and
			 for the costs of administering first aid to the employee while the employee is
			 being transported.
Industrial Comm'n, No.
				33.210, eff. 10-13-77-NAC A by Div. of Industrial Insurance Regulation,
				2-22-88; A by Div. of Industrial Relations by R098-98,
				12-18-98
NRS
				  616A.400,
				  616C.265
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › ACCIDENT BENEFITS PROVIDED BY EMPLOYERS › Section 616C.054 - Motor vehicle as accident benefit; duties and responsibilities of injured employee; exception

Current through June 11, 2024
1. Within 30 days
			 after receipt from a treating physician of medical documentation satisfying the
			 requirements of subsection 2 of
			 NRS
			 616C.245, the insurer or employer providing
			 accident benefits shall, as applicable pursuant to subsection 3 of
			 NRS
			 616C.245, place an order for, purchase or
			 modify a motor vehicle for the injured employee.
2. The insurer or employer providing accident
			 benefits shall determine the make and model of the motor vehicle based on the
			 medical requirements and physical restrictions of the injured employee as set
			 forth by the treating physician. The insurer or employer shall modify the motor
			 vehicle to accommodate the physical restrictions of the injured
			 employee.
3. The insurer or
			 employer providing accident benefits shall, as applicable, purchase or modify a
			 motor vehicle for the injured employee as needed and at least as often as every
			 10 years or 120,000 miles driven, whichever occurs first.
4. An injured employee who receives a motor
			 vehicle pursuant to this section and
			 NRS
			 616C.245 shall at all times maintain a policy
			 of insurance as required by
			 NRS
			 485.185 which includes comprehensive and
			 collision coverage for the motor vehicle. Risk of physical damage to or total
			 loss of the motor vehicle is the responsibility of the injured employee. Care
			 and maintenance of the motor vehicle is the responsibility of the injured
			 employee.
5. If an injured employee
			 is not entitled to receive a motor vehicle pursuant to this section and NRS
			 NRS
			 616C.245, the insurer or employer providing
			 accident benefits shall:
(a) Reimburse the
			 injured employee in the manner prescribed by NAC
			 616C.150; or
(b) Provide transportation, where available,
			 for the injured employee, including, without limitation, in the form of a
			 monthly bus pass, public transportation or other appropriate means of
			 transportation as determined by the insurer or employer, taking into
			 consideration the medical requirements and physical restrictions of the injured
			 employee.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › ACCIDENT BENEFITS PROVIDED BY EMPLOYERS › Section 616C.055 - Reports required

Current through June 11, 2024
1. Each employer
			 who elects to provide accident benefits pursuant to
			 NRS
			 616C.265 shall submit the following reports
			 for all injuries:
(a) An employer's report of
			 an industrial injury, on a form approved by the Administrator. This report is
			 due within 6 working days after the date of notice of the injury or the
			 occupational disease.
(b) An
			 employee's claim for compensation and a physician's or chiropractor's report of
			 initial treatment, on a form approved by the Administrator. This report is due
			 within 5 days after initial treatment.
(c) Upon request, copies of all bills from
			 providers of medical care itemizing the services rendered.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.070 - "Insurer" defined

Current through June 11, 2024
As used in NAC to 616C.336, inclusive, "insurer" includes any
				  employer who provides accident benefits for injured employees pursuant to
				  NRS
				  616C.265.
Added to NAC by Div. of
				  Industrial Relations, eff. 11-10-93; A by R150-04,
				  11-17-2005
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.072 - "Employer" and "notified" interpreted

Current through June 11, 2024
The Administrator will interpret:
1. "Employer," as used in
				NRS
				616C.140, to include, without limitation, a
				former employer of an injured employee that is found liable for payment of a
				claim for compensation filed by the injured employee.
2. "Notified," as used in
				NRS
				616C.065, to mean received a claim for
				compensation pursuant to
				NRS
				616C.020 or
				616C.040.
Added to NAC by Div. of
				  Industrial Relations by R098-98, 12-18-98, eff.
				  7-1-99
NRS
					 616A.400,
					 616C.065,
					 616C.140
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.0725 - "Insurer" and "receipt" interpreted

Current through June 11, 2024
As used in
				  NRS
				  616C.065, the Administrator
				  interprets:
1. The term "insurer" to
				include a third-party administrator.
2. The term "receipt" to mean a written
				acknowledgment from the United States Postal Service of its acceptance for
				mailing of a written determination by an insurer denying a claim in whole or in
				part.
Added to
				  NAC by Div. of Industrial Relations by
				  R130-14,
				  eff. 9/9/2016
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.073 - Claims: Forms; filing; electronic transmission

Current through June 11, 2024
1. A claim for
				compensation must be printed or typed, properly titled, signed and dated by the
				person filing the claim or the person's attorney or other representative. A
				claim for compensation that is filed by electronic transmission must be signed
				with an electronic symbol representing the signature of the person submitting
				the claim that is:
(a) Unique to the person
				who uses it as a signature;
(b)
				Capable of verification; and
(c)
				Linked to data in such a manner that the signature is invalidated if the data
				is altered.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.076 - Form of claim for death benefits

Current through June 11, 2024
A claim for a death benefit must be made on the same form as
				  any other claim.
Industrial Comm'n, No.
				  4.071, eff. 6-30-82-Div. of Industrial Relations
NRS
					 616A.400,
					 616C.020,
					 616C.035
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.077 - Direct deposit of compensation; inability to establish direct deposit of compensation

Current through June 11, 2024
If an insurer or third-party administrator receives a written
				  notice from an employee or a dependent of an employee pursuant to subsection 1
				  of
				  NRS
				  616C.409 which includes all the information
				  required by the financial institution, the insurer or third-party administrator
				  shall, within 60 days after receipt of the written notice:
1. Establish direct deposit of the
				compensation to be paid by the insurer or third-party administrator into the
				account specified by the employee or dependent of the employee in the written
				notice; or
2. If the insurer or
				third-party administrator is unable to establish direct deposit of the
				compensation as required by subsection 1, provide to the employee or dependent
				of the employee a written explanation of the reason for which the insurer or
				third-party administrator is unable to establish direct deposit of the
				compensation as required by subsection 1.
Added to
				  NAC by Div. of Industrial Relations by
				  R130-14,
				  eff. 9/9/2016
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.079 - Execution of medical releases by injured employee

Current through June 11, 2024
An injured employee must sign all medical releases necessary
				  for the insurer to obtain appropriate information and documentation to
				  determine the nature and amount of benefits to which he or she is entitled. If
				  the injured employee fails to do so, the insurer may withhold compensation from
				  him or her.
Industrial Comm'n, No.
				  5.081, eff. 6-30-82-NAC A by Div. of Industrial Relations by R098-98,
				  12-18-98
NRS
					 616A.400,
					 616C.177
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.080 - Duties of physician, chiropractor or medical facility required to file claim

Current through June 11, 2024
1. A health care
				provider who is required to file a claim for compensation pursuant to
				NRS
				616C.040, or a physician assistant or
				advanced practice registered nurse at a medical facility who has been delegated
				the duty to file a claim for compensation pursuant to subsection 2 of
				NRS
				616C.040, shall:
(a) Require the injured employee to complete
				the upper portion of the form designated in NAC
				616A.480 as Form C-4, Employee's
				Claim for Compensation/Report of Initial Treatment, including, without
				limitation, the name, address and telephone number of the employer of the
				injured employee and the name of the insurer or third-party administrator of
				the employer;
(b) Contact the
				employer or the insurer or third-party administrator of the employer to confirm
				the name and address of the insurer or third-party administrator;
(c) Send a copy of the completed Form C-4 to
				the employer and to the insurer or third-party administrator of the employer;
				and
(d) Maintain, together with the
				completed Form C-4, documentation of the steps taken by the health care
				provider to verify that the insurer or third-party administrator is the insurer
				or third-party administrator of the employer.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.082 - Documents concerning claims; action on filings

Current through June 11, 2024
1. An
				insurer, third-party administrator or organization for managed care shall
				ensure that the date of receipt of all documents concerning claims that it
				receives pursuant to chapters 616A to 617, inclusive, of NRS or regulations
				adopted pursuant thereto is indicated on each such document or maintained in an
				electronically generated, verifiable report.
2. All claims filed with the insurer,
				third-party administrator or organization for managed care pursuant to
				subsection 1 and all documents concerning such claims must be filed and
				maintained in chronological order.
3. All documents which constitute the record
				of a claim filed with the insurer, third-party administrator or organization
				for managed care pursuant to subsection 1, including , without limitation,
				investigative reports, medical reports, and records evidencing payments of
				benefits, compensation or awards, remain the property of the insurer.
Industrial Comm'n, No.
				  4.110, eff. 6-30-82-NAC A by Div. of Industrial Relations by R208-97, 4-17-98;
				  A by
				  R130-14,
				  eff. 9/9/2016
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.085 - Log of claims (Repealed)

Current through June 11, 2024
Added to NAC by Div. of
				  Industrial Insurance Regulation, eff. 10-26-83; A by Div. of Industrial
				  Relations by R098-98, 12-18-98; R by
				  R130-14,
				  eff. 9/9/2016
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.091 - Notice of determination to accept or deny claim

Current through June 11, 2024
1. After
				receipt of a claim for compensation, the insurer or third-party administrator
				shall give written notice of its determination to accept or deny the claim to
				the injured employee, the attorney or other authorized representative of the
				injured employee or his or her dependents and, if the injured employee's
				employer is not self-insured, to the injured employee's employer.
2. If the insurer or third-party
				administrator denies the claim in whole or in part:
(a) The insurer or third-party administrator
				shall, pursuant to NRS 616C.065, notify the
				Administrator of the denial.
(b)
				The notice of denial to the injured employee, the attorney or other authorized
				representative of the injured employee or his or her dependents must include:
(1) A written statement of the right to
				request a hearing on the matter before a hearing officer and a form for
				requesting a hearing; and
(2) A
				specific statement of the reasons for the denial of the claim.
(c) The insurer or third-party
				administrator shall provide a copy of each notice of denial it gives pursuant
				to paragraph (b) to:
(1) The physician,
				chiropractic physician, physician assistant or advanced practice registered
				nurse who provided an examination and treatment of the injured employee in the
				context of an initial examination and treatment pursuant to
				NRS
				616C.010; and
(2) The injured employee's treating physician
				or chiropractic physician.
(d) The notice of denial required to be given
				to the Administrator pursuant to paragraph (a) must include:
(1) A copy of the notice of denial given to
				the injured employee, the attorney or other authorized representative of the
				injured employee or his or her dependents; and
(2) A copy of Form C-4, Employee's Claim for
				Compensation/Report of Initial Treatment, that was completed by the injured
				employee or his or her dependents.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.092 - Determination of unreasonable delay or refusal to pay claim

Current through June 11, 2024
To determine whether an insurer has unreasonably delayed or
				  refused to pay a claim for compensation for the purposes of subsection 4 of
				  NRS
				  616C.065, the Administrator will
				  consider:
1. The reasons set forth by
				the insurer for making payment after the time specified in subsection 1 of
				NRS
				616C.065 or for refusing to make
				payment;
2. The efforts made by the
				insurer to make payment within the time specified in subsection 1 of
				NRS
				616C.065;
3. The date on which payment was actually
				made by the insurer; and
4. Any
				other circumstance that the Administrator deems relevant to determine whether a
				delay in or refusal to make payment was unreasonable.
Added to NAC by Div. of
				  Industrial Relations by R098-98, 12-18-98, eff.
				  7-1-99
NRS
					 616A.400,
					 616C.065
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.094 - Notification of determination concerning request relating to claim

Current through June 11, 2024
1. Except as otherwise provided in this
				section, within 30 days after receipt of a written request relating to a claim
				made by:
(a) An injured employee, an employer,
				a health care provider or the attorney or other representative of any of them;
				or
(b) A spouse, child or parent of
				an injured employee who is deceased or incapacitated, the insurer, third-party
				administrator or organization for managed care shall, in writing, notify the
				person making the request of its determination concerning the
				request.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.095 - Resubmission of request for determination relating to claim; request for determination not precluded by failure to timely request hearing

Current through June 11, 2024
1. If an insurer fails to respond to a
				written request for a determination within 30 days after the date on which the
				request for a determination was received by the insurer, the person making the
				request for a determination may resubmit the request.
2. Failure to file a request for a hearing
				within the period specified in subsection 3 of
				NRS
				616C.315 does not preclude a person from
				submitting to an insurer a written request for a
				determination.
Added to
				  NAC by Div. of Industrial Relations by
				  R130-14,
				  eff. 9/9/2016
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.097 - Statement on written notice of determination regarding disagreement with determination

Current through June 11, 2024
1. Any written
				notice of a determination by an organization for managed care that relates to
				accident benefits must include at the bottom of the notice a statement in
				substantially the following form:
If you disagree with the above determination, sign, date, and
				  briefly explain on the bottom of this notice the reason for your appeal and
				  return this notice to the organization for managed care at the address
				  indicated within 14 days after the date on which this notice was mailed by the
				  organization for managed care.
2. Any written notice of a determination by
				an insurer or third-party administrator that relates to benefits, other than
				accident benefits, must include at the bottom of the notice a statement in
				substantially the following form:
If you disagree with the above determination, sign, date, and
				  briefly explain on the bottom of this notice the reason for your appeal and
				  return it to the Hearing Officer at the Department of Administration within 70
				  days after the date on which the notice was mailed by the insurer or
				  third-party administrator.
Added to NAC by Div. of
				  Industrial Relations, eff. 3-28-94-Substituted in revision for NAC 616.5542; A
				  by
				  R130-14,
				  eff. 9/9/2016
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.103 - Rating evaluation of injured employee: Requirements; award of payment; appeal

Current through June 11, 2024
1. For purposes of
				determining whether an injured employee is stable and ratable and entitled to
				an evaluation to determine the extent of any permanent impairment pursuant to
				this section and NRS
				616C.490, the Division interprets the term:
(a) "Stable" to include, without limitation,
				a written indication from a physician or chiropractic physician that the
				industrial injury or occupational disease of the injured employee:
(1) Is stationary, permanent or static;
				or
(2) Has reached maximum medical
				improvement.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.105 - Rating evaluation of injured employee: Payment for cost of travel

Current through June 11, 2024
1. An insurer who requests that an injured
				employee submit to a rating evaluation pursuant to
				NRS
				616C.490 shall include with the notice
				required pursuant to subsection 3 of NAC 616C.103:
(a) Payment for the cost of travel for the
				injured employee;
(b) A receipt
				evidencing payment for the cost of travel for the injured employee;
				or
(c) Any combination
				thereof.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.109 - Presence of representative during rating evaluation

Current through June 11, 2024
1. If an injured employee, employer, insurer
				or third-party administrator is permitted by the rating physician or
				chiropractor to have his or her attorney or other representative present during
				a rating evaluation for a permanent partial disability, that party shall, in
				writing and at least 5 working days before the evaluation, notify each of the
				other persons described and the attorney or other representative of those
				persons of the intent to have his or her attorney or other representative
				attend the evaluation. The rating physician or chiropractor may request an
				attorney or representative to leave the examination room or may terminate the
				examination:
(a) If the attorney or
				representative disrupts the examination; or
(b) To protect the privacy of the injured
				employee.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.112 - Notice of intention to close claim

Current through June 11, 2024
The notice of intention to close a claim required by
				  subsection 1 of
				  NRS
				  616C.235 must include:
1. The provisions of subsection 2 of
				NRS
				616C.390; and
2. An offer to the injured employee of an
				opportunity to appeal from the insurer's determination to close the
				claim.
Added to NAC by Div. of
				  Industrial Insurance Regulation, 10-26-83; A by Div. of Industrial Relations by
				  R006-97, 12-9-97; R090-99, 10-28-99
NRS
					 616A.400,
					 616C.235
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.115 - Expenses of investigation

Current through June 11, 2024
The insurer shall pay all the expenses of any investigation,
				  including, without limitation, the cost of travel and medical examinations,
				  authorized by it to obtain a full and complete record of the cause, scope and
				  origin of a claim and the physical condition of the injured employee.
Industrial Comm'n, No.
				  4.140, eff. 6-30-82-NAC A by Div. of Industrial Insurance Regulation, 10-26-83;
				  A by Div. of Industrial Relations, 10-11-93; R098-98,
				  12-18-98
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Claims for Compensation › Section 616C.1156 - Claim received for employer to whom insurer does not provide coverage: Copy of claim to Administrator

Current through June 11, 2024
If an insurer receives a claim for compensation from an
				  injured employee and determines that the employer named in the claim for
				  compensation is not an employer to whom the insurer provides coverage, the
				  insurer shall, within 3 working days after making such a determination, deliver
				  by electronic transmission or other method a copy of the claim for compensation
				  to the Administrator.
Added to NAC by Div. of
				  Industrial Relations by R098-98, 12-18-98, eff. 7-1-99; A by R105-00,
				  1-18-2001, eff. 3-1-2001
NRS
					 616A.400,
					 616A.417
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Medical Examinations › Section 616C.116 - Applicability of provisions

Current through June 11, 2024
The provisions of NAC2 to 616C.1168, inclusive, do not apply
				  to an evaluation performed pursuant to
				  NRS
				  616C.490.
Added to NAC by Div. of
				  Industrial Relations by R098-98, 12-18-98, eff.
				  7-1-99
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Medical Examinations › Section 616C.1162 - Notification by insurer or employer of request for medical examination

Current through June 11, 2024
1. If an insurer or employer requests that an
				injured employee who has filed a claim for compensation submit to a medical
				examination pursuant to
				NRS
				616C.140, the insurer or employer shall
				notify the injured employee, in writing, of the time and place of the medical
				examination:
(a) At least 10 days before the
				date of the medical examination, if the employee resides within the state in
				which the medical examination will be conducted; or
(b) At least 15 days before the date of the
				medical examination, if the employee resides outside of the state in which the
				medical examination will be conducted.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Medical Examinations › Section 616C.1164 - Provision by insurer or employer of copies of report of medical examination

Current through June 11, 2024
1. An insurer that requests an injured
				employee to submit to a medical examination pursuant to
				NRS
				616C.140 shall provide a copy of the report
				of the medical examination to the injured employee and his or her employer
				within 10 days after receipt of the report.
2. An employer that requests an injured
				employee to submit to a medical examination pursuant to
				NRS
				616C.140 shall provide a copy of the report
				of the medical examination to the injured employee and the insurer of the
				employer within 10 days after receipt of the report.
Added to NAC by Div. of
				  Industrial Relations by R098-98, 12-18-98, eff.
				  7-1-99
NRS
					 616A.400,
					 616C.140
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Medical Examinations › Section 616C.1166 - Payment of charges

Current through June 11, 2024
An insurer or employer that requests an injured employee to
				  submit to a medical examination pursuant to
				  NRS
				  616C.140 shall:
1. If the medical examination is conducted
				within this State, pay the charges in the manner set forth in
				NRS
				616C.135; or
2. If the medical examination is conducted
				outside this State, pay:
(a) The usual and
				customary rate charged by the person performing the medical examination;
				or
(b) The charge upon which the
				person performing the medical examination and the insurer or employer have
				agreed,
whichever is less.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Medical Examinations › Section 616C.1168 - Payment for travel costs

Current through June 11, 2024
An insurer or employer that requests an injured employee to
				  submit to a medical examination pursuant to
				  NRS
				  616C.140 shall include with the notification
				  required pursuant to subsection 1 of NAC 616C.1162 payment for the travel costs
				  of the injured employee in accordance with the following:
1. The insurer or employer shall pay for the
				cost of transportation incurred by the injured employee if the injured employee
				is required to travel 20 miles or more, one way, from:
(a) His or her residence to the place of the
				medical examination; or
(b) His or
				her place of employment to the place at which the medical examination will be
				conducted if the injured employee is required to be examined during his or her
				normal working hours.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.117 - Definitions

Current through June 11, 2024
As used in NAC to 616C.156, inclusive, unless the context
				  otherwise requires, the words and terms defined in NAC 616C.118 and 616C.119
				  have the meanings ascribed to them in those sections.
Added to NAC by Div. of
				  Industrial Relations by R121-97, 12-10-97, eff. 1-1-98; A by R118-02,
				  9-7-2005
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.118 - "Health care records" defined

Current through June 11, 2024
"Health care records" means any reports, notes, orders,
				  photographs, X rays or other recorded data or information which:
1. Is maintained in written, electronic or
				any other form;
2. Is received or
				produced by a provider of health care or any person employed by him or her;
				and
3. Contains information
				relating to the medical history, examination, diagnosis or treatment of an
				injured employee.
Added to NAC by Div. of
				  Industrial Relations by R121-97, 12-10-97, eff.
				  1-1-98
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.119 - "Provider of health care" defined

Current through June 11, 2024
"Provider of health care" means any physician, hospital or
				  other person who is licensed or otherwise authorized by this State to furnish
				  any health care service.
Added to NAC by Div. of
				  Industrial Relations by R121-97, 12-10-97, eff.
				  1-1-98
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.120 - Right of injured employee to inspect or obtain health care records

Current through June 11, 2024
The provisions of NAC 616C.123 to 616C.156, inclusive, do not
				  prohibit or otherwise impair or interfere with the right of an injured employee
				  to inspect or obtain his or her health care records pursuant to the provisions
				  of
				  NRS
				  629.061.
Added to NAC by Div. of
				  Industrial Relations, eff. 3-5-96; A by R121-97, 12-10-97, eff. 1-1-98;
				  R090-99, 10-28-99; R118-02, 9-7-2005
NRS
					 616A.400
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.123 - Occupational Medicine Practice Guidelines : Adoption by reference; annual review by Administrator; use

Current through June 11, 2024
1. The most
				recently published edition of or update to the Occupational Medicine Practice
				Guidelines, developed by the American College of Occupational and Environmental
				Medicine and published by the Reed Group, Ltd., is hereby adopted by reference
				as standards for the provision of accident benefits to employees who have
				suffered industrial injuries or occupational diseases.
2. The Administrator will, on or before
				February 1 of each year, review the most recently published edition of or
				update to the
Guidelines
. Each new edition of or update to the
Guideline
s shall be deemed approved by the Administrator 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 April 1. If the Administrator wishes to disapprove a new edition of
				or update to the
Guidelines
, 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
Guidelines
, 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.126 - Treatment of injured employees in cases of emergency or severe trauma

Current through June 11, 2024
1. The treatment of injured employees in
				cases of an emergency or severe trauma is not restricted to physicians and
				chiropractors who:
(a) Are members of the
				panel of physicians and chiropractors established by the Administrator pursuant
				to
				NRS
				616C.090; or
(b) Have contracted with an insurer or an
				organization for managed care to provide health care services to injured
				employees.
Nevada Administrative Code › Chapter 616C - Industrial Insurance: Benefits for Injury or Death › DETERMINATION AND PAYMENT OF BENEFITS › Accident Benefits › Section 616C.129 - Rules for treatment of injured employees by members of panel of physicians and chiropractors

Current through June 11, 2024
The members of the panel of physicians and chiropractors,
				  approved for treatment of employees protected by workers' compensation, shall
				  adhere to the following rules:
1.
				There may be only one treating physician or chiropractor in any one case at any
				one time, unless prior authorization is obtained from the insurer. Physicians
				and chiropractors associated with the treating physician or chiropractor may
				treat the injured employee during the temporary absence of the treating
				physician or chiropractor. In all cases, the treating physician or chiropractor
				is directly responsible for the management of the health care of the injured
				employee. Physicians in emergency rooms are not considered treating physicians
				within the meaning of NAC
				616C.126 to
				616C.141, inclusive.
2. The insurer shall give written notice to
				all interested persons of the transfer of an injured employee to a new
				physician or chiropractor, which must include notice to the injured employee or
				the attorney or authorized representative of the injured employee of the right
				to appeal the transfer.
3. Except
				as otherwise provided in this subsection, an injured employee or an insurer is
				not financially liable for the payment of the fees of a provider of health care
				who renders treatment to an injured employee for an industrial accident or
				occupational disease, knowing that the injured employee is already under the
				care of another provider of health care. The insurer may be liable for the
				payment of the fees pursuant to this subsection if the insurer gives prior
				written approval for the treatment or good cause is shown for the treatment
				provided.
4. Any prescription or
				service ordered by a physician or chiropractor other than:
(a) The treating physician or chiropractor;
				or
(b) A physician or chiropractor
				associated with the treating physician or chiropractor who is treating the
				injured employee during the temporary absence of the treating physician or
				chiropractor, is not a financial liability of the insurer unless good cause is
				shown for the prescription or service.