S.B. 317
- *SB317*
SENATE BILL NO. 317–SENATOR DALY
MARCH 11, 2025
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises provisions relating to industrial insurance.
(BDR 53-625)
FISCAL NOTE: Effect on Local Government: May have Fiscal Impact.
Effect on the State: Yes.
~
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
AN ACT relating to industrial insurance; establishing provisions
relating to industrial providers of health care; revising the
circumstances under which the Administrator of the
Division of Industrial Relations of the Department of
Business and Industry may impose a benefit penalty;
revising provisions relating to an insurer’s list of certain
physicians and chiropractic physicians; establishing and
revising various requirements for certain hearings relating
to industrial insurance claims; revising provisions
governing an injury or disease that is caused by stress;
revising provisions governing motions to stay certain
decisions and petitions for judicial review; revising
requirements for payments for a period of temporary
partial disability; repealing provisions governing certain
appeals and determinations of a percentage of disability;
and providing other matters properly relating thereto.
Legislative Counsel’s Digest:
Existing law provides for the payment of compensation under industrial 1
insurance if, during the course of employment, an employee is injured or killed by a 2
workplace accident or occupational disease. (Chapters 616A-617 of NRS) Existing 3
law authorizes the Administrator of the Division of Industrial Relations of the 4
Department of Business and Industry to order certain additional payments to a 5
claimant in the form of benefit penalties, if the Administrator determines that an 6
insurer, organization for managed care, health care provider, third-party 7
administrator, employer or professional employer organization has committed 8
certain violations. (NRS 616A.070, 616D.120) Sections 3 and 30 of this bill 9
additionally authorize the imposition of benefit penalties under certain 10
circumstances for: (1) failure to provide or unreasonably delaying payment to an 11
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injured employee or reimbursement to an insurer; or (2) concealing, falsifying or 12
failing to provide certain evidence or documents before certain hearings which 13
would have been useful to an injured employee in seeking benefits or 14
compensation. 15
Existing law requires an insurer to keep a list of physicians and chiropractic 16
physicians from which an injured employee may choose to receive treatment from a 17
panel established and maintained by the Administrator. Existing law also sets forth 18
procedures and limitations governing the removal of a physician or chiropractic 19
physician from an insurer’s list. (NRS 616C.087, 616C.090) Section 14 of this bill: 20
(1) prohibits an insurer from removing a physician or chiropractic physician from 21
the insurer’s list except as expressly provided in existing law; and (2) requires an 22
insurer to replace any physician or chiropractic physician who is removed from the 23
list within 60 days. Sections 4, 6, 7, 12 and 13 of this bill: (1) require an insurer to 24
keep a list of certain providers of health care other than a physician or chiropractic 25
physician, which section 1 of this bill designates as an “industrial provider of 26
health care,” from which an injured employee may choose to receive treatment 27
from a panel established and maintained by the Administrator; and (2) establish 28
certain requirements and restrictions concerning the selection of such an industrial 29
provider of health care. Section 2 of this bill makes a conforming change so that 30
the definition of “industrial provider of health care” applies to the provisions of 31
existing law governing industrial insurance. 32
Section 8 of this bill authorizes a hearing officer or appeals officer of the 33
Hearings Division of the Department of Administration to order any needed 34
examination, assessment or treatment of an injured employee be conducted by any 35
physician, chiropractic physician or industrial provider of health care who will 36
accept the fee schedule adopted by the Administrator, whether located in this State 37
or another state, if the hearing or appeals officer finds that there is a lack of 38
physicians, chiropractic physicians or providers available. Section 9 of this bill 39
establishes certain requirements for the filing and service of certain evidence and 40
documents in advance of a hearing before a hearing officer or appeals officer. 41
Existing law requires a treating physician, chiropractic physician, physician 42
assistant or advanced practice registered nurse to complete and file a claim for 43
compensation within 3 working days after first providing treatment for an injured 44
employee, or delegate the duty to do so to a physician assistant or advanced 45
practice registered nurse at a medical facility. (NRS 616C.040, 616C.045) Sections 46
10 and 11 of this bill similarly authorize a treating physician, chiropractic 47
physician, physician assistant or advanced practice registered nurse to delegate the 48
duty to complete and file the claim for compensation to an industrial provider of 49
health care. 50
Existing law provides that an injury or disease sustained by an employee that is 51
caused by stress is compensable under industrial insurance if it arose out of and in 52
the course of his or her employment. Existing law sets forth the manner by which 53
such an injury must be proven to have arisen out of and in the course of the 54
employment. Under existing law, with certain exceptions, such an injury is deemed 55
to arise out of and in the course of employment only if the employee proves certain 56
elements by clear and convincing medical or psychiatric evidence. (NRS 616C.180) 57
Section 17 of this bill eliminates provisions that make such method of proof the 58
only method, with certain exceptions, by which an employee may prove that such 59
an injury arose in and out of the course of employment. Section 17 additionally 60
eliminates the standard of clear and convincing evidence and instead requires proof 61
by medical, psychological or psychiatric evidence. 62
Section 20 of this bill requires the Chief of the Hearings Division of the 63
Department of Administration to maintain and make accessible to the public on the 64
Internet website of the Division, a calendar of all matters which are before hearing 65
officers and appeals officers. 66
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Sections 23 and 25 of this bill revise provisions governing the circumstances 67
under which: (1) an appeals officer may grant a motion to stay the enforcement of 68
the decision of a hearing officer; and (2) an appeals officer or district court may 69
grant a motion to stay the enforcement of the decision of an appeals officer. 70
Sections 24 and 32 of this bill revise certain procedures for the judicial review of 71
the decision of an appeals officer. 72
If a claim for a period of temporary total disability is allowed, existing law 73
requires an industrial insurer to make the first payment within 14 working days 74
after receipt of the initial certification of disability, and regularly thereafter. (NRS 75
616C.475) Section 27 of this bill establishes the same requirements for payment 76
when a claim for a period of temporary partial disability is allowed. 77
Existing law authorizes hearing officers and appeals officers, under certain 78
circumstances, to allow discovery by deposition or interrogatories according to the 79
Nevada Rules of Civil Procedure. (NRS 616D.050, 616D.090) Sections 28 and 29 80
of this bill prohibit a hearing officer from allowing such discovery, and revise 81
provisions governing the circumstances under which an appeals officer may allow 82
discovery. 83
Existing law sets forth certain procedures for appealing a final determination 84
concerning accident benefits made by an organization for managed care. (NRS 85
616C.305) Existing law requires, for a determination of the percentage of disability 86
resulting from occupational disease of the heart or lungs, that the determination be 87
made jointly by the attending physician and examining physician of a claimant, or, 88
under certain circumstances, a designated third physician or panel of physicians. 89
(NRS 616C.459) Section 34 of this bill repeals those procedures and requirements, 90
and sections 15, 16, 18, 19, 21-23, 26 and 31 of this bill make conforming changes 91
to remove references to those procedures and requirements from existing law. 92
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. Chapter 678A of NRS is hereby amended by 1
adding thereto a new section to read as follows: 2
“Industrial provider of health care” means a provider of health 3
care of the type described in subparagraphs (1) to (12), inclusive, 4
of paragraph (b) of subsection 2 of section 6 of this act. 5
Sec. 2. NRS 616A.025 is hereby amended to read as follows: 6
616A.025 As used in chapters 616A to 616D, inclusive, of 7
NRS, unless the context otherwise requires, the words and terms 8
defined in NRS 616A.030 to 616A.360, inclusive, and section 1 of 9
this act, have the meanings ascribed to them in those sections. 10
Sec. 3. NRS 616A.070 is hereby amended to read as follows: 11
616A.070 “Benefit penalty” means an additional amount of 12
money that is payable to a claimant if the Administrator has 13
determined that a violation of any of the provisions of paragraphs 14
(a) to (e), inclusive, [(h)] or [(i)] (g) to (j), inclusive, of subsection 1 15
of NRS 616D.120 has occurred. 16
Sec. 4. NRS 616B.527 is hereby amended to read as follows: 17
616B.527 1. A self-insured employer, an association of self-18
insured public or private employers or a private carrier may: 19
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(a) Except as otherwise provided in NRS 616B.5273, enter into 1
a contract or contracts with one or more organizations for managed 2
care to provide comprehensive medical and health care services to 3
employees for injuries and diseases that are compensable pursuant 4
to chapters 616A to 617, inclusive, of NRS. 5
(b) Enter into a contract or contracts with providers of health 6
care, including, without limitation, physicians who provide primary 7
care, specialists, pharmacies, physical therapists, radiologists, 8
nurses, diagnostic facilities, laboratories, hospitals and facilities that 9
provide treatment to outpatients, to provide medical and health care 10
services to employees for injuries and diseases that are compensable 11
pursuant to chapters 616A to 617, inclusive, of NRS. 12
(c) Require employees to obtain medical and health care 13
services for their industrial injuries from those organizations and 14
persons with whom the self-insured employer, association or private 15
carrier has contracted pursuant to paragraphs (a) and (b), or as the 16
self-insured employer, association or private carrier otherwise 17
prescribes. 18
(d) Except as otherwise provided in subsection 4 of NRS 19
616C.090 [,] or subsection 4 of section 7 of this act, require 20
employees to obtain the approval of the self-insured employer, 21
association or private carrier before obtaining medical and health 22
care services for their industrial injuries from a provider of health 23
care who has not been previously approved by the self-insured 24
employer, association or private carrier. 25
2. An organization for managed care with whom a self-insured 26
employer, association of self-insured public or private employers or 27
a private carrier has contracted pursuant to this section shall comply 28
with the provisions of NRS 616B.528, 616B.5285 and 616B.529. 29
Sec. 5. Chapter 616C of NRS is hereby amended by adding 30
thereto the provisions set forth as sections 6 to 9, inclusive, of this 31
act. 32
Sec. 6. 1. The Legislature hereby declares that: 33
(a) The choice of industrial providers of health care is a 34
substantive right and substantive benefit of an injured employee 35
who has a claim under the Nevada Industrial Insurance Act or the 36
Nevada Occupational Diseases Act. 37
(b) The injured employees of this State have a substantive right 38
to an adequate choice of industrial providers of health care to 39
treat their industrial injuries and occupational diseases. 40
2. Except as otherwise provided in this subsection and 41
subsection 3: 42
(a) The panel maintained by the Administrator pursuant to 43
section 7 of this act must not include an industrial provider of 44
health care if the industrial provider of health care does not accept 45
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and treat injured employees for industrial injuries or occupational 1
diseases; and 2
(b) An insurer’s list of other industrial providers of health care 3
from which an injured employee may choose pursuant to section 7 4
of this act must include not less than 12 providers of each of the 5
following types from the panel of industrial providers of health 6
care maintained by the Administrator pursuant to section 7 of this 7
act: 8
(1) Persons licensed to practice dentistry, other than 9
persons described in subparagraphs (2) and (3); 10
(2) Persons licensed to practice dentistry who specialize in 11
orthodontia; 12
(3) Persons licensed to practice dentistry who specialize in 13
oral and maxillofacial surgery; 14
(4) Registered nurses who hold a master’s degree in the 15
field of psychiatric nursing and are licensed to practice 16
professional nursing; 17
(5) Optometrists; 18
(6) Speech-language pathologists; 19
(7) Audiologists; 20
(8) Licensed physical therapists; 21
(9) Podiatric physicians; 22
(10) Licensed psychologists; 23
(11) Licensed clinical professional counselors; 24
(12) Licensed clinical social workers; and 25
(13) Licensed clinical alcohol and drug counselors. 26
If the panel of industrial providers of health care maintained by 27
the Administrator pursuant to section 7 of this act contains fewer 28
than 12 industrial providers of health care of a type identified in 29
this subsection, all of the industrial providers of health care on the 30
panel of that type must be included on the insurer’s list. 31
3. For each county whose population is 100,000 or more, an 32
insurer’s list of industrial providers of health care must include 33
for that county a number of industrial providers of health care 34
that is not less than the number required by subsection 2 and that 35
also maintain in that county: 36
(a) An active practice; and 37
(b) A physical office. 38
4. If an insurer fails to maintain a list of industrial providers 39
of health care that complies with the requirements of subsections 2 40
and 3, an injured employee may choose another industrial 41
provider of health care from the panel of industrial providers of 42
health care maintained by the Administrator pursuant to section 7 43
of this act. If an industrial provider of health care is removed from 44
an insurer’s list pursuant to subsection 8 or 9, within 60 days after 45
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the date of removal, the insurer shall replace the industrial 1
provider of health care on the list to maintain compliance with the 2
requirements of subsections 2 and 3. If the insurer fails to do so, 3
an injured employee may choose an industrial provider of health 4
care from the panel of industrial providers of health care 5
maintained by the Administrator pursuant to section 7 of this act. 6
5. Each insurer shall, not later than October 1 of each year, 7
update the list of industrial providers of health care and file the 8
list with the Administrator. The list must be certified by an 9
adjuster who is licensed pursuant to chapter 684A of NRS. An 10
insurer shall not at any time remove an industrial provider of 11
health care from the insurer’s list except as expressly authorized 12
by subsection 8 or 9. 13
6. Upon receipt of a list of industrial providers of health care 14
that is filed pursuant to subsection 5, the Administrator shall: 15
(a) Stamp the list as having been filed; and 16
(b) Indicate on the list the date on which it was filed. 17
7. The Administrator shall: 18
(a) Provide a copy of an insurer’s list of industrial providers of 19
health care to any member of the public who requests a copy; or 20
(b) Post a copy of each insurer’s list of industrial providers of 21
health care on an Internet website maintained by the 22
Administrator and accessible to the public for viewing, printing or 23
downloading. 24
8. At any time, an industrial provider of health care may 25
request in writing that he or she be removed from an insurer’s list 26
of industrial providers of health care. The insurer must comply 27
with the request and omit the industrial provider of health care 28
from the next list which the insurer files with the Administrator. 29
9. An industrial provider of health care may not be 30
involuntarily removed from an insurer’s list of industrial providers 31
of health care except for good cause. As used in this subsection, 32
“good cause” means that one or more of the following 33
circumstances apply: 34
(a) The industrial provider of health care has died or is 35
disabled. 36
(b) The license of the industrial provider of health care has 37
been revoked or suspended. 38
(c) The industrial provider of health care has been convicted 39
of: 40
(1) A felony; or 41
(2) A crime for a violation of a provision of chapter 616D 42
of NRS. 43
(d) The industrial provider of health care has been removed 44
from the panel of industrial providers of health care maintained 45
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by the Administrator pursuant to section 7 of this act by the 1
Administrator upon a finding that the industrial provider of health 2
care: 3
(1) Has failed to comply with the standards for treatment of 4
industrial injuries or occupational diseases as established by the 5
Administrator; or 6
(2) Does not accept and treat injured employees under 7
chapters 616A to 616D, inclusive, or chapter 617 of NRS. 8
10. Unless an industrial provider of health care is removed 9
from an insurer’s list of industrial providers of health care 10
pursuant to subsection 9, an injured employee may continue to 11
receive treatment from that industrial provider of health care even 12
if: 13
(a) The employer of the injured employee changes insurers or 14
administrators. 15
(b) The industrial provider of health care is no longer included 16
in the applicable insurer’s list of industrial providers of health 17
care, so long as the industrial provider of health care agrees to 18
continue to accept compensation for that treatment at the rates 19
which: 20
(1) Were previously agreed upon when the industrial 21
provider of health care was most recently included in the list; or 22
(2) Are newly negotiated but do not exceed the amounts 23
provided under the fee schedule adopted by the Administrator. 24
11. The Administrator shall adopt regulations prescribing the 25
form in which a list of industrial providers of health care created 26
by an employer, insurer or third-party administrator pursuant to 27
this section must be maintained. The Administrator shall require 28
that any such list be in a format which is easily searchable, 29
including, without limitation, an indexed database, a portable 30
document format, a spreadsheet with data that may be filtered, a 31
comma-separated values file or any other comparable format. 32
Sec. 7. 1. The Administrator shall establish, maintain and 33
update not less frequently than annually on or before July 1 of 34
each year, a panel of industrial providers of health care who have 35
demonstrated special competence and interest in industrial health 36
to treat injured employees under chapters 616A to 616D, inclusive, 37
or chapter 617 of NRS. The Administrator shall maintain the 38
following information relating to each industrial provider of 39
health care on the panel: 40
(a) The name of the industrial provider of health care. 41
(b) The title or degree of the industrial provider of health care. 42
(c) The legal name of the practice of the industrial provider of 43
health care and the name under which the practice does business. 44
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(d) The street address of the location of every office of the 1
industrial provider of health care. 2
(e) The telephone number of every office of the industrial 3
provider of health care. 4
(f) Every discipline and specialization practiced by the 5
industrial provider of health care. 6
(g) Every condition and part of the body which the industrial 7
provider of health care will treat. 8
2. Every employer whose insurer has not entered into a 9
contract with an organization for managed care or with providers 10
of health care pursuant to NRS 616B.527 shall maintain a list of 11
those industrial providers of health care on the panel who are 12
reasonably accessible to his or her employees. 13
3. An injured employee whose employer’s insurer has not 14
entered into a contract with an organization for managed care or 15
with providers of health care pursuant to NRS 616B.527 may 16
choose an industrial provider of health care from the panel of 17
industrial providers of health care. If the injured employee is not 18
satisfied with the first industrial provider of health care he or she 19
so chooses, the injured employee may make an alternative choice 20
of industrial provider of health care from the panel if the choice is 21
made within 90 days after his or her injury. The insurer shall 22
notify the first industrial provider of health care in writing. The 23
notice must be postmarked within 3 working days after the insurer 24
receives knowledge of the change. The first industrial provider of 25
health care must be reimbursed only for the services the industrial 26
provider of health care rendered to the injured employee up to and 27
including the date of notification. Except as otherwise provided in 28
this subsection, any further change is subject to the approval of 29
the insurer or by order of a hearing officer or appeals officer. A 30
request for a change of industrial provider of health care must be 31
granted or denied within 10 days after a written request for such a 32
change is received from the injured employee. If the insurer takes 33
no action on the request within 10 days, the request shall be 34
deemed granted. Any request for a change of an industrial 35
provider of health care must include the name of the new 36
industrial provider of health care chosen by the injured employee. 37
If the industrial provider of health care refers the injured 38
employee to a specialist for treatment, the insurer shall provide to 39
the injured employee a list that includes the name of each 40
industrial provider of health care with that specialization who is 41
on the panel. Not later than 14 days after receiving the list, the 42
injured employee shall select an industrial provider of health care 43
from the list. 44
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4. An injured employee whose employer’s insurer has entered 1
into a contract with an organization for managed care or with 2
providers of health care pursuant to NRS 616B.527 must choose 3
an industrial provider of health care pursuant to the terms of that 4
contract. If the injured employee is not satisfied with the first 5
industrial provider of health care he or she so chooses, the injured 6
employee may make an alternative choice of industrial provider of 7
health care pursuant to the terms of the contract without the 8
approval of the insurer if the choice is made within 90 days after 9
his or her injury. Except as otherwise provided in this subsection, 10
any further change is subject to the approval of the insurer or by 11
order of a hearing officer or appeals officer. A request for a 12
change of an industrial provider of health care must be granted or 13
denied within 10 days after a written request for such a change is 14
received from the injured employee. If the insurer takes no action 15
on the request within 10 days, the request shall be deemed 16
granted. If the injured employee, after choosing an industrial 17
provider of health care, moves to a county which is not served by 18
the organization for managed care or providers of health care 19
named in the contract and the insurer determines that it is 20
impractical for the injured employee to continue treatment with 21
the industrial provider of health care, the injured employee must 22
choose an industrial provider of health care who has agreed to the 23
terms of that contract unless the insurer authorizes the injured 24
employee to choose another industrial provider of health care. If 25
the industrial provider of health care refers the injured employee 26
to a specialist for treatment, the insurer shall provide to the 27
injured employee a list that includes the name of each industrial 28
provider of health care with that specialization who is available 29
pursuant to the terms of the contract with the organization for 30
managed care or with providers of health care pursuant to NRS 31
616B.527, as appropriate. Not later than 14 days after receiving 32
the list, the injured employee shall select an industrial provider of 33
health care. If the employee fails to select an industrial provider of 34
health care, the insurer may select an industrial provider of health 35
care with that specialization. If an industrial provider of health 36
care with that specialization is not available pursuant to the terms 37
of the contract, the organization for managed care or the provider 38
of health care may select an industrial provider of health care with 39
that specialization. 40
5. If the injured employee is not satisfied with the industrial 41
provider of health care selected by himself or herself or by the 42
insurer, the organization for managed care or the provider of 43
health care pursuant to subsection 4, the injured employee may 44
make an alternative choice of an industrial provider of health care 45
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pursuant to the terms of the contract. A change in the industrial 1
provider of health care may be made at any time but is subject to 2
the approval of the insurer or by order of a hearing officer or 3
appeals officer. A request for a change of industrial provider of 4
health care must be granted or denied within 10 days after a 5
written request for such a change is received from the injured 6
employee. If no action is taken on the request within 10 days, the 7
request shall be deemed granted. Any request for a change of an 8
industrial provider of health care must include the name of the 9
new industrial provider of health care chosen by the injured 10
employee. If the insurer denies a request for a change in the 11
industrial provider of health care under this subsection, the 12
insurer must include in a written notice of denial to the injured 13
employee the specific reason for the denial of the request. 14
6. Except when emergency medical care is required and 15
except as otherwise provided in NRS 616C.055, the insurer is not 16
responsible for any charges for medical treatment or other 17
accident benefits furnished or ordered by any industrial provider 18
of health care or other person selected by the injured employee in 19
disregard of the provisions of this section or for any compensation 20
for any aggravation of the injured employee’s injury attributable 21
to improper treatments by such industrial provider of health care 22
or other person. 23
7. The Administrator may order necessary changes in a panel 24
of industrial providers of health care and shall: 25
(a) Suspend or remove any industrial provider of health care 26
from a panel for good cause shown in accordance with section 6 27
of this act; and 28
(b) Remove from being included on a panel any industrial 29
provider of health care who does not accept and treat injured 30
employees for industrial injuries or occupational diseases. 31
8. Any interested person may notify the Administrator, on a 32
form prescribed by the Administrator, if the person believes that 33
an industrial provider of health care does not accept and treat 34
injured employees under chapters 616A to 616D, inclusive, or 35
chapter 617 of NRS for industrial injuries or occupational 36
diseases. 37
9. If the Administrator receives notice pursuant to subsection 38
8, the Administrator shall: 39
(a) Conduct an investigation to determine whether the 40
industrial provider of health care may remain on the panel; and 41
(b) Publish or cause to be published on the Internet website of 42
the Division not later than 90 days after receiving the notice the 43
results of the investigation. 44
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10. An industrial provider of health care who is removed 1
from a panel pursuant to paragraph (b) of subsection 7 may 2
request, on a form prescribed by the Administrator, to be 3
reinstated on a panel if the industrial provider of health care 4
demonstrates to the satisfaction of the Administrator that he or she 5
accepts and treats injured employees. 6
11. An injured employee may receive treatment by more than 7
one industrial provider of health care: 8
(a) If the insurer provides written authorization for such 9
treatment; or 10
(b) By order of a hearing officer or appeals officer. 11
12. The Administrator shall design a form that notifies 12
injured employees of their right pursuant to subsections 3, 4 and 5 13
to select an alternative industrial provider of health care and make 14
the form available to insurers for distribution pursuant to 15
subsection 2 of NRS 616C.050. 16
Sec. 8. 1. Upon a finding of good cause in accordance with 17
subsection 2, a hearing officer or an appeals officer may order any 18
needed examination, assessment or treatment by a physician, 19
chiropractic physician or industrial provider of health care be 20
conducted by any physician, chiropractic physician or industrial 21
provider of health care who will accept the fee schedule adopted 22
by the Administrator, whether the physician, chiropractic 23
physician or industrial provider of health care is located in this 24
State or another state. 25
2. For the purpose of subsection 1, good cause exists if a 26
hearing officer or appeals officer finds, for the examination, 27
assessment or treatment which is needed, that there is a lack of 28
physicians, chiropractic physicians or industrial providers of 29
health care available to provide the examination, assessment or 30
treatment. 31
Sec. 9. 1. Not later than 5 business days before the date of 32
a hearing before a hearing officer, the Administrator, employer, 33
insurer or third-party administrator, as applicable, shall: 34
(a) File with the Hearings Division of the Department of 35
Administration the following documents, appropriately numbered 36
and indexed: 37
(1) A brief statement of the reason for the determination of 38
the insurer; and 39
(2) Copies of all documents in the file of the claimant 40
which relate to the matter before the hearing officer; and 41
(b) Serve upon all other parties to the hearing the documents 42
described in paragraph (a), by any means which ensure the 43
documents are received contemporaneously with the filing 44
submitted pursuant to paragraph (a). 45
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2. The claimant may provide copies of any documents he or 1
she will rely upon in a hearing to the hearing officer and any 2
other parties at the time of the hearing. 3
3. Not later than 30 days after the date on which a notice of 4
appeal is filed with an appeals officer, the Administrator, 5
employer, insurer or third-party administrator, as applicable, 6
shall: 7
(a) File with the appeals officer, appropriately indexed and in 8
chronological order, a copy of all documents in the file of the 9
claimant; and 10
(b) Serve upon all other parties to the appeal the documents 11
described in paragraph (a), by any means which ensure the 12
documents are received contemporaneously with the filing 13
submitted pursuant to paragraph (a). 14
4. Before a hearing before an appeals officer, not later than 15
14 days before the date of the hearing for an appellant and not 16
later than 7 days before the date of the hearing for a respondent, 17
each party to the appeal shall: 18
(a) File with the appeals officer, the following documents with 19
all pages separately numbered and including a comprehensive 20
index: 21
(1) All documents the party intends to introduce as evidence 22
at the hearing; 23
(2) A statement of the issues the party will raise or expects 24
will be raised at the hearing; 25
(3) A list of witnesses the party expects to call, including a 26
brief summary of the proposed testimony of each witness and a 27
statement indicating whether any witness is expected to testify via 28
telephone or through the use of audiovisual technology; and 29
(4) An estimate of the length of time required to present the 30
case, including any rebuttal testimony and argument; and 31
(b) Serve upon all other parties the documents described in 32
paragraph (a), by any means which ensure the documents are 33
received contemporaneously with the filing submitted pursuant to 34
paragraph (a). 35
5. Except as otherwise provided in this subsection, upon the 36
objection of a party, an appeals officer shall exclude from the 37
record and shall not rely upon any evidence or portion thereof 38
which is not timely filed and served in accordance with the 39
requirements of this section. An appeals officer may, for good 40
cause shown and to avoid injustice to an injured employee, rely 41
upon and allow untimely evidence to be entered into the record. 42
Sec. 10. NRS 616C.040 is hereby amended to read as follows: 43
616C.040 1. Except as otherwise provided in this section, a 44
treating physician, chiropractic physician, physician assistant or 45
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advanced practice registered nurse shall, within 3 working days after 1
first providing treatment to an injured employee for a particular 2
injury, complete and file a claim for compensation with the 3
employer of the injured employee and the employer’s insurer. If the 4
employer is a self-insured employer, the treating physician, 5
chiropractic physician, physician assistant or advanced practice 6
registered nurse shall file the claim for compensation with the 7
employer’s third-party administrator. If the physician, chiropractic 8
physician, physician assistant or advanced practice registered nurse 9
files the claim for compensation by electronic transmission, the 10
physician, chiropractic physician, physician assistant or advanced 11
practice registered nurse shall, upon request, mail to the insurer or 12
third-party administrator the form prescribed by the Administrator 13
for a claim for compensation that is signed by the injured employee 14
and the physician, chiropractic physician, physician assistant or 15
advanced practice registered nurse. The form must be mailed within 16
7 days after receiving such a request. 17
2. A physician, chiropractic physician, physician assistant or 18
advanced practice registered nurse who has a duty to file a claim for 19
compensation pursuant to subsection 1 may delegate the duty to a 20
physician assistant or an advanced practice registered nurse at a 21
medical facility [.] or an industrial provider of health care. If the 22
physician, chiropractic physician, physician assistant or advanced 23
practice registered nurse delegates the duty to a physician assistant 24
or an advanced practice registered nurse at a medical facility [:] or 25
an industrial provider of health care: 26
(a) The physician assistant or advanced practice registered 27
nurse, as applicable, at the medical facility or the industrial 28
provider of health care must comply with the filing requirements 29
set forth in this section; and 30
(b) The delegation must be in writing and signed by: 31
(1) The delegating physician, chiropractic physician, 32
physician assistant or advanced practice registered nurse; and 33
(2) An authorized representative of the medical facility [.] or 34
the industrial provider of health care. 35
3. A claim for compensation required by subsection 1 must: 36
(a) Be filed on a form prescribed by the Administrator; and 37
(b) Be signed with the original or electronic signatures of the 38
injured employee and: 39
(1) The physician, chiropractic physician, physician assistant 40
or advanced practice registered nurse who treated the injured 41
employee; or 42
(2) The physician assistant , [or] advanced practice registered 43
nurse or the industrial provider of health care to whom the duty to 44
file a claim for compensation is delegated pursuant to subsection 2. 45
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4. If a claim for compensation is accompanied by a certificate 1
of disability, the certificate must include a description of any 2
limitation or restrictions on the injured employee’s ability to work. 3
5. A copy of the completed form that is required to be filed 4
pursuant to subsection 3 and which is fully executed with the 5
required original or electronic signatures must be provided to the 6
injured employee at the time of discharge. 7
6. Each physician, chiropractic physician, physician assistant, 8
advanced practice registered nurse and medical facility that treats 9
injured employees, each insurer, third-party administrator and 10
employer, and the Division shall maintain at their offices a sufficient 11
supply of the forms prescribed by the Administrator for filing a 12
claim for compensation. 13
7. The Administrator may impose an administrative fine of not 14
more than $1,000 for each violation of subsection 1 on: 15
(a) A treating physician, chiropractic physician, physician 16
assistant or advanced practice registered nurse; or 17
(b) A physician assistant or advanced practice registered nurse at 18
a medical facility or an industrial provider of health care if the 19
duty to file the claim for compensation has been delegated to him or 20
her pursuant to this section. 21
Sec. 11. NRS 616C.045 is hereby amended to read as follows: 22
616C.045 1. Except as otherwise provided in NRS 616B.727, 23
within 6 working days after the receipt of a claim for compensation 24
from a physician, chiropractic physician, physician assistant or 25
advanced practice registered nurse, or a medical facility or an 26
industrial provider of health care if the duty to file the claim for 27
compensation has been delegated to the medical facility or the 28
industrial provider of health care pursuant to NRS 616C.040, an 29
employer shall complete and file with his or her insurer or third-30
party administrator an employer’s report of industrial injury or 31
occupational disease. 32
2. The report must: 33
(a) Be filed on a form prescribed by the Administrator; 34
(b) Be signed by the employer or the employer’s designee; 35
(c) Contain specific answers to all questions required by the 36
regulations of the Administrator; and 37
(d) Be accompanied by a statement of the wages of the 38
employee if the claim for compensation received from the treating 39
physician, chiropractic physician, physician assistant or advanced 40
practice registered nurse, or a medical facility or an industrial 41
provider of health care if the duty to file the claim for 42
compensation has been delegated to the medical facility or the 43
industrial provider of health care pursuant to NRS 616C.040, 44
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indicates that the injured employee is expected to be off work for 5 1
days or more. 2
3. An employer who files the report required by subsection 1 3
by electronic transmission shall, upon request, mail to the insurer or 4
third-party administrator the form that contains the original 5
signature of the employer or the employer’s designee. The form 6
must be mailed within 7 days after receiving such a request. 7
4. The Administrator shall impose an administrative fine of not 8
more than $1,000 on an employer for each violation of this section. 9
Sec. 12. NRS 616C.050 is hereby amended to read as follows: 10
616C.050 1. An insurer shall provide to each claimant: 11
(a) Upon written request, one copy of any medical information 12
concerning the claimant’s injury or illness. 13
(b) A statement which contains information concerning the 14
claimant’s right to: 15
(1) Receive the information and forms necessary to file a 16
claim; 17
(2) Select a treating physician or chiropractic physician and 18
an alternative treating physician or chiropractic physician , or an 19
industrial provider of health care and an alternative industrial 20
provider of health care, as applicable, in accordance with the 21
provisions of NRS 616C.090 [;] or section 7 of this act; 22
(3) Request the appointment of the Nevada Attorney for 23
Injured Workers to represent the claimant before the appeals officer; 24
(4) File a complaint with the Administrator; 25
(5) When applicable, receive compensation for: 26
(I) Permanent total disability; 27
(II) Temporary total disability; 28
(III) Permanent partial disability; 29
(IV) Temporary partial disability; 30
(V) All medical costs related to the claimant’s injury or 31
disease; or 32
(VI) The hours the claimant is absent from the place of 33
employment to receive medical treatment pursuant to 34
NRS 616C.477; 35
(6) Receive services for rehabilitation if the claimant’s injury 36
prevents him or her from returning to gainful employment; 37
(7) Review by a hearing officer of any determination or 38
rejection of a claim by the insurer within the time specified by 39
statute; and 40
(8) Judicial review of any final decision within the time 41
specified by statute. 42
2. The insurer’s statement must include a copy of the form 43
designed by the Administrator pursuant to subsection 12 of NRS 44
616C.090 or subsection 12 of section 7 of this act that notifies 45
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injured employees of their right to select an alternative treating 1
physician or chiropractic physician [.] or industrial provider of 2
health care. The Administrator shall adopt regulations for the 3
manner of compliance by an insurer with the other provisions of 4
subsection 1. 5
Sec. 13. NRS 616C.055 is hereby amended to read as follows: 6
616C.055 1. The insurer may not, in accepting responsibility 7
for any charges, use fee schedules which unfairly discriminate 8
among physicians and chiropractic physicians. 9
2. Except as otherwise provided in NRS 616C.087 [,] or 10
section 6 of this act, if a physician , [or] chiropractic physician or 11
industrial provider of health care is removed from the panel 12
established pursuant to NRS 616C.090 or section 7 of this act, as 13
applicable, or from participation in a plan for managed care 14
established pursuant to NRS 616B.527, the physician , [or] 15
chiropractic physician [,] or industrial provider of health care, as 16
applicable, must not be paid for any services rendered to the injured 17
employee after the date of the removal. 18
Sec. 14. NRS 616C.087 is hereby amended to read as follows: 19
616C.087 1. The Legislature hereby declares that: 20
(a) The choice of a treating physician or chiropractic physician 21
is a substantive right and substantive benefit of an injured employee 22
who has a claim under the Nevada Industrial Insurance Act or the 23
Nevada Occupational Diseases Act. 24
(b) The injured employees of this State have a substantive right 25
to an adequate choice of physicians and chiropractic physicians to 26
treat their industrial injuries and occupational diseases. 27
2. Except as otherwise provided in this subsection and 28
subsections 3 and 4: 29
(a) The panel maintained by the Administrator pursuant to NRS 30
616C.090 must not include a physician or chiropractic physician in a 31
discipline or specialization if the physician or chiropractic physician 32
does not accept and treat injured employees for industrial injuries or 33
occupational diseases in that discipline or specialization; and 34
(b) An insurer’s list of physicians and chiropractic physicians 35
from which an injured employee may choose pursuant to NRS 36
616C.090 must include not less than 12 physicians or chiropractic 37
physicians, as applicable, in each of the following disciplines and 38
specializations, without limitation, from the panel of physicians and 39
chiropractic physicians maintained by the Administrator pursuant to 40
NRS 616C.090: 41
(1) Orthopedic surgery on spines; 42
(2) Orthopedic surgery on shoulders; 43
(3) Orthopedic surgery on elbows; 44
(4) Orthopedic surgery on wrists; 45
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(5) Orthopedic surgery on hands; 1
(6) Orthopedic surgery on hips; 2
(7) Orthopedic surgery on knees; 3
(8) Orthopedic surgery on ankles; 4
(9) Orthopedic surgery on feet; 5
(10) Neurosurgery; 6
(11) Neurology; 7
(12) Cardiology; 8
(13) Pulmonology; 9
(14) Psychiatry; 10
(15) Pain management; 11
(16) Occupational medicine; 12
(17) Physiatry or physical medicine; 13
(18) General practice or family medicine; and 14
(19) Chiropractic medicine. 15
If the panel of physicians and chiropractic physicians maintained 16
by the Administrator pursuant to NRS 616C.090 contains fewer than 17
12 physicians or chiropractic physicians, as applicable, for a 18
discipline or specialization specifically identified in this subsection, 19
all of the physicians or chiropractic physicians, as applicable, on the 20
panel for that discipline or specialization must be included on the 21
insurer’s list. 22
3. For any other discipline or specialization not specifically 23
identified in subsection 2, the insurer’s list must include not fewer 24
than 8 physicians or chiropractic physicians, as applicable, unless 25
the panel of physicians and chiropractic physicians maintained by 26
the Administrator pursuant to NRS 616C.090 contains fewer than 8 27
physicians or chiropractic physicians, as applicable, for that 28
discipline or specialization, in which case all of the physicians or 29
chiropractic physicians, as applicable, on the panel for that 30
discipline or specialization must be included on the insurer’s list. 31
4. For each county whose population is 100,000 or more, an 32
insurer’s list of physicians and chiropractic physicians must include 33
for that county a number of physicians and chiropractic physicians, 34
as applicable, that is not less than the number required pursuant to 35
subsections 2 and 3 and that also maintain in that county: 36
(a) An active practice; and 37
(b) A physical office. 38
5. If an insurer fails to maintain a list of physicians and 39
chiropractic physicians that complies with the requirements of 40
subsections 2, 3 and 4, an injured employee may choose a physician 41
or chiropractic physician from the panel of physicians and 42
chiropractic physicians maintained by the Administrator pursuant to 43
NRS 616C.090. If a physician or chiropractic physician is 44
removed from an insurer’s list pursuant to subsection 9 or 10, 45
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within 60 days after the date of removal the insurer shall replace 1
the physician or chiropractic physician on the list to maintain 2
compliance with the requirements of subsections 2, 3 and 4. If the 3
insurer fails to do so, an injured employee may choose a physician 4
or chiropractic physician from the panel maintained by the 5
Administrator pursuant to NRS 616C.090. 6
6. Each insurer shall, not later than October 1 of each year, 7
update the list of physicians and chiropractic physicians and file the 8
list with the Administrator. The list must be certified by an adjuster 9
who is licensed pursuant to chapter 684A of NRS. An insurer shall 10
not at any time remove any physician or chiropractic physician 11
from the insurer’s list except as expressly permitted by subsection 12
9 or 10. 13
7. Upon receipt of a list of physicians and chiropractic 14
physicians that is filed pursuant to subsection 6, the Administrator 15
shall: 16
(a) Stamp the list as having been filed; and 17
(b) Indicate on the list the date on which it was filed. 18
8. The Administrator shall: 19
(a) Provide a copy of an insurer’s list of physicians and 20
chiropractic physicians to any member of the public who requests a 21
copy; or 22
(b) Post a copy of each insurer’s list of physicians and 23
chiropractic physicians on an Internet website maintained by the 24
Administrator and accessible to the public for viewing, printing or 25
downloading. 26
9. At any time, a physician or chiropractic physician may 27
request in writing that he or she be removed from an insurer’s list of 28
physicians and chiropractic physicians. The insurer must comply 29
with the request and omit the physician or chiropractic physician 30
from the next list which the insurer files with the Administrator. 31
10. A physician or chiropractic physician may not be 32
involuntarily removed from an insurer’s list of physicians and 33
chiropractic physicians except for good cause. As used in this 34
subsection, “good cause” means that one or more of the following 35
circumstances apply: 36
(a) The physician or chiropractic physician has died or is 37
disabled. 38
(b) The license of the physician or chiropractic physician has 39
been revoked or suspended. 40
(c) The physician or chiropractic physician has been convicted 41
of: 42
(1) A felony; or 43
(2) A crime for a violation of a provision of chapter 616D of 44
NRS. 45
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(d) The physician or chiropractic physician has been removed 1
from the panel of physicians and chiropractic physicians maintained 2
by the Administrator pursuant to NRS 616C.090 by the 3
Administrator upon a finding that the physician or chiropractic 4
physician: 5
(1) Has failed to comply with the standards for treatment of 6
industrial injuries or occupational diseases as established by the 7
Administrator; or 8
(2) Does not accept and treat injured employees under 9
chapters 616A to 616D, inclusive, or chapter 617 of NRS. 10
11. Unless a physician or chiropractic physician, as applicable, 11
is removed from an insurer’s list of physicians and chiropractic 12
physicians pursuant to subsection 10, an injured employee may 13
continue to receive treatment from that physician or chiropractic 14
physician even if: 15
(a) The employer of the injured employee changes insurers or 16
administrators. 17
(b) The physician or chiropractic physician is no longer included 18
in the applicable insurer’s list of physicians and chiropractic 19
physicians, provided that the physician or chiropractic physician 20
agrees to continue to accept compensation for that treatment at the 21
rates which: 22
(1) Were previously agreed upon when the physician or 23
chiropractic physician was most recently included in the list; or 24
(2) Are newly negotiated but do not exceed the amounts 25
provided under the fee schedule adopted by the Administrator. 26
12. The Administrator shall adopt regulations prescribing the 27
form in which a list of physicians and chiropractic physicians 28
created by an employer, insurer or third-party administrator pursuant 29
to this section must be maintained. The Administrator shall require 30
that any such list be in a format which is easily searchable, 31
including, without limitation, an indexed database, a portable 32
document format, a spreadsheet with data that may be filtered, a 33
comma-separated values file or any other comparable format. 34
Sec. 15. NRS 616C.110 is hereby amended to read as follows: 35
616C.110 1. For the purposes of NRS 616B.557, 616B.578, 36
616B.587 [,] and 616C.490 , [and 617.459,] not later than August 1, 37
2003, the Division shall adopt regulations incorporating the 38
American Medical Association’s Guides to the Evaluation of 39
Permanent Impairment, Fifth Edition, by reference. The regulations: 40
(a) Must provide that the American Medical Association’s 41
Guides to the Evaluation of Permanent Impairment, Fifth Edition, 42
must be applied to all examinations; and 43
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(b) Must be applied to all examinations for a permanent partial 1
disability that are conducted on or after the effective date of the 2
regulations, regardless of the date of injury. 3
2. After adopting the regulations required pursuant to 4
subsection 1, the Division may amend those regulations as it deems 5
necessary, except that the amendments to those regulations: 6
(a) Must be consistent with the Fifth Edition of the American 7
Medical Association’s Guides to the Evaluation of Permanent 8
Impairment; 9
(b) Must not incorporate any contradictory matter from any 10
other edition of the American Medical Association’s Guides to the 11
Evaluation of Permanent Impairment; and 12
(c) Must not consider any factors other than the degree of 13
physical impairment of the whole person in calculating the 14
entitlement to compensation. 15
3. If the Fifth Edition of the American Medical Association’s 16
Guides to the Evaluation of Permanent Impairment contains more 17
than one method of determining the rating of an impairment, the 18
Administrator shall designate by regulation the method from that 19
edition which must be used to rate an impairment pursuant to 20
NRS 616C.490. 21
Sec. 16. NRS 616C.137 is hereby amended to read as follows: 22
616C.137 1. If an insurer, organization for managed care or 23
employer who provides accident benefits for injured employees 24
pursuant to NRS 616C.265 denies payment for some or all of the 25
services itemized on a statement submitted by a provider of health 26
care on the sole basis that those services were not related to the 27
employee’s industrial injury or occupational disease, the insurer, 28
organization for managed care or employer shall, at the same time 29
that it sends notification to the provider of health care of the denial, 30
send a copy of the statement to the injured employee and notify the 31
injured employee that it has denied payment. The notification sent to 32
the injured employee must: 33
(a) State the relevant amount requested as payment in the 34
statement, that the reason for denying payment is that the services 35
were not related to the industrial injury or occupational disease and 36
that, pursuant to subsection 2, the injured employee will be 37
responsible for payment of the relevant amount if the injured 38
employee does not, in a timely manner, appeal the denial pursuant to 39
NRS [616C.305 and] 616C.315 to 616C.385, inclusive, or appeals 40
but is not successful. 41
(b) Include an explanation of the injured employee’s right to 42
request a hearing to appeal the denial pursuant to NRS [616C.305 43
and] 616C.315 to 616C.385, inclusive, and a suitable form for 44
requesting a hearing to appeal the denial. 45
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2. An injured employee who does not, in a timely manner, 1
appeal the denial of payment for the services rendered or who 2
appeals the denial but is not successful is responsible for payment of 3
the relevant charges on the itemized statement. 4
3. To succeed on appeal, the injured employee must show that 5
the: 6
(a) Services provided were related to the employee’s industrial 7
injury or occupational disease; or 8
(b) Insurer, organization for managed care or employer who 9
provides accident benefits for injured employees pursuant to NRS 10
616C.265 gave prior authorization for the services rendered and did 11
not withdraw that prior authorization before the services of the 12
provider of health care were rendered. 13
Sec. 17. NRS 616C.180 is hereby amended to read as follows: 14
616C.180 1. Except as otherwise provided in this section, an 15
injury or disease sustained by an employee that is caused by stress is 16
compensable pursuant to the provisions of chapters 616A to 616D, 17
inclusive, or chapter 617 of NRS if it arose out of and in the course 18
of his or her employment. 19
2. Except as otherwise provided in subsection 4, any ailment or 20
disorder caused by any gradual mental stimulus, and any death 21
or disability ensuing therefrom, shall be deemed not to be an injury 22
or disease arising out of and in the course of employment. 23
3. Except as otherwise provided by subsections 4 and 5, an 24
injury or disease caused by stress shall be deemed to arise out of and 25
in the course of employment [only] if the employee proves by [clear 26
and convincing] medical , psychological or psychiatric evidence 27
that: 28
(a) The employee has a mental injury caused by extreme stress 29
in time of danger; 30
(b) The primary cause of the injury was an event that arose out 31
of and during the course of his or her employment; and 32
(c) The stress was not caused by his or her layoff, the 33
termination of his or her employment or any disciplinary action 34
taken against him or her. 35
4. An injury or disease caused by stress shall be deemed to 36
arise out of and in the course of employment if the employee is a 37
first responder and proves by [clear and convincing] medical , 38
psychological or psychiatric evidence that: 39
(a) The employee has a mental injury caused by extreme stress 40
due to the employee directly witnessing: 41
(1) The death, or the aftermath of the death, of a person as a 42
result of a violent event, including, without limitation, a homicide, 43
suicide or mass casualty incident; or 44
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(2) An injury, or the aftermath of an injury, that involves 1
grievous bodily harm of a nature that shocks the conscience; and 2
(b) The primary cause of the mental injury was the employee 3
witnessing an event or a series of events described in paragraph (a) 4
during the course of his or her employment. 5
5. An injury or disease caused by stress shall be deemed to 6
arise out of and in the course of employment, and shall not be 7
deemed the result of gradual mental stimulus, if the employee is 8
employed by the State or any of its agencies or political subdivisions 9
and proves by [clear and convincing] medical , psychological or 10
psychiatric evidence that: 11
(a) The employee has a mental injury caused by extreme stress 12
due to the employee responding to a mass casualty incident; and 13
(b) The primary cause of the injury was the employee 14
responding to the mass casualty incident during the course of his or 15
her employment. 16
6. An agency which employs a first responder, including, 17
without limitation, a first responder who serves as a volunteer, shall 18
provide educational training to the first responder related to the 19
awareness, prevention, mitigation and treatment of mental health 20
issues. 21
7. The provisions of this section do not apply to a person who 22
is claiming compensation pursuant to NRS 617.457. 23
8. As used in this section: 24
(a) “Directly witness” means to see or hear for oneself. 25
(b) “First responder” means: 26
(1) A salaried or volunteer firefighter; 27
(2) A police officer; 28
(3) An emergency dispatcher or call taker who is employed 29
by a law enforcement or public safety agency in this State; or 30
(4) An emergency medical technician or paramedic who is 31
employed by a public safety agency in this State. 32
(c) “Mass casualty incident” means an event that, for the 33
purposes of emergency response or operations, is designated as a 34
mass casualty incident by one or more governmental agencies that 35
are responsible for public safety or for emergency response. 36
Sec. 18. NRS 616C.220 is hereby amended to read as follows: 37
616C.220 1. The Division shall designate one: 38
(a) Third-party administrator who has a valid certificate issued 39
by the Commissioner pursuant to NRS 683A.085; or 40
(b) Insurer, other than a self-insured employer or association of 41
self-insured public or private employers, 42
to administer claims against the Uninsured Employers’ Claim 43
Account. The designation must be made pursuant to reasonable 44
competitive bidding procedures established by the Administrator. 45
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2. Except as otherwise provided in this subsection, an 1
employee may receive compensation from the Uninsured 2
Employers’ Claim Account if: 3
(a) The employee was hired in this State or is regularly 4
employed in this State; 5
(b) The employee suffers an accident or injury which arises out 6
of and in the course of his or her employment: 7
(1) In this State; or 8
(2) While on temporary assignment outside the State for not 9
more than 12 months; 10
(c) The employee files a claim for compensation with the 11
Division; and 12
(d) The employee makes an irrevocable assignment to the 13
Division of a right to be subrogated to the rights of the injured 14
employee pursuant to NRS 616C.215. 15
An employee who suffers an accident or injury while on 16
temporary assignment outside the State is not eligible to receive 17
compensation from the Uninsured Employers’ Claim Account 18
unless the employee has been denied workers’ compensation in the 19
state in which the accident or injury occurred. 20
3. If the Division receives a claim pursuant to subsection 2, the 21
Division shall immediately notify the employer of the claim. 22
4. For the purposes of this section and NRS 616C.223, the 23
employer has the burden of proving that the employer provided 24
mandatory industrial insurance coverage for the employee or that 25
the employer was not required to maintain industrial insurance for 26
the employee. 27
5. Any employer who has failed to provide mandatory 28
coverage required by the provisions of chapters 616A to 616D, 29
inclusive, of NRS is liable for all payments made on behalf of the 30
employer, including any benefits, administrative costs or attorney’s 31
fees paid from the Uninsured Employers’ Claim Account or 32
incurred by the Division. 33
6. The Division: 34
(a) May recover from the employer the payments made by the 35
Division that are described in subsection 5 and any accrued interest 36
by bringing a civil action or filing an application for the entry of 37
summary judgment pursuant to NRS 616C.223 in a court of 38
competent jurisdiction. For the purposes of this paragraph, the 39
payments made by the Division that are described in subsection 5 40
are presumed to be: 41
(1) Justified by the circumstances of the claim; 42
(2) Made in accordance with applicable law; and 43
(3) Reasonable and necessary. 44
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(b) In any civil action or application for the entry of summary 1
judgment filed pursuant to NRS 616C.223 against the employer, is 2
not required to prove that negligent conduct by the employer was 3
the cause of the employee’s injury. 4
(c) May enter into a contract with any person to assist in the 5
collection of any liability of an uninsured employer. 6
(d) In lieu of a civil action or filing an application for the entry 7
of summary judgment pursuant to NRS 616C.223, may enter into an 8
agreement or settlement regarding the collection of any liability of 9
an uninsured employer. 10
7. The Division shall: 11
(a) Determine whether the employer was insured within 30 days 12
after receiving notice of the claim from the employee. 13
(b) Assign the claim to the third-party administrator or insurer 14
designated pursuant to subsection 1 for administration and payment 15
of compensation. 16
Upon determining whether the claim is accepted or denied, the 17
designated third-party administrator or insurer shall notify the 18
injured employee, the named employer and the Division of its 19
determination. 20
8. Upon demonstration of the: 21
(a) Costs incurred by the designated third-party administrator or 22
insurer to administer the claim or pay compensation to the injured 23
employee; or 24
(b) Amount that the designated third-party administrator or 25
insurer will pay for administrative expenses or compensation to the 26
injured employee and that such amounts are justified by the 27
circumstances of the claim, 28
the Division shall authorize payment from the Uninsured 29
Employers’ Claim Account. 30
9. Any party aggrieved by a determination made by the 31
Division regarding the assignment of any claim made pursuant to 32
this section may appeal that determination by filing a notice of 33
appeal with an appeals officer within 30 days after the determination 34
is rendered. The provisions of NRS 616C.345 to 616C.385, 35
inclusive, apply to an appeal filed pursuant to this subsection. 36
10. Any party aggrieved by a determination to accept or to 37
deny any claim made pursuant to this section or by a determination 38
to pay or to deny the payment of compensation regarding any claim 39
made pursuant to this section may appeal that determination, within 40
70 days after the determination is rendered, to the Hearings Division 41
of the Department of Administration in the manner provided by 42
NRS [616C.305 and] 616C.315. 43
11. All insurers shall bear a proportionate amount of a claim 44
made pursuant to chapters 616A to 616D, inclusive, of NRS, and are 45
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entitled to a proportionate amount of any collection made pursuant 1
to this section as an offset against future liabilities. 2
12. An uninsured employer is liable for the interest on any 3
amount paid on his or her claims from the Uninsured Employers’ 4
Claim Account. The interest must be calculated at a rate equal to the 5
prime rate at the largest bank in Nevada, as ascertained by the 6
Commissioner of Financial Institutions, on January 1 or July 1, as 7
the case may be, immediately preceding the date of the claim, plus 3 8
percent, compounded monthly, from the date the claim is paid from 9
the account until payment is received by the Division from the 10
employer. 11
13. Attorney’s fees recoverable by the Division pursuant to this 12
section must be: 13
(a) If a private attorney is retained by the Division, paid at the 14
usual and customary rate for that attorney. 15
(b) If the attorney is an employee of the Division, paid at the 16
rate established by regulations adopted by the Division. 17
Any money collected must be deposited to the Uninsured 18
Employers’ Claim Account. 19
14. If the Division has not obtained a civil judgment or an 20
entry of summary judgment pursuant to NRS 616C.223 and the 21
Division assigns a debt that arises under this section to the State 22
Controller for collection pursuant to NRS 353C.195, the State 23
Controller may bring an action in his or her own name in a court of 24
competent jurisdiction to recover any amount that the Division is 25
authorized to recover pursuant to this section. 26
Sec. 19. NRS 616C.235 is hereby amended to read as follows: 27
616C.235 1. Except as otherwise provided in subsections 2, 3 28
and 4: 29
(a) When the insurer determines that a claim should be closed 30
before all benefits to which the claimant may be entitled have been 31
paid, the insurer shall send a written notice of its intention to close 32
the claim to the claimant by first-class mail addressed to the last 33
known address of the claimant and, if the insurer has been notified 34
that the claimant is represented by an attorney, to the attorney for 35
the claimant by first-class mail addressed to the last known address 36
of the attorney. The notice must include, on a separate page, a 37
statement describing the effects of closing a claim pursuant to this 38
section and a statement that if the claimant does not agree with the 39
determination, the claimant has a right to request a resolution of the 40
dispute pursuant to NRS [616C.305 and] 616C.315 to 616C.385, 41
inclusive, including, without limitation, a statement which 42
prominently displays the limit on the time that the claimant has to 43
request a resolution of the dispute as set forth in NRS 616C.315. A 44
suitable form for requesting a resolution of the dispute must be 45
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enclosed with the notice. The closure of a claim pursuant to this 1
subsection is not effective unless notice is given as required by this 2
subsection. 3
(b) If the insurer does not receive a request for the resolution of 4
the dispute, it may close the claim. 5
(c) Notwithstanding the provisions of NRS 233B.125, if a 6
hearing is conducted to resolve the dispute, the decision of the 7
hearing officer may be served by first-class mail. 8
2. If, during the first 12 months after a claim is opened, the 9
medical benefits required to be paid for a claim are less than $800, 10
the insurer may close the claim at any time after the insurer sends, 11
by first-class mail addressed to the last known address of the 12
claimant, written notice that includes a statement which prominently 13
displays that: 14
(a) The claim is being closed pursuant to this subsection; 15
(b) The injured employee may appeal the closure of the claim 16
pursuant to the provisions of NRS [616C.305 and] 616C.315 to 17
616C.385, inclusive; and 18
(c) If the injured employee does not appeal the closure of the 19
claim or appeals the closure of the claim but is not successful, the 20
claim cannot be reopened. 21
3. In addition to the notice described in subsection 2, an insurer 22
shall send to each claimant who receives less than $800 in medical 23
benefits within 6 months after the claim is opened a written notice 24
that explains the circumstances under which a claim may be closed 25
pursuant to subsection 2. The written notice provided pursuant to 26
this subsection does not create any right to appeal the contents of 27
that notice. The written notice must be: 28
(a) Sent by first-class mail addressed to the last known address 29
of the claimant; and 30
(b) A document that is separate from any other document or 31
form that is used by the insurer. 32
4. The closure of a claim pursuant to subsection 2 is not 33
effective unless notice is given as required by subsections 2 and 3. 34
5. In addition to the requirements of this section, an insurer 35
shall include in the written notice described in subsection 2: 36
(a) If an evaluation for a permanent partial disability has been 37
scheduled pursuant to NRS 616C.490, a statement to that effect; or 38
(b) If an evaluation for a permanent partial disability will not be 39
scheduled pursuant to NRS 616C.490, a statement explaining that 40
the reason is because the insurer has determined there is no 41
possibility of a permanent impairment of any kind. 42
Sec. 20. NRS 616C.295 is hereby amended to read as follows: 43
616C.295 1. The Chief of the Hearings Division shall adopt 44
regulations establishing: 45
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(a) A code of conduct for hearing officers who conduct hearings 1
in contested cases for compensation under chapters 616A to 617, 2
inclusive, of NRS; and 3
(b) A code of conduct for appeals officers who conduct hearings 4
and appeals as required pursuant to chapters 616A to 617, inclusive, 5
of NRS. 6
2. The codes of conduct established pursuant to subsection 1 7
must be designed to ensure fairness and impartiality, and to avoid 8
the appearance of impropriety. 9
3. The Chief of the Hearings Division shall adopt regulations 10
establishing: 11
(a) Standards for the initial training and continuing education of 12
hearing officers who conduct hearings in contested cases for 13
compensation under chapters 616A to 617, inclusive, of NRS; and 14
(b) Standards for the initial training and continuing education of 15
appeals officers who conduct hearings and appeals as required 16
pursuant to chapters 616A to 617, inclusive, of NRS. 17
4. The standards established pursuant to subsection 3 must, 18
without limitation, include training and continuing education in: 19
(a) The provisions of chapters 616A to 617, inclusive, of NRS; 20
(b) Dispute resolution; and 21
(c) Mediation. 22
5. The Chief of the Hearings Division shall: 23
(a) Prescribe by regulation the qualifications required before a 24
person may, pursuant to chapters 616A to 617, inclusive, of NRS, 25
serve as a hearing officer. 26
(b) Provide for the expediting of the hearing of cases that 27
involve the termination or denial of compensation. 28
(c) Maintain and make accessible to the public on the Internet 29
website maintained by the Hearings Division, a calendar of all 30
matters which are before hearing officers and appeals officers. 31
6. From the cases heard each year by hearing officers and 32
appeals officers regarding claims for benefits by injured employees, 33
the Chief of the Hearings Division shall prepare an annual report 34
which itemizes, on the basis of each insurer and third-party 35
administrator, the number of cases affirmed, reversed, remanded and 36
resolved by other disposition involving that insurer or third-party 37
administrator, including a breakdown of that information by the type 38
of benefits denied by the insurer or third-party administrator. 39
7. As used in this section, “Chief of the Hearings Division” 40
means the Chief of the Hearings Division of the Department of 41
Administration. 42
Sec. 21. NRS 616C.315 is hereby amended to read as follows: 43
616C.315 1. Any person who is subject to the jurisdiction of 44
the hearing officers pursuant to chapters 616A to 616D, inclusive, or 45
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chapter 617 of NRS may request a hearing before a hearing officer 1
of any matter within the hearing officer’s authority. The insurer 2
shall provide, without cost, the forms necessary to request a hearing 3
to any person who requests them. 4
2. A hearing must not be scheduled until the following 5
information is provided to the hearing officer: 6
(a) The name of: 7
(1) The claimant; 8
(2) The employer; and 9
(3) The insurer or third-party administrator; 10
(b) The number of the claim; and 11
(c) If applicable, a copy of the letter of determination being 12
appealed or, if such a copy is unavailable, the date of the 13
determination and the issues stated in the determination. 14
3. Except as otherwise provided in NRS 616B.772, 616B.775, 15
616B.787 [, 616C.305] and 616C.427, a person who is aggrieved 16
by: 17
(a) A written determination of an insurer; or 18
(b) The failure of an insurer to respond within 30 days to a 19
written request mailed to the insurer by the person who is aggrieved, 20
may appeal from the determination or failure to respond by filing 21
a request for a hearing before a hearing officer. Such a request must 22
include the information required pursuant to subsection 2 and, 23
except as otherwise provided in subsections 4 and 5, must be filed 24
within 70 days after the date on which the notice of the insurer’s 25
determination was mailed or, if requested by the claimant or the 26
person acting on behalf of the claimant, sent by facsimile or other 27
electronic transmission the proof of sending and receipt of which is 28
readily verifiable by the insurer or the unanswered written request 29
was mailed to the insurer, as applicable. The failure of an insurer to 30
respond to a written request for a determination within 30 days after 31
receipt of such a request shall be deemed by the hearing officer to be 32
a denial of the request. 33
4. The period specified in subsection 3 within which a request 34
for a hearing must be filed may be: 35
(a) Extended for an additional 90 days if the person aggrieved 36
shows by a preponderance of the evidence that the person was 37
diagnosed with a terminal illness or was informed of the death or 38
diagnosis of a terminal illness of his or her spouse, parent or child. 39
(b) Tolled if the insurer fails to mail or, if requested by the 40
claimant or the person acting on behalf of the claimant, send by 41
facsimile or other electronic transmission the proof of sending and 42
receipt of which is readily verifiable a determination. 43
5. Failure to file a request for a hearing within the period 44
specified in subsection 3 may be excused if the person aggrieved 45
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shows by a preponderance of the evidence that the person did not 1
receive the notice of the determination and the forms necessary to 2
request a hearing. The claimant or employer shall notify the insurer 3
of a change of address. 4
6. The hearing before the hearing officer must be conducted as 5
expeditiously and informally as is practicable. 6
7. The parties to a contested claim may, if the claimant is 7
represented by legal counsel, agree to forego a hearing before a 8
hearing officer and submit the contested claim directly to an appeals 9
officer. 10
8. A claimant may, with regard to a contested claim arising 11
from the provisions of NRS 617.453, 617.455, 617.457, 617.485 or 12
617.487 as described in subsection 2 of NRS 616C.345, submit the 13
contested claim directly to an appeals officer pursuant to subsection 14
2 of NRS 616C.345 without the agreement of any other party. 15
Sec. 22. NRS 616C.320 is hereby amended to read as follows: 16
616C.320 If an employee of a self-insured employer, an 17
employer who is a member of an association of self-insured public 18
or private employers or an employer insured by a private carrier is 19
dissatisfied with a decision of his or her employer, the association or 20
the private carrier, the employee may seek to resolve the dispute 21
pursuant to NRS [616C.305 and] 616C.315 to 616C.385, inclusive. 22
Sec. 23. NRS 616C.345 is hereby amended to read as follows: 23
616C.345 1. Any party aggrieved by a decision of the 24
hearing officer relating to a claim for compensation may appeal 25
from the decision by, except as otherwise provided in subsections 9, 26
10 and 11, filing a notice of appeal with an appeals officer within 30 27
days after the date of the decision. 28
2. A claimant aggrieved by a written determination of the 29
denial of a claim, in whole or in part, by an insurer, or the failure of 30
an insurer to respond in writing within 30 days to a written request 31
of the claimant mailed to the insurer, concerning a claim arising 32
from the provisions of NRS 617.453, 617.455, 617.457, 617.485 or 33
617.487 may file a notice of a contested claim with an appeals 34
officer. The notice must include the information required pursuant 35
to subsection 3 and, except as otherwise provided in subsections 9 to 36
12, inclusive, must be filed within 70 days after the date on which 37
the notice of the insurer’s determination was mailed or, if requested 38
by the claimant or the person acting on behalf of the claimant, sent 39
by facsimile or other electronic transmission the proof of sending 40
and receipt of which is readily verifiable by the insurer or the 41
unanswered written request was mailed to the insurer, as applicable. 42
The failure of an insurer to respond in writing to a written request 43
for a determination within 30 days after receipt of such a request 44
shall be deemed by the appeals officer to be a denial of the request. 45
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The insurer shall provide, without cost, the forms necessary to file a 1
notice of a contested claim to any person who requests them. 2
3. A hearing must not be scheduled until the following 3
information is provided to the appeals officer: 4
(a) The name of: 5
(1) The claimant; 6
(2) The employer; and 7
(3) The insurer or third-party administrator; 8
(b) The number of the claim; and 9
(c) If applicable, a copy of the letter of determination being 10
appealed or, if such a copy is unavailable, the date of the 11
determination and the issues stated in the determination. 12
4. [If a dispute is required to be submitted to a procedure for 13
resolving complaints pursuant to NRS 616C.305 and: 14
(a) A final determination was rendered pursuant to that 15
procedure; or 16
(b) The dispute was not resolved pursuant to that procedure 17
within 14 days after it was submitted, 18
any party to the dispute may, except as otherwise provided in 19
subsections 9 to 12, inclusive, file a notice of appeal within 70 days 20
after the date on which the final determination was mailed to the 21
employee, or the dependent of the employee, or the unanswered 22
request for resolution was submitted. Failure to render a written 23
determination within 30 days after receipt of such a request shall be 24
deemed by the appeals officer to be a denial of the request. 25
5.] Except as otherwise provided in NRS 616C.380, the filing 26
of a notice of appeal does not automatically stay the enforcement of 27
the decision of a hearing officer . [or a determination rendered 28
pursuant to NRS 616C.305.] The appeals officer may order a stay [, 29
when appropriate,] in accordance with the requirements of 30
subsection 5 upon the [application] motion of a party. If a party 31
files such [an application is submitted,] a motion, the decision is 32
automatically stayed until a determination is made concerning the 33
[application.] motion. A determination on the [application] motion 34
must be made within 30 days after the filing of the [application.] 35
motion. If a determination is not made within that period, the 36
motion is automatically denied. If the motion is automatically 37
denied or a stay is not granted by the officer after reviewing the 38
[application,] motion, the decision must be complied with within 10 39
days after the date of the automatic denial or refusal to grant a stay 40
[.] and the nonmoving party is entitled to reasonable attorney’s 41
fees and costs incurred as a result of the motion. 42
5. An appeals officer shall not: 43
(a) Grant a motion to stay the enforcement of the decision of a 44
hearing officer unless the appeals officer makes specific findings 45
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of fact and conclusions of law that the moving party seeking the 1
stay has established, by clear and convincing evidence, that: 2
(1) The moving party has a reasonable likelihood of success 3
in the appeal on the factual merits or as a matter of law; 4
(2) The moving party will suffer irreparable harm if the 5
stay is denied; and 6
(3) The nonmoving party will not suffer irreparable harm if 7
the stay is granted. 8
(b) For the purpose of making findings and conclusions 9
relating to irreparable harm pursuant to paragraph (a), consider 10
the ability to recoup benefits and compensation provided by an 11
industrial insurer to an injured employee during the pendency of 12
the appeal. 13
6. Except as otherwise provided in subsections 3 and 7, within 14
10 days after receiving a notice of appeal pursuant to this section or 15
NRS 616C.220, 616D.140 or 617.401, or within 10 days after 16
receiving a notice of a contested claim pursuant to subsection 7 of 17
NRS 616C.315, the appeals officer shall: 18
(a) Schedule a hearing on the merits of the appeal or contested 19
claim for a date and time within 90 days after receipt of the notice at 20
a place in Carson City, Nevada, or Las Vegas, Nevada, or upon 21
agreement of one or more of the parties to pay all additional costs 22
directly related to an alternative location, at any other place of 23
convenience to the parties, at the discretion of the appeals officer; 24
and 25
(b) Give notice by mail or by personal service to all parties to 26
the matter and their attorneys or agents at least 30 days before the 27
date and time scheduled. 28
7. Except as otherwise provided in subsection 13, a request to 29
schedule the hearing for a date and time which is: 30
(a) Within 60 days after the receipt of the notice of appeal or 31
contested claim; or 32
(b) More than 90 days after the receipt of the notice or claim, 33
may be submitted to the appeals officer only if all parties to the 34
appeal or contested claim agree to the request. 35
8. An appeal or contested claim may be continued upon written 36
stipulation of all parties, or upon good cause shown. 37
9. The period specified in subsection 1 [,] or 2 [or 4] within 38
which a notice of appeal or a notice of a contested claim must be 39
filed may be extended for an additional 90 days if the person 40
aggrieved shows by a preponderance of the evidence that the person 41
was diagnosed with a terminal illness or was informed of the death 42
or diagnosis of a terminal illness of the person’s spouse, parent or 43
child. 44
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10. The period specified in subsection 2 within which a notice 1
of appeal or a notice of a contested claim must be filed may be 2
tolled if the insurer fails to mail or, if requested by the claimant or 3
the person acting on behalf of the claimant, send a determination by 4
facsimile or other electronic transmission the proof of sending and 5
receipt of which is readily verifiable. 6
11. Failure to file a notice of appeal within the period specified 7
in subsection 1 [or 4] may be excused if the party aggrieved shows 8
by a preponderance of the evidence that he or she did not receive 9
the notice of the determination and the forms necessary to appeal the 10
determination. The claimant, employer or insurer shall notify the 11
hearing officer of a change of address. 12
12. Failure to file a notice of a contested claim within the 13
period specified in subsection 2 may be excused if the claimant 14
shows by a preponderance of the evidence that he or she did not 15
receive the notice of the determination and the forms necessary to 16
file the notice. The claimant or employer shall notify the insurer of a 17
change of address. 18
13. Within 10 days after receiving a notice of a contested claim 19
pursuant to subsection 2, the appeals officer shall: 20
(a) Schedule a hearing on the merits of the contested claim for a 21
date and time within 60 days after his or her receipt of the notice at a 22
place in Carson City, Nevada, or Las Vegas, Nevada, or upon 23
agreement of one or more of the parties to pay all additional costs 24
directly related to an alternative location, at any other place of 25
convenience to the parties, at the discretion of the appeals officer; 26
and 27
(b) Give notice by mail or by personal service to all parties to 28
the matter and their attorneys or agents within 10 days after 29
scheduling the hearing. 30
The scheduled date must allow sufficient time for full disclosure, 31
exchange and examination of medical and other relevant 32
information. A party may not introduce information at the hearing 33
which was not previously disclosed to the other parties unless all 34
parties agree to the introduction. 35
Sec. 24. NRS 616C.370 is hereby amended to read as follows: 36
616C.370 1. No judicial proceedings may be instituted for 37
compensation for an injury or death under chapters 616A to 616D, 38
inclusive, of NRS unless: 39
(a) A claim for compensation is filed as provided in NRS 40
616C.020; and 41
(b) A final decision of an appeals officer has been rendered on 42
such claim. 43
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2. Judicial proceedings instituted for compensation for an 1
injury or death, under chapters 616A to 616D, inclusive, of NRS are 2
limited to judicial review of the decision of an appeals officer. 3
3. Notwithstanding any other provision of law: 4
(a) The following requirements, and no others, are mandatory 5
and jurisdictional for a petition for judicial review of the final 6
decision of an appeals officer: 7
(1) The petition must be filed within 30 days after the date 8
of entry and service of the decision and order of the appeals 9
officer; and 10
(2) A copy of the decision and order of the appeals officer 11
must be attached to the petition. 12
(b) Other than the requirements of paragraph (a), a court may 13
excuse any other defect in substance, form, venue or service of a 14
petition for judicial review, and may permit any appropriate 15
amendment or change of venue at any time before the final 16
disposition of the petition. 17
4. The prevailing party in any judicial proceedings instituted 18
for compensation for an injury or death under chapters 616A to 19
616D, inclusive, of NRS shall cause a copy of the final decision 20
issued by the court in the proceedings to be: 21
(a) Served upon the appeals officer whose final decision was 22
appealed. The appeals officer shall include the copy of the final 23
decision in the administrative record on the matter. 24
(b) For a prevailing party in the Court of Appeals or Supreme 25
Court, filed in the district court whose final decision was appealed. 26
Sec. 25. NRS 616C.375 is hereby amended to read as follows: 27
616C.375 1. If an insurer, employer or claimant, or the 28
representative of an insurer, employer or claimant, appeals the 29
decision of an appeals officer, that decision is not stayed unless a 30
stay is granted by the appeals officer or the district court within 30 31
days after the date on which the decision was rendered. 32
2. An appeals officer or district court shall not: 33
(a) Grant a motion to stay the enforcement of the decision of 34
an appeals officer unless the appeals officer or district court 35
makes specific findings of fact and conclusions of law that the 36
moving party seeking the stay has established, by clear and 37
convincing evidence, that: 38
(1) The moving party has a reasonable likelihood of success 39
in the appeal on the factual merits or as a matter of law; 40
(2) The moving party will suffer irreparable harm if the 41
stay is denied; and 42
(3) The nonmoving party will not suffer irreparable harm if 43
the stay is granted. 44
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(b) For the purpose of making findings and conclusions 1
relating to irreparable harm pursuant to paragraph (a), consider 2
the ability to recoup benefits and compensation provided by an 3
industrial insurer to an injured employee during the pendency of 4
the appeal. 5
3. If the appeals officer or district court denies a motion to 6
stay pursuant to this section, the nonmoving party is entitled to 7
reasonable attorney’s fees and costs incurred as a result of the 8
motion. 9
Sec. 26. NRS 616C.390 is hereby amended to read as follows: 10
616C.390 Except as otherwise provided in NRS 616C.392: 11
1. If an application to reopen a claim to increase or rearrange 12
compensation is made in writing more than 1 year after the date on 13
which the claim was closed, the insurer shall reopen the claim if: 14
(a) A change of circumstances warrants an increase or 15
rearrangement of compensation during the life of the claimant; 16
(b) The primary cause of the change of circumstances is the 17
injury for which the claim was originally made; and 18
(c) The application is accompanied by the certificate of a 19
physician or a chiropractic physician showing a change of 20
circumstances which would warrant an increase or rearrangement of 21
compensation. 22
2. After a claim has been closed, the insurer, upon receiving an 23
application and for good cause shown, may authorize the reopening 24
of the claim for medical investigation only. The application must be 25
accompanied by a written request for treatment from the physician 26
or chiropractic physician treating the claimant, certifying that the 27
treatment is indicated by a change in circumstances and is related to 28
the industrial injury sustained by the claimant. 29
3. If a claimant applies for a claim to be reopened pursuant to 30
subsection 1 or 2 and a final determination denying the reopening is 31
issued, the claimant shall not reapply to reopen the claim until at 32
least 1 year after the date on which the final determination is issued. 33
4. Except as otherwise provided in subsection 5, if an 34
application to reopen a claim is made in writing within 1 year after 35
the date on which the claim was closed, the insurer shall reopen the 36
claim only if: 37
(a) The application is supported by medical evidence 38
demonstrating an objective change in the medical condition of the 39
claimant; and 40
(b) There is clear and convincing evidence that the primary 41
cause of the change of circumstances is the injury for which the 42
claim was originally made. 43
5. An application to reopen a claim must be made in writing 44
within 1 year after the date on which the claim was closed if: 45
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(a) The claimant did not meet the minimum duration of 1
incapacity as set forth in NRS 616C.400 as a result of the injury; 2
and 3
(b) The claimant did not receive benefits for a permanent partial 4
disability. 5
If an application to reopen a claim to increase or rearrange 6
compensation is made pursuant to this subsection, the insurer shall 7
reopen the claim if the requirements set forth in paragraphs (a), (b) 8
and (c) of subsection 1 are met. 9
6. If an employee’s claim is reopened pursuant to this section, 10
the employee is not entitled to vocational rehabilitation services or 11
benefits for a temporary total disability if, before the claim was 12
reopened, the employee: 13
(a) Retired; or 14
(b) Otherwise voluntarily removed himself or herself from the 15
workforce, 16
for reasons unrelated to the injury for which the claim was 17
originally made. 18
7. One year after the date on which the claim was closed, an 19
insurer may dispose of the file of a claim authorized to be reopened 20
pursuant to subsection 5, unless an application to reopen the claim 21
has been filed pursuant to that subsection. 22
8. An increase or rearrangement of compensation is not 23
effective before an application for reopening a claim is made unless 24
good cause is shown. The insurer shall, upon good cause shown, 25
allow the cost of emergency treatment the necessity for which has 26
been certified by a physician or a chiropractic physician. 27
9. A claim that closes pursuant to subsection 2 of NRS 28
616C.235 and is not appealed or is unsuccessfully appealed pursuant 29
to the provisions of NRS [616C.305 and] 616C.315 to 616C.385, 30
inclusive, may not be reopened pursuant to this section. 31
10. The provisions of this section apply to any claim for which 32
an application to reopen the claim or to increase or rearrange 33
compensation is made pursuant to this section, regardless of the date 34
of the injury or accident to the claimant. If a claim is reopened 35
pursuant to this section, the amount of any compensation or benefits 36
provided must be determined in accordance with the provisions of 37
NRS 616C.425. 38
11. As used in this section: 39
(a) “Governmental program” means any program or plan under 40
which a person receives payments from a public form of retirement. 41
Such payments from a public form of retirement include, without 42
limitation: 43
(1) Social security received as a result of the Social Security 44
Act, as defined in NRS 287.120; 45
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(2) Payments from the Public Employees’ Retirement 1
System, as established by NRS 286.110; 2
(3) Payments from the Retirees’ Fund, as defined in 3
NRS 287.04064; 4
(4) A disability retirement allowance, as defined in NRS 5
1A.040 and 286.031; 6
(5) A retirement allowance, as defined in NRS 218C.080; 7
and 8
(6) A service retirement allowance, as defined in NRS 9
1A.080 and 286.080. 10
(b) “Retired” means a person who, on the date he or she filed for 11
reopening a claim pursuant to this section: 12
(1) Is not employed or earning wages; and 13
(2) Receives benefits or payments for retirement from a: 14
(I) Pension or retirement plan; 15
(II) Governmental program; or 16
(III) Plan authorized by 26 U.S.C. § 401(a), 401(k), 17
403(b), 457 or 3121. 18
(c) “Wages” means any remuneration paid by an employer to an 19
employee for the personal services of the employee, including, 20
without limitation: 21
(1) Commissions and bonuses; and 22
(2) Remuneration payable in any medium other than cash. 23
Sec. 27. NRS 616C.500 is hereby amended to read as follows: 24
616C.500 1. Except as otherwise provided in subsection 2 25
and NRS 616C.175, every employee in the employ of an employer, 26
within the provisions of chapters 616A to 616D, inclusive, of NRS, 27
who is injured by accident arising out of and in the course of 28
employment, is entitled to receive for a temporary partial disability 29
the difference between the wage earned after the injury and the 30
compensation which the injured person would be entitled to receive 31
if temporarily totally disabled when the wage is less than the 32
compensation, but for a period not to exceed 24 months during the 33
period of disability. 34
2. Except as otherwise provided in NRS 616B.028 and 35
616B.029, an injured employee or his or her dependents are not 36
entitled to accrue or be paid any benefits for a temporary partial 37
disability during the time the employee is incarcerated. The injured 38
employee or his or her dependents are entitled to receive such 39
benefits if the injured employee is released from incarceration 40
during the period of disability specified in subsection 1 and the 41
injured employee is certified as temporarily partially disabled by a 42
physician or chiropractic physician. 43
3. If a claim for the period of temporary partial disability is 44
allowed, the first payment pursuant to this section must be issued 45
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by the insurer within 14 working days after receipt of the initial 1
certification of disability and regularly thereafter. 2
Sec. 28. NRS 616D.050 is hereby amended to read as follows: 3
616D.050 1. Appeals officers, the Administrator, and the 4
Administrator’s designee, in conducting hearings or other 5
proceedings pursuant to the provisions of chapters 616A to 616D, 6
inclusive, or chapter 617 of NRS or regulations adopted pursuant to 7
those chapters may: 8
(a) Issue subpoenas requiring the attendance of any witness or 9
the production of books, accounts, papers, records and documents. 10
(b) Administer oaths. 11
(c) Certify to official acts. 12
(d) Call and examine under oath any witness or party to a claim. 13
(e) Maintain order. 14
(f) Rule upon all questions arising during the course of a hearing 15
or proceeding. 16
(g) [Permit] Except as otherwise provided in subsections 3 and 17
4, permit discovery by deposition or interrogatories. 18
(h) Initiate and hold conferences for the settlement or 19
simplification of issues. 20
(i) Dispose of procedural requests or similar matters. 21
(j) Generally regulate and guide the course of a pending hearing 22
or proceeding. 23
2. Hearing officers, in conducting hearings or other 24
proceedings pursuant to the provisions of chapters 616A to 616D, 25
inclusive, or chapter 617 of NRS or regulations adopted pursuant to 26
those chapters, may: 27
(a) Issue subpoenas requiring the attendance of any witness or 28
the production of books, accounts, papers, records and documents 29
that are relevant to the dispute for which the hearing or other 30
proceeding is being held. 31
(b) Maintain order. 32
(c) [Permit discovery by deposition or interrogatories. 33
(d)] Initiate and hold conferences for the settlement or 34
simplification of issues. 35
[(e)] (d) Dispose of procedural requests or similar matters. 36
[(f)] (e) Generally regulate and guide the course of a pending 37
hearing or proceeding. 38
3. Appeals officers, upon motion and for good cause shown, 39
in conducting hearings pursuant to the provisions of chapters 40
616A to 616D, inclusive, or chapter 617 of NRS or regulations 41
adopted pursuant to those chapters, may grant discovery to any 42
party by any methods available under the Nevada Rules of Civil 43
Procedure. An appeals officer shall not deny an injured 44
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employee’s reasonable request to conduct discovery. The scope of 1
discovery must be: 2
(a) Expressly limited to that which is necessary to the 3
adjudication of the claim for compensation; and 4
(b) Otherwise governed by the standards for relevance and 5
proportionality set forth in Rule 26(b) of the Nevada Rules of Civil 6
Procedure. 7
4. A party seeking to conduct discovery pursuant to 8
subsection 3 shall not serve a request for discovery on another 9
party without the approval of the appeals officer. The party 10
seeking discovery must file a motion for approval which includes, 11
without limitation, a copy of the discovery request to be served, an 12
identification of any witnesses sought to be deposed and a 13
summary of the anticipated testimony of each such witness. Any 14
party opposed to the motion to approve discovery may file an 15
opposition within 5 days after the date of service of the motion. 16
The moving party is not entitled to reply to any opposition. 17
Sec. 29. NRS 616D.090 is hereby amended to read as follows: 18
616D.090 1. In an investigation, the Administrator or a 19
hearing officer may cause depositions of witnesses residing within 20
or without the State to be taken in the manner prescribed by law and 21
Nevada Rules of Civil Procedure for taking depositions in civil 22
actions in courts of record. 23
2. [After] Except as otherwise provided in NRS 616D.050, 24
after the initiation of a claim under the provisions of this chapter or 25
chapter 616A, 616B, 616C or 617 of NRS, in which a claimant or 26
other party is entitled to a hearing on the merits, any party to the 27
proceeding may, in the manner prescribed by law and the Nevada 28
Rules of Civil Procedure for taking written interrogatories and 29
depositions in civil actions in courts of record: 30
(a) Serve upon any other party written interrogatories to be 31
answered by the party served; or 32
(b) Take the testimony of any person, including a party, by 33
deposition upon oral examination. 34
Sec. 30. NRS 616D.120 is hereby amended to read as follows: 35
616D.120 1. Except as otherwise provided in this section, if 36
the Administrator determines that an insurer, organization for 37
managed care, health care provider, third-party administrator, 38
employer or professional employer organization has: 39
(a) Induced a claimant to fail to report an accidental injury or 40
occupational disease; 41
(b) Without justification, persuaded a claimant to: 42
(1) Settle for an amount which is less than reasonable; 43
(2) Settle for an amount which is less than reasonable while a 44
hearing or an appeal is pending; or 45
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(3) Accept less than the compensation found to be due the 1
claimant by a hearing officer, appeals officer, court of competent 2
jurisdiction, written settlement agreement, written stipulation or the 3
Division when carrying out its duties pursuant to chapters 616A to 4
617, inclusive, of NRS; 5
(c) Refused to pay or unreasonably delayed payment to a 6
claimant of compensation or other relief found to be due the 7
claimant by a hearing officer, appeals officer, court of competent 8
jurisdiction, written settlement agreement, written stipulation or the 9
Division when carrying out its duties pursuant to chapters 616A to 10
616D, inclusive, or chapter 617 of NRS, if the refusal or delay 11
occurs: 12
(1) Later than 10 days after the date of the settlement 13
agreement or stipulation; 14
(2) Later than 30 days after the date of the decision of a 15
court, hearing officer, appeals officer or the Division, unless a stay 16
has been granted; or 17
(3) Later than 10 days after a stay of the decision of a court, 18
hearing officer, appeals officer or the Division has been lifted; 19
(d) Refused to process a claim for compensation pursuant to 20
chapters 616A to 616D, inclusive, or chapter 617 of NRS; 21
(e) Made it necessary for a claimant to initiate proceedings 22
pursuant to chapters 616A to 616D, inclusive, or chapter 617 of 23
NRS for compensation or other relief found to be due the claimant 24
by a hearing officer, appeals officer, court of competent jurisdiction, 25
written settlement agreement, written stipulation or the Division 26
when carrying out its duties pursuant to chapters 616A to 616D, 27
inclusive, or chapter 617 of NRS; 28
(f) Failed to comply with the Division’s regulations covering the 29
payment of an assessment relating to the funding of costs of 30
administration of chapters 616A to 617, inclusive, of NRS; 31
(g) Failed to provide or unreasonably delayed payment to an 32
injured employee or reimbursement to an insurer pursuant to 33
NRS 616C.165; 34
(h) Engaged in a pattern of untimely payments to injured 35
employees; [or] 36
(i) Intentionally failed to comply with any provision of, or 37
regulation adopted pursuant to, this chapter or chapter 616A, 616B, 38
616C or 617 of NRS [,] ; or 39
(j) Concealed, falsified or failed to provide any evidence or 40
other document which is required to be filed before a hearing 41
conducted pursuant to NRS 616C.330 or 616C.360 if such 42
concealed, falsified or absent evidence would have been useful to 43
an injured employee in seeking benefits or compensation pursuant 44
to this chapter or chapter 616A, 616B, 616C or 617 of NRS, 45
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the Administrator shall impose an administrative fine of $1,500 1
for each initial violation, or a fine of $15,000 for a second or 2
subsequent violation. 3
2. Except as otherwise provided in chapters 616A to 616D, 4
inclusive, or chapter 617 of NRS, if the Administrator determines 5
that an insurer, organization for managed care, health care provider, 6
third-party administrator, employer or professional employer 7
organization has failed to comply with any provision of this chapter 8
or chapter 616A, 616B, 616C or 617 of NRS, or any regulation 9
adopted pursuant thereto, the Administrator may take any of the 10
following actions: 11
(a) Issue a notice of correction for: 12
(1) A minor violation, as defined by regulations adopted by 13
the Division; or 14
(2) A violation involving the payment of compensation in an 15
amount which is greater than that required by any provision of this 16
chapter or chapter 616A, 616B, 616C or 617 of NRS, or any 17
regulation adopted pursuant thereto. 18
The notice of correction must set forth with particularity the 19
violation committed and the manner in which the violation may be 20
corrected. The provisions of this section do not authorize the 21
Administrator to modify or negate in any manner a determination or 22
any portion of a determination made by a hearing officer, appeals 23
officer or court of competent jurisdiction or a provision contained in 24
a written settlement agreement or written stipulation. 25
(b) Impose an administrative fine for: 26
(1) A second or subsequent violation for which a notice of 27
correction has been issued pursuant to paragraph (a); or 28
(2) Any other violation of this chapter or chapter 616A, 29
616B, 616C or 617 of NRS, or any regulation adopted pursuant 30
thereto, for which a notice of correction may not be issued pursuant 31
to paragraph (a). 32
The fine imposed must not be greater than $375 for an initial 33
violation, or more than $3,000 for any second or subsequent 34
violation. 35
(c) Order a plan of corrective action to be submitted to the 36
Administrator within 30 days after the date of the order. 37
3. If the Administrator determines that a violation of any of the 38
provisions of paragraphs (a) to (e), inclusive, [(h)] or [(i)] (g) to (j), 39
inclusive, of subsection 1 has occurred, the Administrator shall 40
order the insurer, organization for managed care, health care 41
provider, third-party administrator, employer or professional 42
employer organization to pay to the claimant a benefit penalty: 43
(a) Except as otherwise provided in paragraph (b), in an amount 44
that is not less than $17,000 and not greater than $120,000; or 45
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(b) Of $3,000 if the violation involves a late payment of 1
compensation or other relief to a claimant in an amount which is 2
less than $500 or which is not more than 14 days late. 3
4. To determine the amount of the benefit penalty, the 4
Administrator shall consider the degree of physical harm suffered by 5
the injured employee or the dependents of the injured employee as a 6
result of the violation of paragraph (a), (b), (c), (d), (e), (g), (h) , [or] 7
(i) or (j) of subsection 1, the amount of compensation found to be 8
due the claimant and the number of fines and benefit penalties, other 9
than a benefit penalty described in paragraph (b) of subsection 3, 10
previously imposed against the insurer, organization for managed 11
care, health care provider, third-party administrator, employer or 12
professional employer organization pursuant to this section. The 13
Administrator shall also consider the degree of economic harm 14
suffered by the injured employee or the dependents of the injured 15
employee as a result of the violation of paragraph (a), (b), (c), (d), 16
(e), (g), (h) , [or] (i) or (j) of subsection 1. Except as otherwise 17
provided in this section, the benefit penalty is for the benefit of the 18
claimant and must be paid directly to the claimant within 15 days 19
after the date of the Administrator’s determination. If the claimant is 20
the injured employee and the claimant dies before the benefit 21
penalty is paid to him or her, the benefit penalty must be paid to the 22
estate of the claimant. Proof of the payment of the benefit penalty 23
must be submitted to the Administrator within 15 days after the date 24
of the Administrator’s determination unless an appeal is filed 25
pursuant to NRS 616D.140 and a stay has been granted. Any 26
compensation to which the claimant may otherwise be entitled 27
pursuant to chapters 616A to 616D, inclusive, or chapter 617 of 28
NRS must not be reduced by the amount of any benefit penalty 29
received pursuant to this subsection. To determine the amount of the 30
benefit penalty in cases of multiple violations occurring within a 31
certain period of time, the Administrator shall adopt regulations 32
which take into consideration: 33
(a) The number of violations within a certain number of years 34
for which a benefit penalty was imposed; and 35
(b) The number of claims handled by the insurer, organization 36
for managed care, health care provider, third-party administrator, 37
employer or professional employer organization in relation to the 38
number of benefit penalties previously imposed within the period of 39
time prescribed pursuant to paragraph (a). 40
5. In addition to any fine or benefit penalty imposed pursuant 41
to this section, the Administrator may assess against an insurer who 42
violates any regulation concerning the reporting of claims 43
expenditures or premiums received that are used to calculate an 44
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assessment an administrative penalty of up to twice the amount of 1
any underpaid assessment. 2
6. If: 3
(a) The Administrator determines that a person has violated any 4
of the provisions of NRS 616D.200, 616D.220, 616D.240, 5
616D.300, 616D.310 or 616D.350 to 616D.440, inclusive; and 6
(b) The Fraud Control Unit for Industrial Insurance of the Office 7
of the Attorney General established pursuant to NRS 228.420 8
notifies the Administrator that the Unit will not prosecute the person 9
for that violation, 10
the Administrator shall impose an administrative fine of not more 11
than $15,000. 12
7. Two or more fines of $1,000 or more imposed in 1 year for 13
acts enumerated in subsection 1 must be considered by the 14
Commissioner as evidence for the withdrawal of: 15
(a) A certificate to act as a self-insured employer. 16
(b) A certificate to act as an association of self-insured public or 17
private employers. 18
(c) A certificate of registration as a third-party administrator. 19
8. The Commissioner may, without complying with the 20
provisions of NRS 616B.327 or 616B.431, withdraw the 21
certification of a self-insured employer, association of self-insured 22
public or private employers or third-party administrator if, after a 23
hearing, it is shown that the self-insured employer, association of 24
self-insured public or private employers or third-party administrator 25
violated any provision of subsection 1. 26
9. If the Administrator determines that a vocational 27
rehabilitation counselor has violated the provisions of NRS 28
616C.543, the Administrator may impose an administrative fine on 29
the vocational rehabilitation counselor of not more than $250 for a 30
first violation, $500 for a second violation and $1,000 for a third or 31
subsequent violation. 32
10. The Administrator may make a claim against the bond 33
required pursuant to NRS 683A.0857 for the payment of any 34
administrative fine or benefit penalty imposed for a violation of the 35
provisions of this section. 36
Sec. 31. NRS 617.401 is hereby amended to read as follows: 37
617.401 1. The Division shall designate one: 38
(a) Third-party administrator who has a valid certificate issued 39
by the Commissioner pursuant to NRS 683A.085; or 40
(b) Insurer, other than a self-insured employer or association of 41
self-insured public or private employers, 42
to administer claims against the Uninsured Employers’ Claim 43
Account. The designation must be made pursuant to reasonable 44
competitive bidding procedures established by the Administrator. 45
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2. Except as otherwise provided in this subsection, an 1
employee may receive compensation from the Uninsured 2
Employers’ Claim Account if: 3
(a) The employee was hired in this State or is regularly 4
employed in this State; 5
(b) The employee contracts an occupational disease that arose 6
out of and in the course of employment: 7
(1) In this State; or 8
(2) While on temporary assignment outside the State for not 9
more than 12 months; 10
(c) The employee files a claim for compensation with the 11
Division; and 12
(d) The employee makes an irrevocable assignment to the 13
Division of a right to be subrogated to the rights of the employee 14
pursuant to NRS 616C.215. 15
An employee who contracts an occupational disease that arose 16
out of and in the course of employment while on temporary 17
assignment outside the State is not entitled to receive compensation 18
from the Uninsured Employers’ Claim Account unless the employee 19
has been denied workers’ compensation in the state in which the 20
disease was contracted. 21
3. If the Division receives a claim pursuant to subsection 2, the 22
Division shall immediately notify the employer of the claim. 23
4. For the purposes of this section and NRS 617.4015, the 24
employer has the burden of proving that the employer provided 25
mandatory coverage for occupational diseases for the employee or 26
that the employer was not required to maintain industrial insurance 27
for the employee. 28
5. Any employer who has failed to provide mandatory 29
coverage required by the provisions of this chapter is liable for all 30
payments made on behalf of the employer, including, but not limited 31
to, any benefits, administrative costs or attorney’s fees paid from the 32
Uninsured Employers’ Claim Account or incurred by the Division. 33
6. The Division: 34
(a) May recover from the employer the payments made by the 35
Division that are described in subsection 5 and any accrued interest 36
by bringing a civil action or filing an application for the entry of 37
summary judgment pursuant to NRS 617.4015 in a court of 38
competent jurisdiction. For the purposes of this paragraph, the 39
payments made by the Division that are described in subsection 5 40
are presumed to be: 41
(1) Justified by the circumstances of the claim; 42
(2) Made in accordance with applicable law; and 43
(3) Reasonable and necessary. 44
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(b) In any civil action or application for the entry of summary 1
judgment filed pursuant to NRS 617.4015 against the employer, is 2
not required to prove that negligent conduct by the employer was 3
the cause of the occupational disease. 4
(c) May enter into a contract with any person to assist in the 5
collection of any liability of an uninsured employer. 6
(d) In lieu of a civil action or filing an application for the entry 7
of summary judgment pursuant to NRS 617.4015, may enter into an 8
agreement or settlement regarding the collection of any liability of 9
an uninsured employer. 10
7. The Division shall: 11
(a) Determine whether the employer was insured within 30 days 12
after receiving the claim from the employee. 13
(b) Assign the claim to the third-party administrator or insurer 14
designated pursuant to subsection 1 for administration and payment 15
of compensation. 16
Upon determining whether the claim is accepted or denied, the 17
designated third-party administrator or insurer shall notify the 18
injured employee, the named employer and the Division of its 19
determination. 20
8. Upon demonstration of the: 21
(a) Costs incurred by the designated third-party administrator or 22
insurer to administer the claim or pay compensation to the injured 23
employee; or 24
(b) Amount that the designated third-party administrator or 25
insurer will pay for administrative expenses or compensation to the 26
injured employee and that such amounts are justified by the 27
circumstances of the claim, 28
the Division shall authorize payment from the Uninsured 29
Employers’ Claim Account. 30
9. Any party aggrieved by a determination made by the 31
Division regarding the assignment of any claim made pursuant to 32
this section may appeal that determination by filing a notice of 33
appeal with an appeals officer within 30 days after the determination 34
is rendered. The provisions of NRS 616C.345 to 616C.385, 35
inclusive, apply to an appeal filed pursuant to this subsection. 36
10. Any party aggrieved by a determination to accept or to 37
deny any claim made pursuant to this section or by a determination 38
to pay or to deny the payment of compensation regarding any claim 39
made pursuant to this section may appeal that determination, within 40
70 days after the determination is rendered, to the Hearings Division 41
of the Department of Administration in the manner provided by 42
NRS [616C.305 and] 616C.315. 43
11. All insurers shall bear a proportionate amount of a claim 44
made pursuant to this chapter, and are entitled to a proportionate 45
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amount of any collection made pursuant to this section as an offset 1
against future liabilities. 2
12. An uninsured employer is liable for the interest on any 3
amount paid on his or her claims from the Uninsured Employers’ 4
Claim Account. The interest must be calculated at a rate equal to the 5
prime rate at the largest bank in Nevada, as ascertained by the 6
Commissioner of Financial Institutions, on January 1 or July 1, as 7
the case may be, immediately preceding the date of the claim, plus 3 8
percent, compounded monthly, from the date the claim is paid from 9
the Account until payment is received by the Division from the 10
employer. 11
13. Attorney’s fees recoverable by the Division pursuant to this 12
section must be: 13
(a) If a private attorney is retained by the Division, paid at the 14
usual and customary rate for that attorney. 15
(b) If the attorney is an employee of the Division, paid at the 16
rate established by regulations adopted by the Division. 17
Any money collected must be deposited to the Uninsured 18
Employers’ Claim Account. 19
14. If the Division has not obtained a civil judgment or an 20
entry of summary judgment pursuant to NRS 617.4015 and the 21
Division assigns a debt that arises under this section to the State 22
Controller for collection pursuant to NRS 353C.195, the State 23
Controller may bring an action in his or her own name in a court of 24
competent jurisdiction to recover any amount that the Division is 25
authorized to recover pursuant to this section. 26
Sec. 32. NRS 617.405 is hereby amended to read as follows: 27
617.405 1. No judicial proceedings may be instituted for 28
benefits for an occupational disease under this chapter, unless: 29
(a) A claim is filed within the time limits prescribed in NRS 30
617.344; and 31
(b) A final decision by an appeals officer has been rendered on 32
the claim. 33
2. Judicial proceedings instituted for benefits for an 34
occupational disease under this chapter are limited to judicial review 35
of that decision. 36
3. Notwithstanding any other provision of law: 37
(a) The following requirements, and no others, are mandatory 38
and jurisdictional for a petition for judicial review of the final 39
decision of an appeals officer: 40
(1) The petition must be filed within 30 days after the date 41
of entry and service of the decision and order of the appeals 42
officer; and 43
(2) A copy of the decision and order of the appeals officer 44
must be attached to the petition. 45
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(b) Other than the requirements of paragraph (a), a court may 1
excuse any other defect in substance, form, venue or service of a 2
petition for judicial review, and may permit any appropriate 3
amendment or change of venue at any time before the final 4
disposition of the petition. 5
4. The prevailing party in any judicial proceedings instituted 6
for benefits for an occupational disease shall cause a copy of the 7
final decision issued by the court in the proceedings to be: 8
(a) Served upon the appeals officer whose final decision was 9
appealed. The appeals officer shall include the copy of the final 10
decision in the administrative record on the matter. 11
(b) For a prevailing party in the Court of Appeals or Supreme 12
Court, filed in the district court whose final decision was appealed. 13
Sec. 33. The amendatory provisions of this act apply to any 14
claim pursuant to chapters 616A to 616D, inclusive, or 617 of NRS, 15
which is open, filed or reopened on or after the effective date of this 16
act. 17
Sec. 34. NRS 616C.305 and 617.459 are hereby repealed. 18
Sec. 35. This act becomes effective upon passage and 19
approval. 20
TEXT OF REPEALED SECTION S
616C.305 Procedure for appeal of final determination of
organization for managed care which has contracted with
insurer.
1. Except as otherwise provided in subsection 3, any person
who is aggrieved by a final determination concerning accident
benefits made by an organization for managed care which has
contracted with an insurer must, within 14 days of the determination
and before requesting a resolution of the dispute pursuant to NRS
616C.345 to 616C.385, inclusive, appeal that determination in
accordance with the procedure for resolving complaints established
by the organization for managed care.
2. The procedure for resolving complaints established by the
organization for managed care must be informal and must include,
but is not limited to, a review of the appeal by a qualified physician
or chiropractic physician who did not make or otherwise participate
in making the determination.
3. If a person appeals a final determination pursuant to a
procedure for resolving complaints established by an organization
for managed care and the dispute is not resolved within 14 days
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after it is submitted, the person may request a resolution of the
dispute pursuant to NRS 616C.345 to 616C.385, inclusive.
617.459 Determination of percentage of disability resulting
from heart or lung diseases.
1. The percentage of disability resulting from an occupational
disease of the heart or lungs must be determined jointly by the
claimant’s attending physician and the examining physician
designated by the insurer, in accordance with the American Medical
Association’s Guides to the Evaluation of Permanent Impairment as
adopted and supplemented by the Division pursuant to
NRS 616C.110.
2. If the claimant’s attending physician and the designated
examining physician do not agree upon the percentage of disability,
they shall designate a physician specializing in the branch of
medicine which pertains to the disease in question to make the
determination. If they do not agree upon the designation of such a
physician, each shall choose one physician so specializing, and two
physicians so chosen shall choose a third specialist in that branch.
The resulting panel of three physicians shall, by majority vote,
determine the percentage of disability in accordance with the
American Medical Association’s Guides to the Evaluation of
Permanent Impairment as adopted and supplemented by the
Division pursuant to NRS 616C.110.
H