[Rev. 2/11/2015 11:35:11
AM--2014R2]
CHAPTER 616C - INDUSTRIAL INSURANCE:
BENEFITS FOR INJURIES OR DEATH
REPORTS OF INJURIES AND CLAIMS FOR COMPENSATION
NRS 616C.005 Forms
for reporting injuries: Insurer to distribute revised forms to employers
periodically; Administrator to make revised forms available to physicians and
chiropractors.
NRS 616C.010 Employee
to report accident and injury to employer; examination of employee; employee
leasing company to provide to leased employees instructions regarding reporting
of injuries.
NRS 616C.015 Notice
of injury or death: Requirements; availability of form; retention; notice by
leased employee.
NRS 616C.020 Claim
for compensation: Requirements for injured employee, dependent or
representative to file claim; form.
NRS 616C.025 Recovery
of compensation barred if notice of injury or claim for compensation is not
filed; exceptions.
NRS 616C.030 Dependent
of injured employee barred from filing claim for compensation if untimely or
previously denied.
NRS 616C.035 Application
for death benefit.
NRS 616C.040 Claim
for compensation: Duty of treating physician or chiropractor to file or
delegate duty to medical facility; electronic filing; form and contents;
maintenance of forms; penalty.
NRS 616C.045 Report
of industrial injury or occupational disease: Duty of employer to file;
electronic filing; form and contents; penalty.
NRS 616C.050 Information
required to be provided by insurer to claimant.
NRS 616C.052 Exposure
of police officer, firefighter or arson investigator to contagious disease:
Reporting and testing requirements; eligibility for compensation.
NRS 616C.055 Use
of fee schedules which unfairly discriminate among physicians and chiropractors
prohibited; payment for services rendered by physician or chiropractor after
removal from panel prohibited.
NRS 616C.065 Duty
of insurer to accept or deny claim; new determination; penalty; failure of
insurer to indicate acceptance or denial of claim; written determination.
NRS 616C.070 Persons
who are conclusively presumed to be totally dependent on injured or deceased
employee; exception.
NRS 616C.075 Effect
of employee’s refusal to submit to physical examination after accident.
TREATMENT AND RATING OF INJURED EMPLOYEES
NRS 616C.085 Duties
of employer when employee injured: First aid; reimbursement.
NRS 616C.090 Selection
of physician or chiropractor: Powers and duties of Administrator; selection and
alternate selection from established panel or pursuant to contract;
responsibility for charges.
NRS 616C.095 Duty
of physician or chiropractor to advise injured employee of rights.
NRS 616C.100 Additional
determination of percentage of disability permitted if cost paid by injured
employee; authority of injured employee to seek reimbursement of cost; results
of determination may be offered at hearing or conference.
NRS 616C.105 Requirements
for designation of chiropractor to rate permanent partial disabilities.
NRS 616C.110 American
Medical Association’s Guides to the Evaluation of Permanent Impairment:
Duty of Division to adopt Guides by regulation.
NRS 616C.115 Prescription
of generic drugs required; exceptions.
NRS 616C.120 Employee
may elect treatment through prayer in lieu of medical treatment.
NRS 616C.125 Insurer
may contract with suppliers for provision of services and goods to injured
employees.
NRS 616C.130 Insurer’s
payment to physician or chiropractor attending injured employee conditioned
upon receipt of itemized statement and certificate.
NRS 616C.135 Liability
of insurer for payment of charges for treatment related to industrial injury or
occupational disease; acceptance of payment by provider of health care from
injured employee or health or casualty insurer for treatment that was
erroneously denied.
NRS 616C.136 Action
by insurer on bill from provider of health care; payment of interest; request
for additional information; compliance with requirements.
NRS 616C.137 Denial
of payment for unrelated services: Requirements for notification; liability of
injured employee; appeal.
NRS 616C.138 Payment
of provider of health care upon insurer’s denial of authorization or
responsibility for treatment or other services provided; reimbursement of
injured employee or health or casualty insurer; recovery of excess amount paid
to provider of health care.
NRS 616C.140 Medical
examination of claimant; effect of refusal to submit to examination;
communications not privileged.
DETERMINATION AND PAYMENT OF BENEFITS
NRS 616C.150 Compensation
prohibited unless preponderance of evidence establishes that injury arose out
of and in course of employment; rebuttable presumption if notice of injury is
filed after termination of employment.
NRS 616C.155 Payment
of compensation by insurer prohibited before required; recovery of overpayment
by insurer.
NRS 616C.157 Request
for prior authorization: Time to respond; effect of failure to respond in
timely manner.
NRS 616C.160 Newly
developed injury or disease: Inclusion in original claim for compensation;
limitation.
NRS 616C.165 Determination
of responsibility of insurer for undisputed claim for compensation;
reimbursement of insurer initially providing compensation to injured employee.
NRS 616C.170 Resolution
of disputes between insurers if benefits are claimed against more than one
insurer; adoption of regulations by Administrator; appeal of decision of
Administrator; payment of benefits until determination of responsibility by
Administrator.
NRS 616C.175 Employment-related
aggravation of preexisting condition which is not employment related;
aggravation of employment-related injury by incident which is not employment
related.
NRS 616C.177 Medical
records concerning preexisting condition: Authority of insurer to request
records; injured employee required to release records under certain
circumstances.
NRS 616C.180 Injury
or disease caused by stress.
NRS 616C.185 Compensation
for mastectomy and reconstructive surgery.
NRS 616C.190 Compensation
of employee injured out of State.
NRS 616C.195 Acceptance
of compensation or benefits by employee injured out of State constitutes
release of employer and waiver of remedy at common law or statutory remedy
provided in another state.
NRS 616C.200 Commencement
of action in another state to recover damages or compensation by employee
injured out of State constitutes irrevocable waiver of compensation due under
Nevada law; satisfaction of foreign judgment against Nevada employer.
NRS 616C.205 Compensation
not assignable; exempt from attachment, garnishment and execution; accrued
compensation payable to dependents.
NRS 616C.210 Compensation
of nonresident alien dependents; notification of dependent required.
NRS 616C.215 Actions
and proceedings to recover damages in tort or from proceeds of vehicle
insurance: Reduction of compensation by amount of recovery; rights of injured
employee or dependents and of insurer or Administrator; notification and
payment of insurer or Administrator; instructions to jury; calculation of
employer’s premium.
NRS 616C.220 Compensation
from Uninsured Employers’ Claim Account: Administration and payment of claims;
eligibility of employee; liability of employer; powers and duties of Division;
appeals; collection.
NRS 616C.223 Application
for entry of summary judgment: Conditions; notice to employer; filing
requirements; entry of judgment; service of judgment; recordation of judgment;
lien upon property of employer; extension of lien.
NRS 616C.225 Misrepresentation
or concealment of fact to obtain benefits: Insurer entitled to reimbursement or
deduction from benefits; appeal of determination; alternative remedies.
NRS 616C.230 Grounds
for denial, reduction or suspension of compensation; evidence of and
examination for use of alcohol or controlled substance.
NRS 616C.232 Denial
of compensation for temporary total disability because of discharge for
misconduct.
NRS 616C.235 Closure
of claim by insurer: Procedure; notice; special procedure if medical benefits
less than $300.
ACCIDENT BENEFITS
NRS 616C.245 Injured
employee entitled to accident benefits; limitation on receipt of modified motor
vehicle as accident benefit; regulations establishing maximum benefit.
NRS 616C.250 Establishment,
revision and compliance with standards of care for provision of accident
benefits.
NRS 616C.255 Premium
for accident benefits paid by employer; accident benefits provided by private
carrier; separate account for accident benefits.
NRS 616C.260 Fees
and charges for accident benefits: Restrictions; establishment and revision of
schedule; powers and duties of Administrator; penalty for refusal to provide
information; regulations.
NRS 616C.265 Election
by employer to provide accident benefits; reporting requirements; payment of
assessments.
NRS 616C.270 Employers
to notify Administrator when injured employee receives medical services.
NRS 616C.275 Change
of physicians, chiropractors or other requirements; cost of change borne by
insurer; cause of action of injured employee assigned to private carrier.
NRS 616C.280 Withdrawal
of approval for employer to provide accident benefits: Grounds supporting
withdrawal.
NRS 616C.285 Withdrawal
of approval for employer to provide accident benefits: Request for hearing;
notice of decision.
CONTESTED CLAIMS
NRS 616C.295 Duties
of Chief of Hearings Division: Adoption of regulations establishing codes of
conduct for hearing officers and appeals officers, standards for initial
training and continuing education and qualifications for hearing officers;
expediting of certain cases; annual report.
NRS 616C.300 Hearing
officers: Appointment; salary; disqualification from particular case.
NRS 616C.305 Procedure
for appeal of final determination of organization for managed care which has
contracted with insurer.
NRS 616C.310 Contested
cases: Procedures; format; redaction of personal identifying information;
representation of insurer or employer by legal counsel or other agent.
NRS 616C.315 Request
for hearing; forms for request to be provided by insurer; prerequisites to
scheduling of hearing; expeditious and informal hearing required; direct
submission to appeals officer.
NRS 616C.320 Resolution
of disputed decision of self-insured employer or employer who is member of
association of self-insured public or private employers or insured by private
carrier.
NRS 616C.325 Representation
of employee and employer before hearings officer or appeals officer or in
negotiations with insurer; licensure of employer’s representative; employer
liable for representative’s violations; compensation of employer’s
representative must not be contingent on outcome.
NRS 616C.330 Date,
time and place for hearing; evaluation of injured employee; powers and duties
of hearing officer; issuance of decision; procedure for obtaining stay of
decision.
NRS 616C.335 Award
of interest.
NRS 616C.340 Appointment,
term, qualifications and salary of appeals officers and special appeals
officers; conflicts of interest; finality of decision by appeals officer.
NRS 616C.345 Notice
of appeal; notice of contested claim; prerequisites to scheduling of hearing on
appeal; effect of appeal on enforcement of decision of hearing officer; setting
of date, time and place for hearing on appeal; continuances.
NRS 616C.350 Testimony
of physician or chiropractor before appeals officer; privileged communications.
NRS 616C.355 Use
of affidavits or declarations as evidence at hearing; notice to opposing party;
waiver of right to cross-examine affiant or declarant; effect of waiver.
NRS 616C.360 Record
of hearing before appeals officer; rules of evidence; evaluation of injured
employee; submission to independent review organization; powers and duties of
appeals officer; transcripts; issuance of decision.
NRS 616C.363 External
review: Duties of independent review organization; contents and submission of
decision by organization; costs; regulations.
NRS 616C.365 Reimbursement
of employee’s expenses incurred and wages lost as result of hearing requested
by employer or insurer; regulations.
NRS 616C.370 Judicial
review.
NRS 616C.375 Stay
of decision of appeals officer.
NRS 616C.380 Payment
pending appeal when decision not stayed; effect of final resolution of claim.
NRS 616C.385 Costs
and attorney’s fees for frivolous petitions for judicial review.
NRS 616C.390 Reopening
claim: General requirements and procedure; limitations; applicability.
NRS 616C.392 Reopening
claim: Circumstances under which insurer is required to reopen claim for
permanent partial disability.
COMPENSATION FOR INJURIES AND DEATH
General Provisions
NRS 616C.400 Minimum
duration of incapacity.
NRS 616C.405 Limitations
on benefits received by employee.
NRS 616C.408 Restrictive
endorsements on checks issued by insurers.
NRS 616C.409 Direct
deposit of compensation.
NRS 616C.410 Prohibition
of settlements paid in lump sum; exceptions.
NRS 616C.412 Purchase
of annuity by insurer to ensure payment of claim; adoption of regulations by
Commissioner.
NRS 616C.415 Written
explanation of alternative settlements to be given to employee or dependents.
NRS 616C.420 Method
of determining average monthly wage.
NRS 616C.425 Date
of determination of amount of compensation and benefits.
NRS 616C.427 Challenge
to determination of average monthly wage; remedy for incorrect average monthly
wage.
Permanent Total Disability
NRS 616C.435 Injuries
deemed total and permanent.
NRS 616C.440 Amount
and duration of compensation; limitations; effect of previous award of
compensation.
NRS 616C.445 Recipient
of compensation to report annual earnings; payments suspended if report not
made.
NRS 616C.447 Insurer
required to make certain accountings to injured employee who is entitled to
compensation for permanent total disability; additional accountings may be
requested by injured employee.
NRS 616C.450 Compensation
to injured employee or dependents of injured employee for permanent total
disability or death benefit if injury or occupational disease occurred before
July 1, 1980.
NRS 616C.453 Additional
annual payment to certain claimants and dependents of claimants who are
entitled to receive compensation for permanent total disability; adoption of
regulations to determine amount of payment.
NRS 616C.455 Increase
in benefits for permanent total disability incurred before April 9, 1971.
NRS 616C.460 Additional
increase in benefits for permanent total disability incurred before July 1,
1973.
NRS 616C.465 Increase
in benefits for permanent total disability incurred on or after April 9, 1971,
or for claimant or dependent not entitled to benefits for disability from
federal social security system.
NRS 616C.470 Increase
in benefits for permanent total disability if claimant is entitled to benefits
for disability from federal social security system.
NRS 616C.473 Annual
increase in benefits for permanent total disability incurred on or after
January 1, 2004.
Temporary Total Disability
NRS 616C.475 Amount
and duration of compensation; limitations; requirements for certification of
disability; offer of light-duty employment.
NRS 616C.477 Compensation
for lost wages incurred by employee who receives medical treatment after
returning to work; prohibition against employer requiring employee to use
personal leave for such treatment.
NRS 616C.480 Reduction
of benefits for previous injury causing permanent partial disability
prohibited.
Permanent and Temporary Partial Disabilities
NRS 616C.485 Permanent
partial disability: Loss of or permanent damage to teeth.
NRS 616C.490 Permanent
partial disability: Compensation.
NRS 616C.495 Permanent
partial disability: Payments in lump sum.
NRS 616C.500 Temporary
partial disability: Compensation.
Death Benefits
NRS 616C.505 Amount
and duration of compensation.
NRS 616C.510 Increased
death benefits if injury or disablement occurred before July 1, 1973.
NRS 616C.515 Additional
increase in death benefits if injury or disablement occurred before July 1,
1973.
NRS 616C.520 Increased
death benefits if injury or disablement occurred on or after July 1, 1973.
VOCATIONAL REHABILITATION
NRS 616C.530 Priorities
for returning injured employee to work.
NRS 616C.540 Supervision,
ratio and review of uncertified counselors; knowledge of labor market required.
NRS 616C.542 Prohibiting
vocational rehabilitation counselor employed by entity administering injured
employee’s case from providing services to injured employee without provision
of certain written disclosures; right of injured employee to be assigned
alternate counselor.
NRS 616C.543 Prohibited
acts of vocational rehabilitation counselor.
NRS 616C.545 Duty
of insurer to determine physical limitations on injured employee’s ability to
work.
NRS 616C.547 General
duties of vocational rehabilitation counselor.
NRS 616C.550 Written
assessment of injured employee.
NRS 616C.555 Plan
for program of vocational rehabilitation.
NRS 616C.560 Extension
of program for vocational rehabilitation.
NRS 616C.570 On-the-job
training as component of plan for program of vocational rehabilitation.
NRS 616C.575 Payment
of vocational rehabilitation maintenance.
NRS 616C.580 Provision
of services outside of State; limited lump-sum payment in lieu of services.
NRS 616C.585 Limit
on goods and services which may be provided; exceptions.
NRS 616C.590 Eligibility
for services; effect of incarceration; effect of refusing services offered by
insurer; effect of inability of insurer to locate injured employee.
NRS 616C.595 Agreements
for payment of compensation in lump sum in lieu of provision of vocational
rehabilitation services.
NRS 616C.597 Response
to request for payment of compensation in lump sum in lieu of provision of
vocational rehabilitation services.
NRS 616C.600 Orders
for self-employment or payment of compensation in lump sum for vocational
rehabilitation prohibited; agreements concerning self-employment authorized.
CATASTROPHIC INJURIES
NRS 616C.700 Duties
of insurer who accepts a claim for catastrophic injury; life care plan.
NRS 616C.703 Injured
employee may request insurer to administer claim as for catastrophic injury;
insurer to issue determination.
NRS 616C.707 Insurer
to designate claim as for catastrophic injury if injury later satisfies
requirements for catastrophic injury.
NRS 616C.710 Rescission
or revision of determination of catastrophic injury.
NRS 616C.720 Requirements
for adjuster who administers claim for catastrophic injury.
_________
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REPORTS OF INJURIES AND CLAIMS FOR COMPENSATION
NRS 616C.005 Forms for reporting injuries: Insurer to distribute revised
forms to employers periodically; Administrator to make revised forms available
to physicians and chiropractors. On
or before September 1 of each year:
1. An insurer shall distribute to each
employer that it insures any form for reporting injuries that has been revised
within the previous 12 months.
2. The Administrator shall make available
to physicians and chiropractors any form for reporting injuries that has been
revised within the previous 12 months.
(Added to NRS by 1991, 2395; A 1997, 1434)
NRS 616C.010 Employee to report accident and injury to employer; examination
of employee; employee leasing company to provide to leased employees
instructions regarding reporting of injuries.
1. Whenever any accident occurs to any
employee, the employee shall forthwith report the accident and the injury
resulting therefrom to his or her employer.
2. When an employer learns of an accident,
whether or not it is reported, the employer may direct the employee to submit
to, or the employee may request, an examination by a physician or chiropractor,
in order to ascertain the character and extent of the injury and render medical
attention which is required immediately. The employer shall:
(a) If the employer’s insurer has entered into a
contract with an organization for managed care or with providers of health care
pursuant to NRS 616B.527, furnish the
names, addresses and telephone numbers of:
(1) Two or more physicians or
chiropractors who are qualified to conduct the examination and who are
available pursuant to the terms of the contract, if there are two or more such
physicians or chiropractors within 30 miles of the employee’s place of
employment; or
(2) One or more physicians or chiropractors
who are qualified to conduct the examination and who are available pursuant to
the terms of the contract, if there are not two or more such physicians or
chiropractors within 30 miles of the employee’s place of employment.
(b) If the employer’s insurer has not entered
into a contract with an organization for managed care or with providers of
health care pursuant to NRS 616B.527,
furnish the names, addresses and telephone numbers of:
(1) Two or more physicians or
chiropractors who are qualified to conduct the examination, if there are two or
more such physicians or chiropractors within 30 miles of the employee’s place
of employment; or
(2) One or more physicians or
chiropractors who are qualified to conduct the examination, if there are not
two or more such physicians or chiropractors within 30 miles of the employee’s
place of employment.
3. From among the names furnished by the
employer pursuant to subsection 2, the employee shall select one of those
physicians or chiropractors to conduct the examination, but the employer shall not
require the employee to select a particular physician or chiropractor from
among the names furnished by the employer. Thereupon, the examining physician
or chiropractor shall report forthwith to the employer and to the insurer the
character and extent of the injury. The employer shall not require the employee
to disclose or permit the disclosure of any other information concerning the
employee’s physical condition except as required by NRS
616C.177.
4. Further medical attention, except as
otherwise provided in NRS 616C.265, must be
authorized by the insurer.
5. This section does not prohibit an
employer from requiring the employee to submit to an examination by a physician
or chiropractor specified by the employer at any convenient time after medical
attention which is required immediately has been completed.
6. An employee leasing company must
provide to each employee covered under an employee leasing contract
instructions on how to notify the leasing company supervisor and client company
of an injury in plain, clear language placed in conspicuous type in a
specifically labeled area of instructions given to the employee.
[Part 52:168:1947; 1943 NCL § 2680.52]—(NRS A 1981, 1167, 1471; 1983, 478; 1985, 1543; 2007, 3344; 2009, 1130)
NRS 616C.015 Notice of injury or death: Requirements; availability of form;
retention; notice by leased employee.
1. An employee or, in the event of the
employee’s death, one of the dependents of the employee, shall provide written
notice of an injury that arose out of and in the course of employment to the
employer of the employee as soon as practicable, but within 7 days after the
accident.
2. The notice required by subsection 1
must:
(a) Be on a form prescribed by the Administrator.
The form must allow the injured employee or the dependent of the employee to
describe briefly the accident that caused the injury or death.
(b) Be signed by the injured employee or by a
person on behalf of the employee, or in the event of the employee’s death, by
one of the dependents of the employee or by a person acting on behalf of the
dependent.
(c) Include an explanation of the procedure for
filing a claim for compensation.
(d) Be prepared in duplicate so that the injured
employee or the dependent of the employee and the employer can retain a copy of
the notice.
3. Upon receipt of the notice required by
subsection 1, the employer, the injured employee’s supervisor or the agent of
the employer who was in charge of the type of work or the area where the accident
occurred shall sign the notice. The signature of the employer, the supervisor
or the employer’s agent is an acknowledgment of the receipt of the notice and
shall not be deemed to be a waiver of any of the employer’s defenses or rights.
4. An employer shall maintain a sufficient
supply of the forms required to file the notice required by subsection 1 for
use by his or her employees.
5. An employer shall retain any notice
provided pursuant to subsection 1 for 3 years after the date of the accident. An
employer insured by a private carrier shall not file a notice of injury with
the private carrier.
6. The claim of a leased employee is not
barred if the leased employee gives notice to his or her client company
supervisor, rather than to his or her leasing company supervisor. Notification
of an injury by a leased employee to his or her client company supervisor shall
be deemed sufficient notice of injury to the employer.
[55:168:1947; 1943 NCL § 2680.55]—(NRS A 1969, 95;
1973, 604; 1979,
1052, 1053;
1981, 1487;
1989, 332; 1991, 2415, 2416; 1993, 731; 1995, 2031, 2146; 1997, 585; 1999, 1775; 2009, 1131)
NRS 616C.020 Claim for compensation: Requirements for injured employee,
dependent or representative to file claim; form.
1. Except as otherwise provided in
subsection 2, an injured employee, or a person acting on behalf of the
employee, shall file a claim for compensation with the insurer within 90 days
after an accident if:
(a) The employee has sought medical treatment for
an injury arising out of and in the course of his or her employment; or
(b) The employee was off work as a result of an
injury arising out of and in the course of his or her employment.
2. In the event of the death of the
injured employee resulting from the injury, a dependent of the employee, or a
person acting on behalf of the employee, shall file a claim for compensation
with the insurer within 1 year after the death of the injured employee.
3. The claim for compensation must be
filed on a form prescribed by the Administrator.
(Added to NRS by 1993, 661)—(Substituted
in revision for NRS 616.501)
NRS 616C.025 Recovery of compensation barred if notice of injury or claim for
compensation is not filed; exceptions.
1. Except as otherwise provided in
subsection 2, an employee or, in the event of the death of the employee, a
dependent of the employee, is barred from recovering compensation pursuant to
the provisions of chapters 616A to 616D, inclusive, of NRS if the employee or
dependent, as applicable, fails to file a notice of injury pursuant to NRS 616C.015 or a claim for compensation pursuant to NRS 616C.020.
2. An insurer may excuse the failure to
file a notice of injury or a claim for compensation pursuant to the provisions
of this section if:
(a) The injury to the employee or another cause
beyond the control of the employee prevented the employee from providing the
notice or claim;
(b) The failure was caused by the employee’s or
dependent’s mistake or ignorance of fact or of law;
(c) The failure was caused by the physical or
mental inability of the employee or the dependent; or
(d) The failure was caused by fraud,
misrepresentation or deceit.
(Added to NRS by 1993, 661)—(Substituted
in revision for NRS 616.5011)
NRS 616C.030 Dependent of injured employee barred from filing claim for
compensation if untimely or previously denied. A
dependent of an injured employee may not file a claim for compensation for an
industrial injury pursuant to the provisions of chapters
616A to 616D, inclusive, of NRS if:
1. The time for filing the claim has
expired pursuant to NRS 616C.020 and the failure
to file the claim is not excused pursuant to NRS
616C.025; or
2. The injured employee or another
dependent filed a claim for compensation for that industrial injury, the claim
was denied and, upon final resolution of the claim, it was denied.
(Added to NRS by 1993, 663)—(Substituted
in revision for NRS 616.50115)
NRS 616C.035 Application for death benefit. Where
death results from injury, the parties entitled to compensation under chapters 616A to 616D, inclusive, of NRS, or someone in their
behalf, must make application for compensation to the insurer. The application
must be accompanied by:
1. Proof of death;
2. Proof of relationship showing the
parties to be entitled to compensation under chapters
616A to 616D, inclusive, of NRS;
3. Certificates of the attending
physician, if any; and
4. Such other proof as required by the
regulations of the Division.
[54:168:1947; 1943 NCL § 2680.54]—(NRS A 1979, 1053; 1981, 1488; 1993, 1869)—(Substituted
in revision for NRS 616.505)
NRS 616C.040 Claim for compensation: Duty of treating physician or
chiropractor to file or delegate duty to medical facility; electronic filing;
form and contents; maintenance of forms; penalty.
1. Except as otherwise provided in this
section, a treating physician or chiropractor shall, within 3 working days
after first providing treatment to an injured employee for a particular injury,
complete and file a claim for compensation with the employer of the injured
employee and the employer’s insurer. If the employer is a self-insured
employer, the treating physician or chiropractor shall file the claim for
compensation with the employer’s third-party administrator. If the physician or
chiropractor files the claim for compensation by electronic transmission, the
physician or chiropractor shall, upon request, mail to the insurer or
third-party administrator the form that contains the original signatures of the
injured employee and the physician or chiropractor. The form must be mailed
within 7 days after receiving such a request.
2. A physician or chiropractor who has a
duty to file a claim for compensation pursuant to subsection 1 may delegate the
duty to a medical facility. If the physician or chiropractor delegates the duty
to a medical facility:
(a) The medical facility must comply with the
filing requirements set forth in this section; and
(b) The delegation must be in writing and signed
by:
(1) The physician or chiropractor; and
(2) An authorized representative of the
medical facility.
3. A claim for compensation required by
subsection 1 must be filed on a form prescribed by the Administrator.
4. If a claim for compensation is
accompanied by a certificate of disability, the certificate must include a
description of any limitation or restrictions on the injured employee’s ability
to work.
5. Each physician, chiropractor and
medical facility that treats injured employees, each insurer, third-party
administrator and employer, and the Division shall maintain at their offices a
sufficient supply of the forms prescribed by the Administrator for filing a
claim for compensation.
6. The Administrator may impose an
administrative fine of not more than $1,000 for each violation of subsection 1
on:
(a) A physician or chiropractor; or
(b) A medical facility if the duty to file the
claim for compensation has been delegated to the medical facility pursuant to
this section.
(Added to NRS by 1993, 661; A 1995, 649; 1997, 1434; 2003, 2305)
NRS 616C.045 Report of industrial injury or occupational disease: Duty of
employer to file; electronic filing; form and contents; penalty.
1. Except as otherwise provided in NRS 616B.727, within 6 working days
after the receipt of a claim for compensation from a physician or chiropractor,
or a medical facility if the duty to file the claim for compensation has been
delegated to the medical facility pursuant to NRS
616C.040, an employer shall complete and file with his or her insurer or
third-party administrator an employer’s report of industrial injury or
occupational disease.
2. The report must:
(a) Be filed on a form prescribed by the
Administrator;
(b) Be signed by the employer or the employer’s
designee;
(c) Contain specific answers to all questions
required by the regulations of the Administrator; and
(d) Be accompanied by a statement of the wages of
the employee if the claim for compensation received from the treating physician
or chiropractor, or a medical facility if the duty to file the claim for
compensation has been delegated to the medical facility pursuant to NRS 616C.040, indicates that the injured employee is
expected to be off work for 5 days or more.
3. An employer who files the report
required by subsection 1 by electronic transmission shall, upon request, mail
to the insurer or third-party administrator the form that contains the original
signature of the employer or the employer’s designee. The form must be mailed
within 7 days after receiving such a request.
4. The Administrator shall impose an
administrative fine of not more than $1,000 on an employer for each violation
of this section.
(Added to NRS by 1993, 661; A 1995, 649; 1997, 1435; 1999, 3146; 2003, 2305)
NRS 616C.050 Information required to be provided by insurer to claimant.
1. An insurer shall provide to each
claimant:
(a) Upon written request, one copy of any medical
information concerning the claimant’s injury or illness.
(b) A statement which contains information
concerning the claimant’s right to:
(1) Receive the information and forms
necessary to file a claim;
(2) Select a treating physician or
chiropractor and an alternative treating physician or chiropractor in
accordance with the provisions of NRS 616C.090;
(3) Request the appointment of the Nevada
Attorney for Injured Workers to represent the claimant before the appeals
officer;
(4) File a complaint with the
Administrator;
(5) When applicable, receive compensation
for:
(I) Permanent total disability;
(II) Temporary total disability;
(III) Permanent partial disability;
(IV) Temporary partial disability;
(V) All medical costs related to the
claimant’s injury or disease; or
(VI) The hours the claimant is
absent from the place of employment to receive medical treatment pursuant to NRS 616C.477;
(6) Receive services for rehabilitation if
the claimant’s injury prevents him or her from returning to gainful employment;
(7) Review by a hearing officer of any
determination or rejection of a claim by the insurer within the time specified
by statute; and
(8) Judicial review of any final decision
within the time specified by statute.
2. The insurer’s statement must include a
copy of the form designed by the Administrator pursuant to subsection 8 of NRS 616C.090 that notifies injured employees of their
right to select an alternative treating physician or chiropractor. The
Administrator shall adopt regulations for the manner of compliance by an
insurer with the other provisions of subsection 1.
(Added to NRS by 1995, 2003; A 2001, 1892; 2005, 100; 2009, 1277)
NRS 616C.052 Exposure of police officer, firefighter or arson investigator to
contagious disease: Reporting and testing requirements; eligibility for
compensation.
1. Except as otherwise provided in NRS 617.485 and 617.487, if a police officer, a salaried
or volunteer firefighter or an arson investigator is exposed to a contagious
disease:
(a) Upon battery by an offender; or
(b) While performing the duties of a police
officer, firefighter or arson investigator,
Ê the employer
of the police officer, firefighter or arson investigator shall create and
maintain a report concerning the exposure that includes, without limitation, the
name of each police officer, firefighter or arson investigator, as applicable,
who was exposed to the contagious disease and the name of each person, if any,
to whom the police officer, firefighter or arson investigator was exposed.
2. Except as otherwise provided in
paragraph (d) of subsection 2 of NRS
616A.265, if the results of a physical examination administered pursuant to
NRS 617.455 or 617.457 to a police officer, a salaried or
volunteer firefighter or an arson investigator after the commencement of
employment reveal that the police officer, firefighter or arson investigator
tested positive for exposure to tuberculosis, the police officer, firefighter
or arson investigator is eligible, during his or her lifetime, to receive
compensation pursuant to chapters 616A to 617, inclusive, of NRS for tuberculosis and any
additional diseases or conditions that are associated with or result from
tuberculosis.
3. Except as otherwise provided in NRS 617.485 and 617.487, if the employment of a police
officer, a salaried or volunteer firefighter or an arson investigator is
terminated, voluntarily or involuntarily, the employer of the police officer,
firefighter or arson investigator, regardless of whether the police officer,
firefighter or arson investigator has been exposed to a contagious disease
during his or her employment and regardless of whether the employer has created
or maintained a report concerning any exposure of the police officer,
firefighter or arson investigator to a contagious disease pursuant to
subsection 1, shall:
(a) At the time of termination and at 3 months
after the date of termination, provide to the police officer, firefighter or
arson investigator a purified protein derivative skin test to screen for
exposure to tuberculosis, unless the police officer, firefighter or arson
investigator previously submitted to such a test and tested positive for
exposure to tuberculosis. Except as otherwise provided in paragraph (d) of
subsection 2 of NRS 616A.265, if a
skin test administered pursuant to this paragraph and provided to the employer
reveals that the police officer, firefighter or arson investigator tested
positive for exposure to tuberculosis, the police officer, firefighter or arson
investigator is eligible, during his or her lifetime, to receive compensation
pursuant to chapters 616A to 617, inclusive, of NRS for tuberculosis and any
additional diseases or conditions that are associated with or result from
tuberculosis.
(b) Within 30 days after the date of termination
and at 6 and 12 months after the date of termination, provide to the police
officer, firefighter or arson investigator a blood test or other appropriate
test to screen for other contagious diseases, including, without limitation,
hepatitis A, hepatitis B, hepatitis C and human immunodeficiency virus, unless
the police officer, firefighter or arson investigator previously submitted to
such a test for a contagious disease and tested positive for exposure to that contagious
disease. Except as otherwise provided in paragraph (d) of subsection 2 of NRS 616A.265, if a blood test or other
appropriate test administered pursuant to this paragraph and provided to the
employer reveals that the police officer, firefighter or arson investigator has
any other contagious disease or the antibodies associated with a contagious
disease, the police officer, firefighter or arson investigator is eligible,
during his or her lifetime, to receive compensation pursuant to chapters 616A to 617,
inclusive, of NRS for such a disease and any additional diseases or conditions
that are associated with or result from the contagious disease.
4. The former employer of a police
officer, a salaried or volunteer firefighter or an arson investigator shall pay
all the costs associated with providing skin and blood tests and other
appropriate tests required pursuant to subsection 3.
5. As used in this section, the term
“battery” includes, without limitation, the intentional propelling or placing,
or the causing to be propelled or placed, of any human excrement or bodily
fluid upon the person of an employee.
(Added to NRS by 1999, 2446; A 2001, 1015, 1873; 2005, 342, 2238; 2009, 543)
NRS 616C.055 Use of fee schedules which unfairly discriminate among
physicians and chiropractors prohibited; payment for services rendered by
physician or chiropractor after removal from panel prohibited.
1. The insurer may not, in accepting
responsibility for any charges, use fee schedules which unfairly discriminate
among physicians and chiropractors.
2. If a physician or chiropractor is
removed from the panel established pursuant to NRS
616C.090 or from participation in a plan for managed care established
pursuant to NRS 616B.527, the
physician or chiropractor, as applicable, must not be paid for any services
rendered to the injured employee after the date of the removal.
(Added to NRS by 1979, 651; A 1981, 1168, 1488; 1983, 325; 1985, 1546; 1991, 2417; 1993, 733; 1999, 1776)
NRS 616C.065 Duty of insurer to accept or deny claim; new determination;
penalty; failure of insurer to indicate acceptance or denial of claim; written
determination.
1. Except as otherwise provided in NRS 616C.136, within 30 days after the insurer has
been notified of an industrial accident, every insurer shall:
(a) Accept a claim for compensation, notify the
claimant or the person acting on behalf of the claimant that the claim has been
accepted and commence payment of the claim; or
(b) Deny the claim and notify the claimant or the
person acting on behalf of the claimant and the Administrator that the claim
has been denied.
2. If an insurer is ordered by the
Administrator, a hearing officer, an appeals officer, a district court, the
Court of Appeals or the Supreme Court of Nevada to make a new determination,
including, without limitation, a new determination regarding the acceptance or
denial of a claim for compensation, the insurer shall make the new
determination within 30 days after the date on which the insurer has been
ordered to do so.
3. Payments made by an insurer pursuant to
this section are not an admission of liability for the claim or any portion of
the claim.
4. Except as otherwise provided in this
subsection, if an insurer unreasonably delays or refuses to pay the claim within
30 days after the insurer has been notified of an industrial accident, the
insurer shall pay upon order of the Administrator an additional amount equal to
three times the amount specified in the order as refused or unreasonably
delayed. This payment is for the benefit of the claimant and must be paid to
the claimant with the compensation assessed pursuant to chapters 616A to 617,
inclusive, of NRS. The provisions of this section do not apply to the payment
of a bill for accident benefits that is governed by the provisions of NRS 616C.136.
5. The insurer shall notify the claimant
or the person acting on behalf of the claimant that a claim has been accepted
or denied pursuant to subsection 1 or 2 by:
(a) Mailing its written determination to the
claimant or the person acting on behalf of the claimant; and
(b) If the claim has been denied, in whole or in
part, obtaining a certificate of mailing.
6. The failure of the insurer to obtain a
certificate of mailing as required by paragraph (b) of subsection 5 shall be
deemed to be a failure of the insurer to mail the written determination of the
denial of a claim as required by this section.
7. The failure of the insurer to indicate
the acceptance or denial of a claim for a part of the body or condition does
not constitute a denial or acceptance thereof.
8. Upon request, the insurer shall provide
a copy of the certificate of mailing, if any, to the claimant or the person
acting on behalf of the claimant.
9. For the purposes of this section, the
insurer shall mail the written determination to:
(a) The mailing address of the claimant or the
person acting on behalf of the claimant that is provided on the form prescribed
by the Administrator for filing the claim; or
(b) Another mailing address if the claimant or
the person acting on behalf of the claimant provides to the insurer written
notice of another mailing address.
10. As used in this section, “certificate
of mailing” means a receipt that provides evidence of the date on which the
insurer presented its written determination to the United States Postal Service
for mailing.
(Added to NRS by 1995, 2001; A 2001, 2738; 2007, 3345; 2009, 1278,
3031; 2013, 1794)
NRS 616C.070 Persons who are conclusively presumed to be totally dependent on
injured or deceased employee; exception.
1. A person is conclusively presumed to be
totally dependent upon an injured or deceased employee if:
(a) The person is a natural, posthumous or
adopted child, whether legitimate or illegitimate, under the age of 18 years;
or
(b) The person is a natural, posthumous or
adopted child, there is no surviving parent and the person is:
(1) Over the age of 18 years and
physically or mentally incapacitated from wage earning; or
(2) Over the age of 18 years but under the
age of 22 years and enrolled as a full-time student in an accredited vocational
or educational institution.
2. Stepparents may be regarded in chapters 616A to 616D, inclusive, or chapter 617 of NRS as parents if the fact of dependency
is shown, and a stepchild or stepchildren may be regarded in chapters 616A to 616D, inclusive, or chapter 617 of NRS as a natural child or children if the
existence and fact of dependency are shown.
3. Except as otherwise provided in
subsection 13 of NRS 616C.505, questions as to who
constitute dependents and the extent of their dependency must be determined as
of the date of the accident or injury to the employee, and their right to any
benefit becomes fixed at that time, irrespective of any subsequent change in
conditions, and the benefits are directly recoverable by and payable to the
dependent or dependents entitled thereto or to their legal guardians or
trustees.
4. The presumptions of this section do not
apply in favor of aliens who are nonresidents of the United States at the time
of the accident, injury to, or death of the employee.
[24:168:1947; 1943 NCL § 2680.24]—(NRS A 1971, 321;
1975, 598; 1985,
1460; 1993,
733; 1999,
219; 2007,
3346; 2009,
3072)
NRS 616C.075 Effect of employee’s refusal to submit to physical examination
after accident. If an employee is
properly directed to submit to a physical examination and the employee refuses
to permit the treating physician or chiropractor to make an examination and to
render medical attention as may be required immediately, no compensation may be
paid for the injury claimed to result from the accident.
[Part 52:168:1947; 1943 NCL § 2680.52]—(NRS A 1973,
599; 1981, 1167,
1471; 1985, 1544; 1993, 715)—(Substituted
in revision for NRS 616.365)
TREATMENT AND RATING OF INJURED EMPLOYEES
NRS 616C.085 Duties of employer when employee injured: First aid;
reimbursement.
1. Every employer within the provisions of
chapters 616A to 616D, inclusive, of NRS shall, immediately
upon the occurrence of an injury to any of his or her employees, render to the
injured employee all necessary first aid, including the cost of transportation
of the injured employee to the nearest place of proper treatment if the injury
is such as to make it reasonably necessary for such transportation.
2. An employer who is not self-insured or
a member of an association of self-insured public or private employers is
entitled to receive reimbursement from the employer’s insurer for the costs
incurred in rendering the necessary first aid and transportation of an injured
employee to the nearest place of proper treatment.
[Part 58:168:1947; 1943 NCL § 2680.58]—(NRS A 1975,
252, 826; 1979,
1489; 1981,
1165, 1469;
1985, 664; 1991, 2404; 1993, 713, 1862)—(Substituted
in revision for NRS 616.340)
NRS 616C.090 Selection of physician or chiropractor: Powers and duties of
Administrator; selection and alternate selection from established panel or
pursuant to contract; responsibility for charges.
1. The Administrator shall establish a
panel of physicians and chiropractors who have demonstrated special competence
and interest in industrial health to treat injured employees under chapters 616A to 616D, inclusive, or chapter 617 of NRS. Every employer whose insurer has not
entered into a contract with an organization for managed care or with providers
of health care services pursuant to NRS
616B.527 shall maintain a list of those physicians and chiropractors on the
panel who are reasonably accessible to his or her employees.
2. An injured employee whose employer’s
insurer has not entered into a contract with an organization for managed care
or with providers of health care services pursuant to NRS 616B.527 may choose a treating
physician or chiropractor from the panel of physicians and chiropractors. If
the injured employee is not satisfied with the first physician or chiropractor
he or she so chooses, the injured employee may make an alternative choice of
physician or chiropractor from the panel if the choice is made within 90 days
after his or her injury. The insurer shall notify the first physician or
chiropractor in writing. The notice must be postmarked within 3 working days
after the insurer receives knowledge of the change. The first physician or
chiropractor must be reimbursed only for the services the physician or
chiropractor, as applicable, rendered to the injured employee up to and
including the date of notification. Except as otherwise provided in this
subsection, any further change is subject to the approval of the insurer, which
must be granted or denied within 10 days after a written request for such a
change is received from the injured employee. If no action is taken on the
request within 10 days, the request shall be deemed granted. Any request for a
change of physician or chiropractor must include the name of the new physician
or chiropractor chosen by the injured employee. If the treating physician or
chiropractor refers the injured employee to a specialist for treatment, the
treating physician or chiropractor shall provide to the injured employee a list
that includes the name of each physician or chiropractor with that
specialization who is on the panel. After receiving the list, the injured
employee shall, at the time the referral is made, select a physician or
chiropractor from the list.
3. An injured employee whose employer’s
insurer has entered into a contract with an organization for managed care or
with providers of health care services pursuant to NRS 616B.527 must choose a treating
physician or chiropractor pursuant to the terms of that contract. If the
injured employee is not satisfied with the first physician or chiropractor he
or she so chooses, the injured employee may make an alternative choice of
physician or chiropractor pursuant to the terms of the contract without the
approval of the insurer if the choice is made within 90 days after his or her
injury. If the injured employee, after choosing a treating physician or
chiropractor, moves to a county which is not served by the organization for
managed care or providers of health care services named in the contract and the
insurer determines that it is impractical for the injured employee to continue
treatment with the physician or chiropractor, the injured employee must choose
a treating physician or chiropractor who has agreed to the terms of that
contract unless the insurer authorizes the injured employee to choose another
physician or chiropractor. If the treating physician or chiropractor refers the
injured employee to a specialist for treatment, the treating physician or
chiropractor shall provide to the injured employee a list that includes the
name of each physician or chiropractor with that specialization who is
available pursuant to the terms of the contract with the organization for managed
care or with providers of health care services pursuant to NRS 616B.527, as appropriate. After
receiving the list, the injured employee shall, at the time the referral is
made, select a physician or chiropractor from the list. If the employee fails
to select a physician or chiropractor, the insurer may select a physician or
chiropractor with that specialization. If a physician or chiropractor with that
specialization is not available pursuant to the terms of the contract, the
organization for managed care or the provider of health care services may
select a physician or chiropractor with that specialization.
4. If the injured employee is not
satisfied with the physician or chiropractor selected by himself or herself or
by the insurer, the organization for managed care or the provider of health
care services pursuant to subsection 3, the injured employee may make an
alternative choice of physician or chiropractor pursuant to the terms of the
contract. A change in the treating physician or chiropractor may be made at any
time but is subject to the approval of the insurer, which must be granted or
denied within 10 days after a written request for such a change is received
from the injured employee. If no action is taken on the request within 10 days,
the request shall be deemed granted. Any request for a change of physician or
chiropractor must include the name of the new physician or chiropractor chosen
by the injured employee. If the insurer denies a request for a change in the
treating physician or chiropractor under this subsection, the insurer must
include in a written notice of denial to the injured employee the specific
reason for the denial of the request.
5. Except when emergency medical care is
required and except as otherwise provided in NRS
616C.055, the insurer is not responsible for any charges for medical
treatment or other accident benefits furnished or ordered by any physician,
chiropractor or other person selected by the injured employee in disregard of
the provisions of this section or for any compensation for any aggravation of
the injured employee’s injury attributable to improper treatments by such
physician, chiropractor or other person.
6. The Administrator may order necessary
changes in a panel of physicians and chiropractors and shall suspend or remove
any physician or chiropractor from a panel for good cause shown.
7. An injured employee may receive
treatment by more than one physician or chiropractor if the insurer provides
written authorization for such treatment.
8. The Administrator shall design a form
that notifies injured employees of their right pursuant to subsections 2, 3 and
4 to select an alternative treating physician or chiropractor and make the form
available to insurers for distribution pursuant to subsection 2 of NRS 616C.050.
(Added to NRS by 1973, 1595; A 1979, 651, 1045, 1046; 1981, 1166, 1196, 1470, 1829; 1985, 1542; 1991, 2405, 2406; 1993, 713; 1995, 2137; 1999, 219, 1776, 2214; 2001, 115, 1893; 2009, 1279)
NRS 616C.095 Duty of physician or chiropractor to advise injured employee of
rights. The physician or
chiropractor shall inform the injured employee of the injured employee’s rights
under chapters 616A to 616D, inclusive, or chapter 617 of NRS and lend all necessary assistance in
making application for compensation and such proof of other matters as required
by the rules of the Division, without charge to the employee.
[53:168:1947; 1943 NCL § 2680.53]—(NRS A 1981, 1470; 1985, 1543; 1993, 1863; 1999, 220)
NRS 616C.100 Additional determination of percentage of disability permitted
if cost paid by injured employee; authority of injured employee to seek
reimbursement of cost; results of determination may be offered at hearing or
conference.
1. If an injured employee disagrees with
the percentage of disability determined by a physician or chiropractor, the
injured employee may obtain a second determination of the percentage of
disability. If the employee wishes to obtain such a determination, the employee
must select the next physician or chiropractor in rotation from the list of
qualified physicians or chiropractors maintained by the Administrator pursuant
to subsection 2 of NRS 616C.490. If a second
determination is obtained, the injured employee shall pay for the
determination. If the physician or chiropractor selected to make the second
determination finds a higher percentage of disability than the first physician
or chiropractor, the injured employee may request a hearing officer or appeals
officer to order the insurer to reimburse the employee pursuant to the
provisions of NRS 616C.330 or 616C.360.
2. The results of a second determination
made pursuant to subsection 1 may be offered at any hearing or settlement
conference.
(Added to NRS by 1991, 2398; A 1993, 736; 1995, 2148; 1999, 1777)
NRS 616C.105 Requirements for designation of chiropractor to rate permanent
partial disabilities. The
Administrator shall not designate a chiropractor to rate permanent partial
disabilities unless the chiropractor has completed an advanced program of
training in rating disabilities using the American Medical Association’s Guides
to the Evaluation of Permanent Impairment which is offered or approved by
the Administrator.
(Added to NRS by 1991, 2392)—(Substituted
in revision for NRS 616.5417)
NRS 616C.110 American Medical Association’s Guides to the Evaluation of
Permanent Impairment: Duty of Division to adopt Guides by
regulation.
1. For the purposes of NRS 616B.557, 616B.578, 616B.587, 616C.490
and 617.459, not later than August 1,
2003, the Division shall adopt regulations incorporating the American Medical
Association’s Guides to the Evaluation of Permanent Impairment, Fifth
Edition, by reference. The regulations:
(a) Must provide that the American Medical
Association’s Guides to the Evaluation of Permanent Impairment, Fifth
Edition, must be applied to all examinations; and
(b) Must be applied to all examinations for a
permanent partial disability that are conducted on or after the effective date
of the regulations, regardless of the date of injury.
2. After adopting the regulations required
pursuant to subsection 1, the Division may amend those regulations as it deems
necessary, except that the amendments to those regulations:
(a) Must be consistent with the Fifth Edition of
the American Medical Association’s Guides to the Evaluation of Permanent
Impairment;
(b) Must not incorporate any contradictory matter
from any other edition of the American Medical Association’s Guides to the
Evaluation of Permanent Impairment; and
(c) Must not consider any factors other than the
degree of physical impairment of the whole person in calculating the
entitlement to compensation.
3. If the Fifth Edition of the American Medical
Association’s Guides to the Evaluation of Permanent Impairment contains
more than one method of determining the rating of an impairment, the
Administrator shall designate by regulation the method from that edition which
must be used to rate an impairment pursuant to NRS
616C.490.
(Added to NRS by 1995, 2128; A 1999, 1777; 2003, 1671; 2009, 3032)
NRS 616C.115 Prescription of generic drugs required; exceptions.
1. Except as otherwise provided in
subsection 2, a physician or advanced practice registered nurse shall prescribe
for an injured employee a generic drug in lieu of a drug with a brand name if
the generic drug is biologically equivalent and has the same active ingredient
or ingredients of the same strength, quantity and form of dosage as the drug
with a brand name.
2. A physician or advanced practice
registered nurse is not required to comply with the provisions of subsection 1
if:
(a) The physician or advanced practice registered
nurse determines that the generic drug would not be beneficial to the health of
the injured employee; or
(b) The generic drug is higher in cost than the
drug with a brand name.
(Added to NRS by 1993, 669; A 2013, 2092)
NRS 616C.120 Employee may elect treatment through prayer in lieu of medical
treatment. Any provision of this
chapter or chapter 616A, 616B, 616D
or 617 of NRS must not prevent an employee
from providing for treatment for the employee’s injuries or disease through prayer
or other spiritual means in accordance with the tenets and practices of a
recognized church, which treatment is recognized in this State in lieu of
medical treatment.
(Added to NRS by 1973, 1595; A 1999, 220)
NRS 616C.125 Insurer may contract with suppliers for provision of services
and goods to injured employees. An
insurer may contract with suppliers to provide services and goods to injured
employees. Such contracts may provide for the exclusive provision of specified
services or goods to injured employees.
(Added to NRS by 1987, 2148; A 1989, 1429; 1993, 714)—(Substituted
in revision for NRS 616.344)
NRS 616C.130 Insurer’s payment to physician or chiropractor attending injured
employee conditioned upon receipt of itemized statement and certificate. The insurer shall not authorize the payment of
any money to a physician or chiropractor for services rendered by the physician
or chiropractor, as applicable, in attending an injured employee until an
itemized statement for the services has been received by the insurer
accompanied by a certificate of the physician or chiropractor stating that a
duplicate of the itemized statement has been filed with the employer of the
injured employee.
(Added to NRS by 1957, 232; A 1981, 1167, 1471; 1985, 1543; 1997, 1435)
NRS 616C.135 Liability of insurer for payment of charges for treatment
related to industrial injury or occupational disease; acceptance of payment by
provider of health care from injured employee or health or casualty insurer for
treatment that was erroneously denied.
1. A provider of health care who accepts a
patient as a referral for the treatment of an industrial injury or an
occupational disease may not charge the patient for any treatment related to
the industrial injury or occupational disease, but must charge the insurer. The
provider of health care may charge the patient for any services that are not
related to the employee’s industrial injury or occupational disease.
2. The insurer is liable for the charges
for approved services related to the industrial injury or occupational disease
if the charges do not exceed:
(a) The fees established in accordance with NRS 616C.260 or the usual fee charged by that person
or institution, whichever is less; and
(b) The charges provided for by the contract
between the provider of health care and the insurer or the contract between the
provider of health care and the organization for managed care.
3. A provider of health care may accept
payment from an injured employee or from a health or casualty insurer paying on
behalf of the injured employee pursuant to NRS
616C.138 for treatment or other services that the injured employee alleges
are related to the industrial injury or occupational disease.
4. If a provider of health care, an
organization for managed care, an insurer or an employer violates the
provisions of this section, the Administrator shall impose an administrative
fine of not more than $250 for each violation.
(Added to NRS by 1983, 1291; A 1985, 574; 1991, 2407; 1993, 715; 2001, 1894, 2738, 2742; 2005, 237, 1265)
NRS 616C.136 Action by insurer on bill from provider of health care; payment
of interest; request for additional information; compliance with requirements.
1. Except as otherwise provided in this
section, an insurer shall approve or deny a bill for accident benefits received
from a provider of health care within 30 calendar days after the insurer
receives the bill. If the bill for accident benefits is approved, the insurer
shall pay the bill within 30 calendar days after it is approved. Except as otherwise
provided in this section, if the approved bill for accident benefits is not
paid within that period, the insurer shall pay interest to the provider of
health care at a rate of interest equal to the prime rate at the largest bank
in Nevada, as ascertained by the Commissioner of Financial Institutions, on
January 1 or July 1, as the case may be, immediately preceding the date on
which the payment was due, plus 6 percent. The interest must be calculated from
30 calendar days after the date on which the bill is approved until the date on
which the bill is paid.
2. If an insurer needs additional
information to determine whether to approve or deny a bill for accident
benefits received from a provider of health care, the insurer shall notify the
provider of health care of his or her request for the additional information
within 20 calendar days after the insurer receives the bill. The insurer shall
notify the provider of health care of all the specific reasons for the delay in
approving or denying the bill for accident benefits. Upon the receipt of such a
request, the provider of health care shall furnish the additional information
to the insurer within 20 calendar days after receiving the request. If the
provider of health care fails to furnish the additional information within that
period, the provider of health care is not entitled to the payment of interest
to which the provider of health care would otherwise be entitled for the late
payment of the bill for accident benefits. The insurer shall approve or deny
the bill for accident benefits within 20 calendar days after the insurer
receives the additional information. If the bill for accident benefits is
approved, the insurer shall pay the bill within 20 calendar days after the
insurer receives the additional information. Except as otherwise provided in
this subsection, if the approved bill for accident benefits is not paid within
that period, the insurer shall pay interest to the provider of health care at
the rate set forth in subsection 1. The interest must be calculated from 20
calendar days after the date on which the insurer receives the additional
information until the date on which the bill is paid.
3. An insurer shall not request a provider
of health care to resubmit information that the provider of health care has
previously provided to the insurer, unless the insurer provides a legitimate
reason for the request and the purpose of the request is not to delay the
payment of the accident benefits, harass the provider of health care or
discourage the filing of claims.
4. An insurer shall not pay only a portion
of a bill for accident benefits that has been approved and is fully payable.
5. The Administrator may require an
insurer to provide evidence which demonstrates that the insurer has
substantially complied with the requirements of this section, including,
without limitation, payment within the time required of at least 95 percent of
approved accident benefits or at least 90 percent of the total dollar amount of
approved accident benefits. If the Administrator determines that an insurer is
not in substantial compliance with the requirements of this section, the
Administrator may require the insurer to pay an administrative fine in an
amount to be determined by the Administrator.
6. The payment of interest provided for in
this section for the late payment of an approved claim may be waived only if
the payment was delayed because of an act of God or another cause beyond the
control of the insurer.
7. Payments made by an insurer pursuant to
this section are not an admission of liability for the accident benefits or any
portion of the accident benefits.
(Added to NRS by 2001, 2736)
NRS 616C.137 Denial of payment for unrelated services: Requirements for
notification; liability of injured employee; appeal.
1. If an insurer, organization for managed
care or employer who provides accident benefits for injured employees pursuant
to NRS 616C.265 denies payment for some or all of
the services itemized on a statement submitted by a provider of health care on
the sole basis that those services were not related to the employee’s
industrial injury or occupational disease, the insurer, organization for
managed care or employer shall, at the same time that it sends notification to
the provider of health care of the denial, send a copy of the statement to the
injured employee and notify the injured employee that it has denied payment.
The notification sent to the injured employee must:
(a) State the relevant amount requested as
payment in the statement, that the reason for denying payment is that the
services were not related to the industrial injury or occupational disease and
that, pursuant to subsection 2, the injured employee will be responsible for
payment of the relevant amount if the injured employee does not, in a timely
manner, appeal the denial pursuant to NRS 616C.305
and 616C.315 to 616C.385,
inclusive, or appeals but is not successful.
(b) Include an explanation of the injured
employee’s right to request a hearing to appeal the denial pursuant to NRS 616C.305 and 616C.315
to 616C.385, inclusive, and a suitable form for
requesting a hearing to appeal the denial.
2. An injured employee who does not, in a
timely manner, appeal the denial of payment for the services rendered or who
appeals the denial but is not successful is responsible for payment of the
relevant charges on the itemized statement.
3. To succeed on appeal, the injured
employee must show that the:
(a) Services provided were related to the
employee’s industrial injury or occupational disease; or
(b) Insurer, organization for managed care or
employer who provides accident benefits for injured employees pursuant to NRS 616C.265 gave prior authorization for the
services rendered and did not withdraw that prior authorization before the
services of the provider of health care were rendered.
(Added to NRS by 2001, 2737)
NRS 616C.138 Payment of provider of health care upon insurer’s denial of
authorization or responsibility for treatment or other services provided;
reimbursement of injured employee or health or casualty insurer; recovery of
excess amount paid to provider of health care.
1. Except as otherwise provided in this
section, if a provider of health care provides treatment or other services that
an injured employee alleges are related to an industrial injury or occupational
disease and an insurer, an organization for managed care, a third-party
administrator or an employer who provides accident benefits for injured
employees pursuant to NRS 616C.265 denies
authorization or responsibility for payment for the treatment or other services,
the provider of health care is entitled to be paid for the treatment or other
services as follows:
(a) If the treatment or other services will be
paid by a health insurer which has a contract with the provider of health care
under a health benefit plan that covers the injured employee, the provider of
health care is entitled to be paid the amount that is allowed for the treatment
or other services under that contract.
(b) If the treatment or other services will be
paid by a health insurer which does not have a contract with the provider of
health care as set forth in paragraph (a) or by a casualty insurer or the
injured employee, the provider of health care is entitled to be paid not more
than:
(1) The amount which is allowed for the
treatment or other services set forth in the schedule of fees and charges
established pursuant to NRS 616C.260; or
(2) If the insurer which denied
authorization or responsibility for the payment has contracted with an
organization for managed care or with providers of health care pursuant to NRS 616B.527, the amount that is allowed
for the treatment or other services under that contract.
2. The provisions of subsection 1:
(a) Apply only to treatment or other services
provided by the provider of health care before the date on which the insurer,
organization for managed care, third-party administrator or employer who
provides accident benefits first denies authorization or responsibility for
payments for the alleged industrial injury or occupational disease.
(b) Do not apply to a provider of health care
that is a hospital as defined in NRS
439B.110. The provisions of this paragraph do not exempt the provider of
health care from complying with the provisions of subsections 3 and 4.
3. If:
(a) The injured employee pays for the treatment
or other services or a health or casualty insurer pays for the treatment or
other services on behalf of the injured employee;
(b) The injured employee requests a hearing
before a hearing officer or appeals officer regarding the denial of coverage;
and
(c) The hearing officer or appeals officer
ultimately determines that the treatment or other services should have been
covered, or the insurer, organization for managed care, third-party
administrator or employer who provides accident benefits subsequently accepts
responsibility for payment,
Ê the hearing
officer or appeals officer shall order the insurer, organization for managed
care, third-party administrator or employer who provides accident benefits to
pay to the injured employee or the health or casualty insurer the amount which
the injured employee or the health or casualty insurer paid that is allowed for
the treatment or other services set forth in the schedule of fees and charges
established pursuant to NRS 616C.260 or, if the
insurer has contracted with an organization for managed care or with providers
of health care pursuant to NRS 616B.527,
the amount that is allowed for the treatment or other services under that
contract.
4. If the injured employee or the health
or casualty insurer paid the provider of health care any amount in excess of
the amount that the provider would have been entitled to be paid pursuant to
this section, the injured employee or the health or casualty insurer is
entitled to recover the excess amount from the provider. Within 30 days after
receiving notice of such an excess amount, the provider of health care shall
reimburse the injured employee or the health or casualty insurer for the excess
amount.
5. As used in this section:
(a) “Casualty insurer” means any insurer or other
organization providing coverage or benefits under a policy or contract of
casualty insurance in the manner described in subsection 2 of NRS 681A.020.
(b) “Health benefit plan” means any type of
policy, contract, agreement or plan providing health coverage or benefits in
accordance with state or federal law.
(c) “Health insurer” means any insurer or other
organization providing health coverage or benefits in accordance with state or
federal law.
(Added to NRS by 2001, 1892; A 2005, 237, 1266)
NRS 616C.140 Medical examination of claimant; effect of refusal to submit to
examination; communications not privileged.
1. Any employee who is entitled to receive
compensation under chapters 616A to 616D, inclusive, of NRS shall, if:
(a) Requested by the insurer or employer; or
(b) Ordered by an appeals officer or a hearing
officer,
Ê submit to a medical
examination at a time and from time to time at a place reasonably convenient
for the employee, and as may be provided by the regulations of the Division.
2. If the insurer has reasonable cause to
believe that an injured employee who is receiving compensation for a permanent
total disability is no longer disabled, the insurer may request the employee to
submit to an annual medical examination to determine whether the disability
still exists. The insurer shall pay the costs of the examination.
3. The request or order for an examination
must fix a time and place therefor, with due regard for the nature of the
medical examination, the convenience of the employee, the employee’s physical
condition and the employee’s ability to attend at the time and place fixed.
4. The employee is entitled to have a
physician or chiropractor, provided and paid for by the employee, present at
any such examination.
5. If the employee refuses to submit to an
examination ordered or requested pursuant to subsection 1 or 2 or obstructs the
examination, the right of the employee to compensation is suspended until the
examination has taken place, and no compensation is payable during or for the
period of suspension.
6. Any physician or chiropractor who makes
or is present at any such examination may be required to testify as to the
result thereof.
[67:168:1947; 1943 NCL § 2680.67] + [68:168:1947;
1943 NCL § 2680.68]—(NRS A 1975, 763; 1977, 314; 1979, 1054; 1981, 1169, 1197, 1489, 1830; 1985, 1546; 1993, 735, 1869; 1995, 579; 1997, 1394)
DETERMINATION AND PAYMENT OF BENEFITS
NRS 616C.150 Compensation prohibited unless preponderance of evidence
establishes that injury arose out of and in course of employment; rebuttable
presumption if notice of injury is filed after termination of employment.
1. An injured employee or the dependents
of the injured employee are not entitled to receive compensation pursuant to
the provisions of chapters 616A to 616D, inclusive, of NRS unless the employee or
the dependents establish by a preponderance of the evidence that the employee’s
injury arose out of and in the course of his or her employment.
2. For the purposes of chapters 616A to 616D, inclusive, of NRS, if the employee files
a notice of an injury pursuant to NRS 616C.015
after his or her employment has been terminated for any reason, there is a
rebuttable presumption that the injury did not arise out of and in the course
of his or her employment.
(Added to NRS by 1993, 662)—(Substituted
in revision for NRS 616.5015)
NRS 616C.155 Payment of compensation by insurer prohibited before required;
recovery of overpayment by insurer.
1. An insurer shall not provide
compensation to or for an employee or the dependents of the employee before the
compensation is required to be paid pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS.
2. If, within 30 days after a payment is
made to an injured employee pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS, the insurer
determines that it has overpaid the injured employee as a result of a clerical
error in its calculation of the amount of payment, or as a result of using
improper or incorrect information to determine the injured employee’s
eligibility for payment or to calculate the amount of payment, the insurer may
deduct the amount of the overpayment from future benefits related to that claim
to which the injured employee is entitled, other than accident benefits, if:
(a) The insurer notifies the injured employee in
writing of its determination;
(b) The insurer informs the injured employee of
the injured employee’s right to contest the deduction; and
(c) The injured employee fails to contest the
deduction or does so and upon final resolution of the contested deduction, it
is determined that such an overpayment was made.
3. Any deductions made pursuant to
subsection 2 must be made in a reasonable manner which does not cause undue
hardship to the injured employee.
(Added to NRS by 1993, 662)—(Substituted
in revision for NRS 616.5017)
NRS 616C.157 Request for prior authorization: Time to respond; effect of
failure to respond in timely manner.
1. An insurer, organization for managed
care or third-party administrator shall respond to a written request for prior
authorization for:
(a) Treatment;
(b) Diagnostic testing; or
(c) Consultation,
Ê within 5
working days after receiving the written request.
2. If the insurer, organization for
managed care or third-party administrator fails to respond to such a request
within 5 working days, authorization shall be deemed to be given. The insurer,
organization for managed care or third-party administrator may subsequently deny
authorization.
3. If the insurer, organization for
managed care or third-party administrator subsequently denies a request for
authorization submitted by a provider of health care for additional visits or
treatments, it shall pay for the additional visits or treatments actually
provided to the injured employee, up to the number of treatments for which
payment is requested by the provider of health care before the denial of
authorization is received by the provider.
(Added to NRS by 1999, 2214)
NRS 616C.160 Newly developed injury or disease: Inclusion in original claim
for compensation; limitation. If,
after a claim for compensation is filed pursuant to NRS
616C.020:
1. The injured employee seeks treatment
from a physician or chiropractor for a newly developed injury or disease; and
2. The employee’s medical records for the
injury reported do not include a reference to the injury or disease for which
treatment is being sought, or there is no documentation indicating that there
was possible exposure to an injury described in paragraph (b), (c) or (d) of
subsection 2 of NRS 616A.265,
Ê the injury
or disease for which treatment is being sought must not be considered part of
the employee’s original claim for compensation unless the physician or
chiropractor establishes by medical evidence a causal relationship between the
injury or disease for which treatment is being sought and the original
accident.
(Added to NRS by 1993, 663; A 1999, 2447; 2001, 1016)
NRS 616C.165 Determination of responsibility of insurer for undisputed claim
for compensation; reimbursement of insurer initially providing compensation to
injured employee. If
responsibility for an undisputed claim for compensation by an injured employee
is contested, the insurer to which the employee first submits the claim is
responsible for providing the required compensation to the employee pending
final resolution of the issue regarding which insurer is responsible for the
claim. If the insurer that initially provides compensation to the injured
employee is not held responsible for payment of the claim, the insurer that is
held responsible shall reimburse that insurer within 30 days after final
resolution of the issue of responsibility for payment of the claim.
(Added to NRS by 1995, 2122)
NRS 616C.170 Resolution of disputes between insurers if benefits are claimed
against more than one insurer; adoption of regulations by Administrator; appeal
of decision of Administrator; payment of benefits until determination of
responsibility by Administrator.
1. The Administrator shall resolve any
disputes between insurers if an injured employee claims benefits against more
than one insurer.
2. The Administrator shall adopt
regulations concerning the resolution of disputes between insurers regarding
benefits to be paid to any injured employee.
3. If the insurer or the employee is
dissatisfied with the decision of the Administrator, the dissatisfied party may
request a hearing before an appeals officer.
4. Until the Administrator has determined
which insurer is responsible for a claim, the current insurer of the employer
shall pay benefits to the claimant pursuant to chapters
616A to 617, inclusive, of NRS. Payments
made by an insurer pursuant to this subsection are not an admission of
liability for the claim or any portion of the claim.
(Added to NRS by 1995, 2002)
NRS 616C.175 Employment-related aggravation of preexisting condition which is
not employment related; aggravation of employment-related injury by incident
which is not employment related.
1. The resulting condition of an employee
who:
(a) Has a preexisting condition from a cause or
origin that did not arise out of or in the course of the employee’s current or
past employment; and
(b) Subsequently sustains an injury by accident
arising out of and in the course of his or her employment which aggravates, precipitates
or accelerates the preexisting condition,
Ê shall be
deemed to be an injury by accident that is compensable pursuant to the
provisions of chapters 616A to 616D, inclusive, of NRS, unless the insurer
can prove by a preponderance of the evidence that the subsequent injury is not
a substantial contributing cause of the resulting condition.
2. The resulting condition of an employee
who:
(a) Sustains an injury by accident arising out of
and in the course of his or her employment; and
(b) Subsequently aggravates, precipitates or
accelerates the injury in a manner that does not arise out of and in the course
of his or her employment,
Ê shall be
deemed to be an injury by accident that is compensable pursuant to the
provisions of chapters 616A to 616D, inclusive, of NRS, unless the insurer
can prove by a preponderance of the evidence that the injury described in
paragraph (a) is not a substantial contributing cause of the resulting
condition.
(Added to NRS by 1993, 663; A 1995, 2147; 1999, 1777)
NRS 616C.177 Medical records concerning preexisting condition: Authority of
insurer to request records; injured employee required to release records under
certain circumstances.
1. An insurer may inquire about and
request medical records of an injured employee that concern a preexisting
medical condition that is reasonably related to the industrial injury of that
injured employee.
2. An injured employee must sign all
medical releases necessary for the insurer of his or her employer to obtain
information and records about a preexisting medical condition that is
reasonably related to the industrial injury of the employee and that will
assist the insurer to determine the nature and amount of workers’ compensation
to which the employee is entitled.
(Added to NRS by 1999, 1775)
NRS 616C.180 Injury or disease caused by stress.
1. Except as otherwise provided in this
section, an injury or disease sustained by an employee that is caused by stress
is compensable pursuant to the provisions of chapters
616A to 616D, inclusive, or chapter 617 of NRS if it arose out of and in the course
of his or her employment.
2. Any ailment or disorder caused by any
gradual mental stimulus, and any death or disability ensuing therefrom, shall
be deemed not to be an injury or disease arising out of and in the course of
employment.
3. An injury or disease caused by stress
shall be deemed to arise out of and in the course of employment only if the
employee proves by clear and convincing medical or psychiatric evidence that:
(a) The employee has a mental injury caused by
extreme stress in time of danger;
(b) The primary cause of the injury was an event
that arose out of and during the course of his or her employment; and
(c) The stress was not caused by his or her
layoff, the termination of his or her employment or any disciplinary action
taken against him or her.
4. The provisions of this section do not
apply to a person who is claiming compensation pursuant to NRS 617.457.
(Added to NRS by 1993, 663; A 1993, 2445)—(Substituted
in revision for NRS 616.5019)
NRS 616C.185 Compensation for mastectomy and reconstructive surgery.
1. If compensation is paid to an employee
under chapters 616A to 616D, inclusive, of NRS for the surgical
procedure known as a mastectomy, the employee is also entitled to receive
commensurate compensation for at least two prosthetic devices and for
reconstructive surgery incident to the mastectomy. Except as otherwise provided
in subsection 2, this compensation is subject to the same requirements and
conditions that apply to the compensation for the mastectomy.
2. If reconstructive surgery is begun
within 3 years after a mastectomy, the amount of the compensation provided for
that surgery must equal those amounts provided for in chapters 616A to 616D, inclusive, of NRS at the time of the
mastectomy. If the surgery is begun more than 3 years after the mastectomy, the
compensation provided is subject to the requirements and conditions that apply
at the time of the reconstructive surgery.
3. For the purposes of this section,
“reconstructive surgery” means a surgical procedure performed following a
mastectomy on one breast or both breasts to re-establish symmetry between the
two breasts. The term includes, but is not limited to, augmentation mammoplasty,
reduction mammoplasty and mastopexy.
(Added to NRS by 1983, 617; A 1989, 1892)—(Substituted
in revision for NRS 616.503)
NRS 616C.190 Compensation of employee injured out of State.
1. Except as otherwise provided in
subsection 4 of NRS 616B.600, if an
employee who has been hired or is regularly employed in this State receives a
personal injury by an accident arising out of and in the course of such
employment outside of this State, the employee, or the dependents of the
employee in case of the death of the employee, are entitled to receive
compensation according to the law of this State, and such compensation is the
exclusive remedy of the employee or dependents.
2. The provisions of this section apply
only to those injuries received by the employee within 6 months after leaving
this State, unless before the expiration of the 6-month period the employer has
filed with the private carrier or, in the case of a self-insured employer or an
association of self-insured public or private employers, with the Administrator
notice that he or she has elected to extend the coverage for a greater period.
[Part 74:168:1947; A 1955, 187]—(NRS A 1981, 1168, 1488; 1989, 579; 1995, 2031; 1999, 1778)
NRS 616C.195 Acceptance of compensation or benefits by employee injured out
of State constitutes release of employer and waiver of remedy at common law or
statutory remedy provided in another state.
1. Anything to the contrary in chapters 616A to 616D, inclusive, of NRS notwithstanding, if an
employee who has been hired or is regularly employed in this State receives
personal injury by accident arising out of and in the course of such employment
outside this State, and the employee, or the dependents of the employee in case
of his or her death, accepts any compensation or benefits under the provisions
of chapters 616A to 616D, inclusive, of NRS, the acceptance of
such compensation shall constitute a waiver by such employee or dependents of
all rights and remedies against the employer at common law or given under the
laws of any other state, and shall further constitute a full and complete
release of such employer from any and all liability arising from such injury or
death.
2. No compensation shall be paid to any
such employee, or his or her dependents in case of death, until such employee,
the employee’s personal or legal representatives, dependents or next of kin
shall have executed and delivered to the employer a full and complete release
of such employer from any and all liability arising from or growing out of such
injury or death.
[74.1:168:1947; added 1955, 187]—(Substituted in
revision for NRS 616.525)
NRS 616C.200 Commencement of action in another state to recover damages or
compensation by employee injured out of State constitutes irrevocable waiver of
compensation due under Nevada law; satisfaction of foreign judgment against
Nevada employer.
1. If an employee who has been hired or is
regularly employed in this State receives a personal injury by an accident
arising out of and in the course of such employment outside this State, and the
employee, or the employee’s personal or legal representatives, dependents or
next of kin commence any action or proceeding in any other state to recover any
damages or compensation from his or her employer for the injury or death, the
act of commencing such an action or proceeding constitutes an irrevocable
waiver of all compensation for the injury or death to which persons would otherwise
have been entitled under the laws of this State.
2. If the injured employee or the
employee’s personal or legal representatives, dependents or next of kin recover
a final judgment against the employer for damages arising out of the injury or
death in any court of competent jurisdiction in any other state, the
compensation which would otherwise have been payable under the laws of this
State, up to the full amount thereof, but less any sums previously paid for the
injury or death, must be applied in satisfaction of the judgment as follows:
(a) Upon receipt of an authenticated copy of the
final judgment and writ of execution or other process issued in aid thereof,
the insurer shall immediately determine the total amount of compensation which
would have been payable under the laws of this State if a claim therefor had
been made to the insurer. In the case of compensation payable in installments,
the insurer shall convert it into a lump sum by such a system of computation as
the Administrator deems proper.
(b) The insurer shall thereupon order to be paid
in full or partial satisfaction of the judgment a sum not to exceed the total
amount of compensation computed as provided in this section or the amount of
the judgment, whichever is less.
(c) Except for a self-insured employer or an
employer who is a member of an association of self-insured public or private
employers, if the judgment is satisfied fully by the employer before any
payment by the private carrier pursuant to paragraph (b), the amount payable
thereunder must be paid to the employer.
[74.2:168:1947; added 1955, 187]—(NRS A 1979, 1054; 1981, 1169, 1489; 1995, 2031; 1999, 1778)
NRS 616C.205 Compensation not assignable; exempt from attachment, garnishment
and execution; accrued compensation payable to dependents. Except as otherwise provided in this section
and NRS 31A.150 and 31A.330, compensation payable or paid
under chapters 616A to 616D, inclusive, or chapter 617 of NRS, whether determined or due, or not:
1. Is not assignable before the issuance
and delivery of the check or the deposit of any payment for compensation
pursuant to NRS 616C.409;
2. Is exempt from attachment, garnishment
and execution; and
3. Does not pass to any other person by
operation of law.
Ê In the case
of the death of an injured employee covered by chapters
616A to 616D, inclusive, or chapter 617 of NRS from causes independent from the
injury for which compensation is payable, any compensation due the employee
which was awarded or accrued but for which a check was not issued or delivered
or for which payment was not made pursuant to NRS
616C.409 at the date of death of the employee is payable to the dependents
of the employee as defined in NRS 616C.505.
[Part 66:168:1947; A 1955, 71]—(NRS A 1979, 1055; 1983, 1880; 1985, 1434; 1993, 543; 1999, 221, 3285; 2007, 400)
NRS 616C.210 Compensation of nonresident alien dependents; notification of
dependent required.
1. The insurer shall notify a dependent of
a deceased employee who is residing outside of the United States by certified
mail at the last known address of the dependent if compensation is due the
decedent or beneficiary pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS. The dependent may request that
payment be made directly to him or her within 90 calendar days after the notice
was mailed. The insurer shall pay compensation which is due a beneficiary
directly to the beneficiary if the beneficiary requests payment within 90
calendar days after the notice was mailed.
2. If the insurer does not receive a
request that payment be made directly to a beneficiary within 90 days after the
notice required by subsection 1 is mailed, payments to the consul general, vice
consul general, consul or vice consul of the nation of which any dependent of a
deceased employee is a resident or subject, or a representative of such consul
general, vice consul general, consul or vice consul, of any compensation due
under chapters 616A to 616D, inclusive, or chapter 617 of NRS to any dependent residing outside of
the United States, any power of attorney to receive or receipt for the same to
the contrary notwithstanding, are as full a discharge of the benefits or
compensation payable under those chapters as if payments were made directly to
the beneficiary.
[Part 66:168:1947; A 1955, 71]—(NRS A 1991, 804; 1999, 221)
NRS 616C.215 Actions and proceedings to recover damages in tort or from
proceeds of vehicle insurance: Reduction of compensation by amount of recovery;
rights of injured employee or dependents and of insurer or Administrator;
notification and payment of insurer or Administrator; instructions to jury;
calculation of employer’s premium.
1. If an injured employee or, in the event
of his or her death, the dependents of the employee, bring an action in tort
against his or her employer to recover payment for an injury which is
compensable pursuant to the provisions of chapters
616A to 616D, inclusive, or chapter 617 of NRS and, notwithstanding the provisions
of NRS 616A.020, receive payment from
the employer for that injury:
(a) The amount of compensation the injured
employee or the dependents of the employee are entitled to receive pursuant to
the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS, including any future compensation,
must be reduced by the amount paid by the employer.
(b) The insurer, or in the case of claims involving
the Uninsured Employers’ Claim Account or a subsequent injury account the
Administrator, has a lien upon the total amount paid by the employer if the
injured employee or the dependents of the employee receive compensation
pursuant to the provisions of chapters 616A
to 616D, inclusive, or chapter 617 of NRS.
Ê This subsection
is applicable whether the money paid to the employee or the dependents of the
employee by the employer is classified as a gift, a settlement or otherwise.
The provisions of this subsection do not grant to an injured employee any right
of action in tort to recover damages from the employer for the injury.
2. When an employee receives an injury for
which compensation is payable pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS and which was caused under
circumstances creating a legal liability in some person, other than the
employer or a person in the same employ, to pay damages in respect thereof:
(a) The injured employee, or in case of death the
dependents of the employee, may take proceedings against that person to recover
damages, but the amount of the compensation the injured employee or the
dependents of the employee are entitled to receive pursuant to the provisions
of chapters 616A to 616D, inclusive, or chapter 617 of NRS, including any future compensation,
must be reduced by the amount of the damages recovered, notwithstanding any act
or omission of the employer or a person in the same employ which was a direct
or proximate cause of the employee’s injury.
(b) If the injured employee, or in case of death
the dependents of the employee, receive compensation pursuant to the provisions
of chapters 616A to 616D, inclusive, or chapter 617 of NRS, the insurer, or in case of claims
involving the Uninsured Employers’ Claim Account or a subsequent injury account
the Administrator, has a right of action against the person so liable to pay
damages and is subrogated to the rights of the injured employee or of the
employee’s dependents to recover therefor.
3. When an injured employee incurs an
injury for which compensation is payable pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS and which was caused under
circumstances entitling the employee, or in the case of death the dependents of
the employee, to receive proceeds under his or her employer’s policy of
uninsured or underinsured vehicle coverage:
(a) The injured employee, or in the case of death
the dependents of the employee, may take proceedings to recover those proceeds,
but the amount of compensation the injured employee or the dependents of the
employee are entitled to receive pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS, including any future compensation,
must be reduced by the amount of proceeds received.
(b) If an injured employee, or in the case of
death the dependents of the employee, receive compensation pursuant to the
provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS, the insurer, or in the case of
claims involving the Uninsured Employers’ Claim Account or a subsequent injury
account the Administrator, is subrogated to the rights of the injured employee
or the dependents of the employee to recover proceeds under the employer’s
policy of uninsured or underinsured vehicle coverage. The insurer and the
Administrator are not subrogated to the rights of an injured employee or the
dependents of the employee under a policy of uninsured or underinsured vehicle
coverage purchased by the employee.
(c) Any provision in the employer’s policy of
uninsured or underinsured vehicle coverage which has the effect of:
(1) Limiting the rights of the injured
employee or the dependents of the employee to recover proceeds under the policy
because of the receipt of any compensation pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS;
(2) Limiting the rights of subrogation of
the insurer or Administrator provided by paragraph (b); or
(3) Excluding coverage which inures to the
direct or indirect benefit of the insurer or Administrator,
Ê is void.
4. In any action or proceedings taken by
the insurer or the Administrator pursuant to this section, evidence of the
amount of compensation, accident benefits and other expenditures which the
insurer, the Uninsured Employers’ Claim Account or a subsequent injury account
have paid or become obligated to pay by reason of the injury or death of the
employee is admissible. If in such action or proceedings the insurer or the
Administrator recovers more than those amounts, the excess must be paid to the
injured employee or the dependents of the employee.
5. In any case where the insurer or the
Administrator is subrogated to the rights of the injured employee or of the
employee’s dependents as provided in subsection 2 or 3, the insurer or the
Administrator has a lien upon the total proceeds of any recovery from some
person other than the employer, whether the proceeds of such recovery are by
way of judgment, settlement or otherwise. The injured employee, or in the case
of his or her death the dependents of the employee, are not entitled to double recovery
for the same injury, notwithstanding any act or omission of the employer or a
person in the same employ which was a direct or proximate cause of the
employee’s injury.
6. The lien provided for pursuant to
subsection 1 or 5 includes the total compensation expenditure incurred by the
insurer, the Uninsured Employers’ Claim Account or a subsequent injury account
for the injured employee and the dependents of the employee.
7. An injured employee, or in the case of
death the dependents of the employee, or the attorney or representative of the
injured employee or the dependents of the employee, shall notify the insurer,
or in the case of claims involving the Uninsured Employers’ Claim Account or a
subsequent injury account the Administrator, in writing before initiating a
proceeding or action pursuant to this section.
8. Within 15 days after the date of
recovery by way of actual receipt of the proceeds of the judgment, settlement
or otherwise:
(a) The injured employee or the dependents of the
employee, or the attorney or representative of the injured employee or the
dependents of the employee; and
(b) The third-party insurer,
Ê shall notify
the insurer, or in the case of claims involving the Uninsured Employers’ Claim
Account or a subsequent injury account the Administrator, of the recovery and
pay to the insurer or the Administrator, respectively, the amount due pursuant
to this section together with an itemized statement showing the distribution of
the total recovery. The attorney or representative of the injured employee or
the dependents of the employee and the third-party insurer are jointly and
severally liable for any amount to which an insurer is entitled pursuant to this
section if the attorney, representative or third-party insurer has knowledge of
the lien provided for in this section.
9. An insurer shall not sell its lien to a
third-party insurer unless the injured employee or the dependents of the
employee, or the attorney or representative of the injured employee or the
dependents of the employee, refuses to provide to the insurer information
concerning the action against the third party.
10. In any trial of an action by the
injured employee, or in the case of his or her death by the dependents of the
employee, against a person other than the employer or a person in the same
employ, the jury must receive proof of the amount of all payments made or to be
made by the insurer or the Administrator. The court shall instruct the jury
substantially as follows:
Payment of workmen’s
compensation benefits by the insurer, or in the case of claims involving the
Uninsured Employers’ Claim Account or a subsequent injury account the
Administrator, is based upon the fact that a compensable industrial accident
occurred, and does not depend upon blame or fault. If the plaintiff does not
obtain a judgment in his or her favor in this case, the plaintiff is not
required to repay his or her employer, the insurer or the Administrator any
amount paid to the plaintiff or paid on the behalf of the plaintiff by the
plaintiff’s employer, the insurer or the Administrator.
If you decide that the
plaintiff is entitled to judgment against the defendant, you shall find damages
for the plaintiff in accordance with the court’s instructions on damages and
return your verdict in the plaintiff’s favor in the amount so found without
deducting the amount of any compensation benefits paid to or for the plaintiff.
The law provides a means by which any compensation benefits will be repaid from
your award.
11. To calculate an employer’s premium,
the employer’s account with the private carrier must be credited with an amount
equal to that recovered by the private carrier from a third party pursuant to
this section, less the private carrier’s share of the expenses of litigation
incurred in obtaining the recovery, except that the total credit must not
exceed the amount of compensation actually paid or reserved by the private
carrier on the injured employee’s claim.
12. As used in this section, “third-party
insurer” means an insurer that issued to a third party who is liable for
damages pursuant to subsection 2, a policy of liability insurance the proceeds
of which are recoverable pursuant to this section. The term includes an insurer
that issued to an employer a policy of uninsured or underinsured vehicle
coverage.
[75:168:1947; A 1949, 659; 1943 NCL § 2680.75]—(NRS A
1957, 519; 1973, 498; 1977, 216, 424; 1979, 1055; 1981, 1491; 1991, 2419; 1993, 621, 742; 1997, 599; 1999, 221, 763, 1779; 2001, 2765; 2007, 3346)
NRS 616C.220 Compensation from Uninsured Employers’ Claim Account:
Administration and payment of claims; eligibility of employee; liability of
employer; powers and duties of Division; appeals; collection.
1. The Division shall designate one:
(a) Third-party administrator who has a valid certificate
issued by the Commissioner pursuant to NRS
683A.085; or
(b) Insurer, other than a self-insured employer
or association of self-insured public or private employers,
Ê to administer
claims against the Uninsured Employers’ Claim Account. The designation must be
made pursuant to reasonable competitive bidding procedures established by the
Administrator.
2. Except as otherwise provided in this
subsection, an employee may receive compensation from the Uninsured Employers’
Claim Account if:
(a) The employee was hired in this State or is
regularly employed in this State;
(b) The employee suffers an accident or injury
which arises out of and in the course of his or her employment:
(1) In this State; or
(2) While on temporary assignment outside
the State for not more than 12 months;
(c) The employee files a claim for compensation
with the Division; and
(d) The employee makes an irrevocable assignment
to the Division of a right to be subrogated to the rights of the injured
employee pursuant to NRS 616C.215.
Ê An employee
who suffers an accident or injury while on temporary assignment outside the
State is not eligible to receive compensation from the Uninsured Employers’
Claim Account unless the employee has been denied workers’ compensation in the
state in which the accident or injury occurred.
3. If the Division receives a claim
pursuant to subsection 2, the Division shall immediately notify the employer of
the claim.
4. For the purposes of this section and NRS 616C.223, the employer has the burden of proving
that the employer provided mandatory industrial insurance coverage for the
employee or that the employer was not required to maintain industrial insurance
for the employee.
5. Any employer who has failed to provide
mandatory coverage required by the provisions of chapters
616A to 616D, inclusive, of NRS is
liable for all payments made on behalf of the employer, including any benefits,
administrative costs or attorney’s fees paid from the Uninsured Employers’
Claim Account or incurred by the Division.
6. The Division:
(a) May recover from the employer the payments
made by the Division that are described in subsection 5 and any accrued
interest by bringing a civil action or filing an application for the entry of
summary judgment pursuant to NRS 616C.223 in a
court of competent jurisdiction. For the purposes of this paragraph, the
payments made by the Division that are described in subsection 5 are presumed
to be:
(1) Justified by the circumstances of the
claim;
(2) Made in accordance with applicable
law; and
(3) Reasonable and necessary.
(b) In any civil action or application for the
entry of summary judgment filed pursuant to NRS
616C.223 against the employer, is not required to prove that negligent
conduct by the employer was the cause of the employee’s injury.
(c) May enter into a contract with any person to
assist in the collection of any liability of an uninsured employer.
(d) In lieu of a civil action or filing an
application for the entry of summary judgment pursuant to NRS 616C.223, may enter into an agreement or
settlement regarding the collection of any liability of an uninsured employer.
7. The Division shall:
(a) Determine whether the employer was insured
within 30 days after receiving notice of the claim from the employee.
(b) Assign the claim to the third-party
administrator or insurer designated pursuant to subsection 1 for administration
and payment of compensation.
Ê Upon
determining whether the claim is accepted or denied, the designated third-party
administrator or insurer shall notify the injured employee, the named employer
and the Division of its determination.
8. Upon demonstration of the:
(a) Costs incurred by the designated third-party
administrator or insurer to administer the claim or pay compensation to the
injured employee; or
(b) Amount that the designated third-party
administrator or insurer will pay for administrative expenses or compensation
to the injured employee and that such amounts are justified by the
circumstances of the claim,
Ê the Division
shall authorize payment from the Uninsured Employers’ Claim Account.
9. Any party aggrieved by a determination
made by the Division regarding the assignment of any claim made pursuant to
this section may appeal that determination by filing a notice of appeal with an
appeals officer within 30 days after the determination is rendered. The
provisions of NRS 616C.345 to 616C.385, inclusive, apply to an appeal filed
pursuant to this subsection.
10. Any party aggrieved by a determination
to accept or to deny any claim made pursuant to this section or by a
determination to pay or to deny the payment of compensation regarding any claim
made pursuant to this section may appeal that determination, within 70 days
after the determination is rendered, to the Hearings Division of the Department
of Administration in the manner provided by NRS
616C.305 and 616C.315.
11. All insurers shall bear a
proportionate amount of a claim made pursuant to chapters
616A to 616D, inclusive, of NRS, and
are entitled to a proportionate amount of any collection made pursuant to this
section as an offset against future liabilities.
12. An uninsured employer is liable for
the interest on any amount paid on his or her claims from the Uninsured
Employers’ Claim Account. The interest must be calculated at a rate equal to
the prime rate at the largest bank in Nevada, as ascertained by the
Commissioner of Financial Institutions, on January 1 or July 1, as the case may
be, immediately preceding the date of the claim, plus 3 percent, compounded
monthly, from the date the claim is paid from the account until payment is
received by the Division from the employer.
13. Attorney’s fees recoverable by the
Division pursuant to this section must be:
(a) If a private attorney is retained by the
Division, paid at the usual and customary rate for that attorney.
(b) If the attorney is an employee of the
Division, paid at the rate established by regulations adopted by the Division.
Ê Any money
collected must be deposited to the Uninsured Employers’ Claim Account.
14. If the Division has not obtained a
civil judgment or an entry of summary judgment pursuant to NRS 616C.223 and the Division assigns a debt that
arises under this section to the State Controller for collection pursuant to NRS 353C.195, the State Controller may
bring an action in his or her own name in a court of competent jurisdiction to
recover any amount that the Division is authorized to recover pursuant to this
section.
(Added to NRS by 1975, 599; A 1981, 1197, 1830; 1991, 2408; 1993, 716, 1863; 1995, 579; 1997, 1436; 1999, 1726; 2001, 2739, 2767; 2003, 195, 2306; 2009, 1182;
2011, 893)
NRS 616C.223 Application for entry of summary judgment: Conditions; notice to
employer; filing requirements; entry of judgment; service of judgment;
recordation of judgment; lien upon property of employer; extension of lien.
1. Except as otherwise provided in this
subsection, if an employer fails to pay to the Division any amount due pursuant
to NRS 616C.220, the Division may, after the date
on which the debt became due, file with the office of the clerk of a court of
competent jurisdiction an application for the entry of summary judgment against
the employer for the amount due. The Division may not enforce a judgment
against an employer if an appeal requested by the employer pursuant to NRS 616C.220 is pending.
2. If the Division intends to file an
application for the entry of summary judgment, the Division shall, not less
than 15 days before the date on which the application is filed, notify the
employer of the Division’s intention to file the application. The notification
must be sent by certified mail to the last known address of the employer and
must include the name of the employee for whom the claim was paid, the amount
sought to be recovered and the date on which the application will be filed with
the court.
3. An application for the entry of summary
judgment must:
(a) Be accompanied by a certificate which
specifies:
(1) The amount owed by the employer,
including any attorney’s fees, interest and administrative costs due;
(2) The name and address of the employer;
and
(3) That the Division has complied with
the applicable provisions of law relating to the determination of the amount
required to be paid; and
(b) Include:
(1) A request that judgment be entered
against the employer for the amount specified in the certificate; and
(2) Evidence that the employer was
notified of the application for the entry of summary judgment in accordance
with subsection 2.
4. The court clerk, upon the filing of an
application for the entry of summary judgment which complies with the
requirements set forth in this section, shall forthwith enter a judgment
against the employer in the amount of the debt, plus any attorney’s fees,
interest and administrative costs, as set forth in the certificate. The
Division shall serve a copy of the judgment, together with a copy of the
application and the certificate, upon the employer against whom the judgment is
entered, either by personal service or by mailing a copy to the last known
address of the employer.
5. An abstract of the judgment entered
pursuant to subsection 4, or a copy thereof, may be recorded in the office of
the county recorder of any county.
6. From the time of its recordation, the
judgment constitutes a lien upon all real and personal property situated in the
county that is owned by the employer, or which the employer may afterward
acquire, until the lien expires. The lien has the force, effect and priority of
a judgment lien and continues for 6 years after the date of the judgment so
entered by the court clerk unless sooner released or otherwise discharged.
7. Within 6 years after the date of the
recording of the judgment or within 6 years after the date of the last
extension of the lien pursuant to this subsection, the lien may be extended by
recording an affidavit of renewal in the office of the county recorder. From
the date of recording, the lien is extended for 6 years to all real and
personal property situated in the county that is owned by the employer or
acquired by the employer afterwards, unless the lien is sooner released or
otherwise discharged.
(Added to NRS by 2011, 891)
NRS 616C.225 Misrepresentation or concealment of fact to obtain benefits:
Insurer entitled to reimbursement or deduction from benefits; appeal of
determination; alternative remedies.
1. Except as otherwise provided in this
section, if an insurer determines that an employee has knowingly misrepresented
or concealed a material fact to obtain any benefit or payment under the
provisions of chapters 616A to 616D, inclusive, of NRS, the insurer may
deduct from any benefits or payments due to the employee, the amount obtained
by the employee because of the misrepresentation or concealment of a material
fact. The employee shall reimburse the insurer for all benefits or payments
received because of the willful misrepresentation or concealment of a material
fact.
2. An employee who is aggrieved by a
determination of an insurer made pursuant to subsection 1 may appeal that
determination pursuant to NRS 616C.315 to 616C.385, inclusive. If the final decision by an
appeals officer is favorable to the employee, the Administrator shall order the
insurer to pay $2,000 to that employee, in addition to any benefits or payments
the employee is entitled to receive, if the Administrator determines that the
insurer had no reasonable basis for believing that the employee knowingly
misrepresented or concealed a material fact to obtain any benefit or payment.
3. If an employee elects to receive an
award for a permanent partial disability in a lump sum pursuant to NRS 616C.495 and a criminal action is brought against
the employee for an alleged violation of NRS
616D.300, the insurer shall, upon receiving notice of the action and until
a judgment is entered in the action, pay reasonable portions of the lump-sum
award in monthly installments. If the employee is not convicted of the alleged
violation, the insurer shall pay the employee the balance of the award in a
lump sum. The provisions of subsection 2 do not apply to require any additional
payment at the conclusion of a criminal action.
4. This section does not preclude an
insurer from making an investigation pursuant to, or pursuing the remedies
provided by, NRS 616D.300.
(Added to NRS by 1989, 1993; A 1993, 745; 1995, 1873)—(Substituted
in revision for NRS 616.563)
NRS 616C.230 Grounds for denial, reduction or suspension of compensation;
evidence of and examination for use of alcohol or controlled substance.
1. Compensation is not payable pursuant to
the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS for an injury:
(a) Caused by the employee’s willful intention to
injure himself or herself.
(b) Caused by the employee’s willful intention to
injure another.
(c) Proximately caused by the employee’s
intoxication. If the employee was intoxicated at the time of his or her injury,
intoxication must be presumed to be a proximate cause unless rebutted by
evidence to the contrary.
(d) Proximately caused by the employee’s use of a
controlled substance. If the employee had any amount of a controlled substance
in his or her system at the time of his or her injury for which the employee
did not have a current and lawful prescription issued in the employee’s name or
that the employee was not using in accordance with the provisions of chapter 453A of NRS, the controlled substance
must be presumed to be a proximate cause unless rebutted by evidence to the
contrary.
2. For the purposes of paragraphs (c) and
(d) of subsection 1:
(a) The affidavit or declaration of an expert or
other person described in NRS 50.310, 50.315 or 50.320 is admissible to prove the
existence of any alcohol or the existence, quantity or identity of a controlled
substance in an employee’s system. If the affidavit or declaration is to be so
used, it must be submitted in the manner prescribed in NRS
616C.355.
(b) When an examination requested or ordered
includes testing for the use of alcohol or a controlled substance, the
laboratory that conducts the testing must be licensed pursuant to the
provisions of chapter 652 of NRS.
3. No compensation is payable for the
death, disability or treatment of an employee if the employee’s death is caused
by, or insofar as the employee’s disability is aggravated, caused or continued
by, an unreasonable refusal or neglect to submit to or to follow any competent
and reasonable surgical treatment or medical aid.
4. If any employee persists in an
unsanitary or injurious practice that imperils or retards his or her recovery,
or refuses to submit to such medical or surgical treatment as is necessary to
promote his or her recovery, the employee’s compensation may be reduced or
suspended.
5. An injured employee’s compensation,
other than accident benefits, must be suspended if:
(a) A physician or chiropractor determines that
the employee is unable to undergo treatment, testing or examination for the
industrial injury solely because of a condition or injury that did not arise
out of and in the course of employment; and
(b) It is within the ability of the employee to
correct the nonindustrial condition or injury.
Ê The
compensation must be suspended until the injured employee is able to resume
treatment, testing or examination for the industrial injury. The insurer may
elect to pay for the treatment of the nonindustrial condition or injury.
[70:168:1947; 1943 NCL § 2680.70] + [71:168:1947;
1943 NCL § 2680.71] + [72:168:1947; 1943 NCL § 2680.72]—(NRS A 1979, 1057; 1981, 1198; 1991, 2421; 1993, 745; 1995, 2153; 1997, 1394, 1421; 1999, 224, 442, 2215; 2001, 3072; 2009, 1280)
NRS 616C.232 Denial of compensation for temporary total disability because of
discharge for misconduct.
1. If an injured employee is discharged
from his or her employment as a result of misconduct, an insurer may deny
compensation for temporary total disability to the injured employee because of
that discharge for misconduct only if the insurer proves by a preponderance of
the evidence that:
(a) The injured employee was discharged from his
or her employment solely for the employee’s misconduct and not for any reason
relating to the employee’s claim for compensation; and
(b) It is the injured employee’s discharge from
his or her employment for misconduct, and not the injury, that is the sole
cause for the injured employee’s inability to return to work with the preinjury
employer.
2. An insurer waives its rights under
subsection 1 if the insurer does not make a determination to deny or suspend
compensation to the injured employee within 70 days after the date on which the
insurer learns that the injured employee has been discharged for misconduct.
3. An insurer may not deny any
compensation pursuant to this section except for compensation for temporary
total disability pursuant to subsection 1.
4. Discharge from employment for reasons
other than gross misconduct does not limit an injured employee’s entitlement to
receive benefits for temporary total disability.
(Added to NRS by 2007, 3343; A 2009, 1281,
3033)
NRS 616C.235 Closure of claim by insurer: Procedure; notice; special
procedure if medical benefits less than $300.
1. Except as otherwise provided in
subsections 2, 3 and 4:
(a) When the insurer determines that a claim
should be closed before all benefits to which the claimant may be entitled have
been paid, the insurer shall send a written notice of its intention to close
the claim to the claimant by first-class mail addressed to the last known
address of the claimant and, if the insurer has been notified that the claimant
is represented by an attorney, to the attorney for the claimant by first-class
mail addressed to the last known address of the attorney. The notice must
include, on a separate page, a statement describing the effects of closing a
claim pursuant to this section and a statement that if the claimant does not
agree with the determination, the claimant has a right to request a resolution
of the dispute pursuant to NRS 616C.305 and 616C.315 to 616C.385,
inclusive, including, without limitation, a statement which prominently
displays the limit on the time that the claimant has to request a resolution of
the dispute as set forth in NRS 616C.315. A
suitable form for requesting a resolution of the dispute must be enclosed with
the notice. The closure of a claim pursuant to this subsection is not effective
unless notice is given as required by this subsection.
(b) If the insurer does not receive a request for
the resolution of the dispute, it may close the claim.
(c) Notwithstanding the provisions of NRS 233B.125, if a hearing is conducted
to resolve the dispute, the decision of the hearing officer may be served by
first-class mail.
2. If, during the first 12 months after a
claim is opened, the medical benefits required to be paid for a claim are less
than $300, the insurer may close the claim at any time after the insurer sends,
by first-class mail addressed to the last known address of the claimant,
written notice that includes a statement which prominently displays that:
(a) The claim is being closed pursuant to this
subsection;
(b) The injured employee may appeal the closure
of the claim pursuant to the provisions of NRS
616C.305 and 616C.315 to 616C.385, inclusive; and
(c) If the injured employee does not appeal the
closure of the claim or appeals the closure of the claim but is not successful,
the claim cannot be reopened.
3. In addition to the notice described in
subsection 2, an insurer shall send to each claimant who receives less than
$300 in medical benefits within 6 months after the claim is opened a written
notice that explains the circumstances under which a claim may be closed
pursuant to subsection 2. The written notice provided pursuant to this
subsection does not create any right to appeal the contents of that notice. The
written notice must be:
(a) Sent by first-class mail addressed to the
last known address of the claimant; and
(b) A document that is separate from any other
document or form that is used by the insurer.
4. The closure of a claim pursuant to
subsection 2 is not effective unless notice is given as required by subsections
2 and 3.
5. In addition to the requirements of this
section, an insurer shall include in the written notice described in subsection
2:
(a) If an evaluation for a permanent partial
disability has been scheduled pursuant to NRS 616C.490,
a statement to that effect; or
(b) If an evaluation for a permanent partial
disability will not be scheduled pursuant to NRS
616C.490, a statement explaining that the reason is because the insurer has
determined there is no possibility of a permanent impairment of any kind.
(Added to NRS by 1979, 707; A 1981, 1140, 1492; 1989, 333; 1991, 2421; 1993, 746; 1997, 1437; 1999, 1783, 2416; 2001, 115; 2007, 3349; 2009, 1282)
ACCIDENT BENEFITS
NRS 616C.245 Injured employee entitled to accident benefits; limitation on
receipt of modified motor vehicle as accident benefit; regulations establishing
maximum benefit.
1. Every injured employee within the
provisions of chapters 616A to 616D, inclusive, of NRS is entitled to receive
promptly such accident benefits as may reasonably be required at the time of
the injury and within 6 months thereafter. Such benefits may be further
extended for additional periods as may be required.
2. An injured employee is entitled to
receive as an accident benefit a motor vehicle that is modified to allow the
employee to operate the vehicle safely if:
(a) As a result of an injury arising out of and
in the course of his or her employment, the injured employee is quadriplegic,
paraplegic or has had a part of his or her body amputated; and
(b) The injured employee cannot be fitted with a
prosthetic device which allows the employee to operate a motor vehicle safely.
3. If an injured employee is entitled to
receive a motor vehicle pursuant to subsection 2, a motor vehicle must be
modified to allow the employee to operate it safely in the following order of
preference:
(a) A motor vehicle owned by the injured employee
must be so modified if the insurer or employer providing accident benefits
determines that it is reasonably feasible to do so.
(b) A used motor vehicle must be so modified if
the insurer or employer providing accident benefits determines that it is
reasonably feasible to do so.
(c) A new motor vehicle must be so modified.
4. The Administrator shall adopt
regulations establishing a maximum benefit to be paid under the provisions of
this section.
[Part 58:168:1947; 1943 NCL § 2680.58]—(NRS A 1957,
28; 1973, 605; 1993,
733; 2003,
2332)
NRS 616C.250 Establishment, revision and compliance with standards of care
for provision of accident benefits.
1. The Division shall, after consulting
with and considering the advice of persons representative of organized labor
groups, employers, insurers and providers of health care, adopt regulations
establishing standards of care for the provision of accident benefits to
employees who have suffered industrial injuries or occupational diseases. The
standards must include, but are not limited to criteria and protocols to be
used as minimal guides for evaluating and ensuring the quality of programs of
treatment and for reviewing the:
(a) Utilization of diagnostic procedures and the
provision of other medical services;
(b) Treatment and expected durations of
industrial injuries and occupational diseases;
(c) Utilization of narcotic drugs and other forms
of medication;
(d) Referral of patients to obtain a second
opinion; and
(e) Provision of care by more than one provider
of health care.
Ê The
standards must be consistent with national or regional guidelines and must be
specific to medicine for industrial injuries and occupational diseases.
2. The Division shall, after consulting
with and considering the advice of persons representative of organized labor
groups, employers, insurers and providers of health care, periodically review
and revise as necessary the standards established pursuant to subsection 1.
3. An insurer and each person who provides
any accident benefit to an employee who has suffered an industrial injury or
occupational disease shall comply with the regulations adopted pursuant to this
section.
(Added to NRS by 1991, 389; A 1993, 1858)—(Substituted
in revision for NRS 616.188)
NRS 616C.255 Premium for accident benefits paid by employer; accident
benefits provided by private carrier; separate account for accident benefits.
1. Each private carrier shall collect a
premium upon the total payroll of every employer insured by the private carrier
at the rate filed with the Commissioner pursuant to chapter 686B of NRS.
2. Every employer paying this premium is
relieved from furnishing accident benefits, and the accident benefits must be
provided by the private carrier.
3. The private carrier is liable for any
accident benefits provided in this section. The account provided for accident
benefits must be kept as a separate account on the records of the private
carrier.
[Part 58:168:1947; 1943 NCL § 2680.58]—(NRS A 1973,
601; 1981, 1475;
1995, 2027;
1997, 1438;
1999, 444, 1784)
NRS 616C.260 Fees and charges for accident benefits: Restrictions;
establishment and revision of schedule; powers and duties of Administrator;
penalty for refusal to provide information; regulations.
1. All fees and charges for accident
benefits must not:
(a) Exceed the amounts usually billed and paid in
the State for similar treatment.
(b) Be unfairly discriminatory as between persons
legally qualified to provide the particular service for which the fees or
charges are asked.
2. The Administrator shall, giving
consideration to the fees and charges being billed and paid in the State,
establish a schedule of reasonable fees and charges allowable for accident
benefits provided to injured employees whose insurers have not contracted with
an organization for managed care or with providers of health care services
pursuant to NRS 616B.527. The
Administrator shall review and revise the schedule on or before February 1 of
each year. In the revision, the Administrator shall adjust the schedule by the
corresponding annual change in the Consumer Price Index, Medical Care
Component.
3. The Administrator shall designate a
vendor who compiles data on a national basis concerning fees and charges that are
billed and paid for treatment or services similar to the treatment and services
that qualify as accident benefits in this State to provide the Administrator
with such information as the Administrator deems necessary to carry out the
provisions of subsection 2. The designation must be made pursuant to reasonable
competitive bidding procedures established by the Administrator. In addition,
the Administrator may request a health insurer, health maintenance organization
or provider of accident benefits, an agent or employee of such a person, or an
agency of the State to provide the Administrator with information concerning
fees and charges that are billed and paid in this State for similar services as
the Administrator deems necessary to carry out the provisions of subsection 2.
The Administrator shall require a health insurer, health maintenance
organization or provider of accident benefits, an agent or employee of such a
person, or an agency of the State that provides records or reports of fees and
charges billed and paid pursuant to this section to provide interpretation and
identification concerning the information delivered. The Administrator may
impose an administrative fine of $500 on a health insurer, health maintenance
organization or provider of accident benefits, or an agent or employee of such
a person for each refusal to provide the information requested pursuant to this
subsection.
4. The Division may adopt reasonable
regulations necessary to carry out the provisions of this section. The
regulations must include provisions concerning:
(a) Standards for the development of the schedule
of fees and charges that are billed and paid; and
(b) The monitoring of compliance by providers of
benefits with the schedule of fees and charges.
5. The Division shall adopt regulations
requiring the use of a system of billing codes as recommended by the American
Medical Association.
(Added to NRS by 1981, 1454; A 1983, 325, 1294; 1985, 574; 1987, 2148; 1991, 2412; 1993, 723, 1865; 1995, 579; 1999, 1784; 2001, 961)
NRS 616C.265 Election by employer to provide accident benefits; reporting
requirements; payment of assessments.
1. Except as otherwise provided in NRS 616C.280, every employer operating under chapters 616A to 616D, inclusive, of NRS, alone or together with
other employers, may make arrangements to provide accident benefits as defined
in those chapters for injured employees.
2. Employers electing to make such
arrangements shall notify the Administrator of the election and render a
detailed statement of the arrangements made, which arrangements do not become
effective until approved by the Administrator.
3. Every employer who maintains a hospital
of any kind for his or her employees, or who contracts for the hospital care of
injured employees, shall, on or before January 30 of each year, make a written
report to the Administrator for the preceding year, which must contain a statement
showing:
(a) The total amount of hospital fees collected,
showing separately the amount contributed by the employees and the amount
contributed by the employers;
(b) An itemized account of the expenditures,
investments or other disposition of such fees; and
(c) What balance, if any, remains.
4. Every employer who provides accident
benefits pursuant to this section:
(a) Shall, in accordance with regulations adopted
by the Administrator, make a written report to the Division of that employer’s
actual and expected annual expenditures for claims and such other information
as the Division deems necessary to calculate an estimated or final annual
assessment and shall, to the extent that the regulations refer to the
responsibility of insurers to make such reports, be deemed to be an insurer.
(b) Shall pay the assessments collected pursuant
to NRS 232.680 and 616A.430.
5. The reports required by the provisions
of subsections 3 and 4 must be verified:
(a) If the employer is a natural person, by the
employer;
(b) If the employer is a partnership, by one of
the partners;
(c) If the employer is a corporation, by the
secretary, president, general manager or other executive officer of the
corporation; or
(d) If the employer has contracted with a
physician or chiropractor for the hospital care of injured employees, by the
physician or chiropractor.
6. No employee is required to accept the
services of a physician or chiropractor provided by his or her employer, but
may seek professional medical services of the employee’s choice as provided in NRS 616C.090. Expenses arising from such medical
services must be paid by the employer who has elected to provide benefits,
pursuant to the provisions of this section, for the employer’s injured
employees.
7. Every employer who fails to notify the
Administrator of such election and arrangements, or who fails to render the
financial reports required, is liable for accident benefits as provided by NRS 616C.255.
[Part 58:168:1947; 1943 NCL § 2680.58]—(NRS A 1973,
602; 1975, 796; 1981,
1475; 1983,
427; 1985,
1544; 1991,
2413; 1993,
1866; 2001,
2454)
NRS 616C.270 Employers to notify Administrator when injured employee receives
medical services.
1. Every employer who has elected to
provide accident benefits for his or her injured employees shall prepare and
submit a written report to the Administrator:
(a) Within 6 days after any accident if an
injured employee is examined or treated by a physician or chiropractor; and
(b) If the injured employee receives additional
medical services.
2. The Administrator shall review each
report to determine whether the employer is furnishing the accident benefits
required by chapters 616A to 616D, inclusive, of NRS.
3. The content and form of the written
reports must be prescribed by the Administrator.
(Added to NRS by 1977, 393; A 1981, 1476; 1985, 1545)—(Substituted
in revision for NRS 616.417)
NRS 616C.275 Change of physicians, chiropractors or other requirements; cost
of change borne by insurer; cause of action of injured employee assigned to
private carrier.
1. If the Administrator finds that the
employer is furnishing the requirements of accident benefits in such a manner
that there are reasonable grounds for believing that the health, life or
recovery of the employee is being endangered or impaired thereby, or that an
employer has failed to provide benefits pursuant to NRS
616C.265 for which he or she has made arrangements, the Administrator may,
upon application of the employee, or upon the Administrator’s own motion, order
a change of physicians or chiropractors or of any other requirements of
accident benefits.
2. If the Administrator orders a change of
physicians or chiropractors or of any other accident benefits, the cost of the
change must be borne by the insurer.
3. The cause of action of an injured
employee against an employer insured by a private carrier must be assigned to
the private carrier.
[Part 58:168:1947; 1943 NCL § 2680.58]—(NRS A 1973,
602; 1975, 797; 1981,
1168, 1476;
1985, 308, 1545; 1993, 724; 1995, 2027; 1999, 1785)
NRS 616C.280 Withdrawal of approval for employer to provide accident
benefits: Grounds supporting withdrawal. The
Administrator may withdraw his or her approval of an employer’s providing
accident benefits for his or her employees and require the employer to pay the
premium collected pursuant to NRS 616C.255 if the
employer intentionally:
1. Determines incorrectly that a claimed
injury did not arise out of and in the course of the employee’s employment;
2. Fails to advise an injured employee of
the employee’s rights under chapters 616A
to 616D, inclusive, or chapter 617 of NRS;
3. Impedes the determination of disability
or benefits by delaying a needed change of an injured employee’s physician or
chiropractor;
4. Causes an injured employee to file a
legal action to recover any compensation or other medical benefits due the
employee from the employer;
5. Violates any of the Administrator’s or
the Division’s regulations regarding the provision of accident benefits by
employers; or
6. Discriminates against an employee who
claims benefits under chapters 616A to 616D, inclusive, or chapter 617 of NRS.
(Added to NRS by 1983, 426; A 1985, 1545; 1997, 1438; 1999, 225)
NRS 616C.285 Withdrawal of approval for employer to provide accident
benefits: Request for hearing; notice of decision.
1. If an employer requests a hearing
concerning the withdrawal of approval pursuant to NRS
616C.280, the Administrator shall set a date for a hearing within 20 days
after receiving the request, and shall give the employer at least 10 business
days’ notice of the time and place of the hearing.
2. A record of the hearing must be kept,
but it need not be transcribed unless it is requested by the employer and the
employer pays the cost of transcription.
3. Within 5 business days after the
hearing, the Administrator shall either affirm or disaffirm the withdrawal of
approval and give the employer written notice thereof by certified mail or
electronic transmission.
(Added to NRS by 1983, 427; A 1997, 1438)
CONTESTED CLAIMS
NRS 616C.295 Duties of Chief of Hearings Division: Adoption of regulations
establishing codes of conduct for hearing officers and appeals officers,
standards for initial training and continuing education and qualifications for
hearing officers; expediting of certain cases; annual report.
1. The Chief of the Hearings Division
shall adopt regulations establishing:
(a) A code of conduct for hearing officers who
conduct hearings in contested cases for compensation under chapters 616A to 617,
inclusive, of NRS; and
(b) A code of conduct for appeals officers who
conduct hearings and appeals as required pursuant to chapters 616A to 617,
inclusive, of NRS.
2. The codes of conduct established
pursuant to subsection 1 must be designed to ensure fairness and impartiality,
and to avoid the appearance of impropriety.
3. The Chief of the Hearings Division
shall adopt regulations establishing:
(a) Standards for the initial training and
continuing education of hearing officers who conduct hearings in contested
cases for compensation under chapters 616A
to 617, inclusive, of NRS; and
(b) Standards for the initial training and
continuing education of appeals officers who conduct hearings and appeals as
required pursuant to chapters 616A to 617, inclusive, of NRS.
4. The standards established pursuant to
subsection 3 must, without limitation, include training and continuing
education in:
(a) The provisions of chapters 616A to 617,
inclusive, of NRS;
(b) Dispute resolution; and
(c) Mediation.
5. The Chief of the Hearings Division
shall:
(a) Prescribe by regulation the qualifications
required before a person may, pursuant to chapters
616A to 617, inclusive, of NRS, serve as
a hearing officer.
(b) Provide for the expediting of the hearing of
cases that involve the termination or denial of compensation.
6. From the cases heard each year by
hearing officers and appeals officers regarding claims for benefits by injured
employees, the Chief of the Hearings Division shall prepare an annual report
which itemizes, on the basis of each insurer and third-party administrator, the
number of cases affirmed, reversed, remanded and resolved by other disposition
involving that insurer or third-party administrator, including a breakdown of
that information by the type of benefits denied by the insurer or third-party administrator.
7. As used in this section, “Chief of the
Hearings Division” means the Chief of the Hearings Division of the Department
of Administration.
(Added to NRS by 1991, 2396; A 2005, 101; 2007, 3350)
NRS 616C.300 Hearing officers: Appointment; salary; disqualification from
particular case.
1. The Director of the Department of
Administration shall appoint one or more hearing officers to conduct hearings
in contested cases for compensation under chapters
616A to 617, inclusive, of NRS. Each
hearing officer shall serve at the pleasure of the Director of the Department
of Administration. Each hearing officer is entitled to receive an annual salary
in an amount provided by law and is in the unclassified service of the State.
2. If a hearing officer determines that he
or she has a personal interest or a conflict of interest, directly or
indirectly, in any case which is before him or her, the hearing officer shall
disqualify himself or herself from hearing the case and the case must be
assigned to another hearing officer.
(Added to NRS by 1993, 669)—(Substituted
in revision for NRS 616.184)
NRS 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 chiropractor 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
after it is submitted, the person may request a resolution of the dispute
pursuant to NRS 616C.345 to 616C.385, inclusive.
(Added to NRS by 1993, 691; A 1993, 2452; 1995, 2149; 1999, 2216)
NRS 616C.310 Contested cases: Procedures; format; redaction of personal
identifying information; representation of insurer or employer by legal counsel
or other agent.
1. The Chief of the Hearings Division of
the Department of Administration:
(a) May by regulation provide for specific
procedures for the determination of contested cases.
(b) Shall develop a format to be used by hearing
officers to indicate their findings in contested cases.
(c) Shall adopt regulations to provide for the
redaction of personal identifying information of a person filing a claim for
compensation from a document relating to the contested case of the person,
unless the identity of the person is at issue. As used in this paragraph,
“personal identifying information” means any information which would identify a
person, including, without limitation, an address, a birth date or a social
security number.
2. An insurer or employer may be
represented in a contested case by private legal counsel or by any other agent.
(Added to NRS by 1973, 1596; A 1975, 761; 1977, 1389; 1979, 1042; 1985, 50; 1991, 2417; 2005, 2511; 2005, 22nd
Special Session, 97)
NRS 616C.315 Request for hearing; forms for request to be provided by
insurer; prerequisites to scheduling of hearing; expeditious and informal
hearing required; direct submission to appeals officer.
1. Any person who is subject to the
jurisdiction of the hearing officers pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS may request a hearing before a
hearing officer of any matter within the hearing officer’s authority. The
insurer shall provide, without cost, the forms necessary to request a hearing
to any person who requests them.
2. A hearing must not be scheduled until
the following information is provided to the hearing officer:
(a) The name of:
(1) The claimant;
(2) The employer; and
(3) The insurer or third-party
administrator;
(b) The number of the claim; and
(c) If applicable, a copy of the letter of
determination being appealed or, if such a copy is unavailable, the date of the
determination and the issues stated in the determination.
3. Except as otherwise provided in NRS 616B.772, 616B.775, 616B.787, 616C.305
and 616C.427, a person who is aggrieved by:
(a) A written determination of an insurer; or
(b) The failure of an insurer to respond within
30 days to a written request mailed to the insurer by the person who is
aggrieved,
Ê may appeal
from the determination or failure to respond by filing a request for a hearing
before a hearing officer. Such a request must include the information required
pursuant to subsection 2 and, except as otherwise provided in subsections 4 and
5, must be filed within 70 days after the date on which the notice of the
insurer’s determination was mailed by the insurer or the unanswered written
request was mailed to the insurer, as applicable. The failure of an insurer to
respond to a written request for a determination within 30 days after receipt
of such a request shall be deemed by the hearing officer to be a denial of the
request.
4. The period specified in subsection 3
within which a request for a hearing must be filed may be extended for an
additional 90 days if the person aggrieved shows by a preponderance of the
evidence that the person was diagnosed with a terminal illness or was informed
of the death or diagnosis of a terminal illness of his or her spouse, parent or
child.
5. Failure to file a request for a hearing
within the period specified in subsection 3 may be excused if the person
aggrieved shows by a preponderance of the evidence that the person did not
receive the notice of the determination and the forms necessary to request a
hearing. The claimant or employer shall notify the insurer of a change of
address.
6. The hearing before the hearing officer
must be conducted as expeditiously and informally as is practicable.
7. The parties to a contested claim may,
if the claimant is represented by legal counsel, agree to forego a hearing
before a hearing officer and submit the contested claim directly to an appeals
officer.
8. A claimant may, with regard to a
contested claim arising from the provisions of NRS 617.453, 617.455, 617.457, 617.485 or 617.487 as described in subsection 2 of NRS 616C.345, submit the contested claim directly to
an appeals officer pursuant to subsection 2 of NRS
616C.345 without the agreement of any other party.
(Added to NRS by 1979, 1040; A 1981, 1490; 1983, 1294; 1985, 668; 1991, 834, 2417; 1993, 736; 1999, 3380; 2001, 2256; 2003, 2333; 2007, 3351; 2009, 1283)
NRS 616C.320 Resolution of disputed decision of self-insured employer or
employer who is member of association of self-insured public or private
employers or insured by private carrier. If
an employee of a self-insured employer, an employer who is a member of an
association of self-insured public or private employers or an employer insured
by a private carrier is dissatisfied with a decision of his or her employer,
the association or the private carrier, the employee may seek to resolve the
dispute pursuant to NRS 616C.305 and 616C.315 to 616C.385,
inclusive.
(Added to NRS by 1979, 1039; A 1993, 737; 1995, 2032)
NRS 616C.325 Representation of employee and employer before hearings officer
or appeals officer or in negotiations with insurer; licensure of employer’s
representative; employer liable for representative’s violations; compensation
of employer’s representative must not be contingent on outcome.
1. It is unlawful for any person to
represent an employee before a hearing officer, or in any negotiations,
settlements, hearings or other meetings with an insurer concerning the
employee’s claim or possible claim, unless the person is:
(a) Employed by the employee’s labor organization
and is not an independent contractor;
(b) Admitted to practice law in this State;
(c) Employed full-time by and under the
supervision of an attorney admitted to practice law in this State; or
(d) Appearing without compensation on behalf of
the employee.
Ê It is
unlawful for any person who is not admitted to practice law in this State to
represent the employee before an appeals officer.
2. It is unlawful for any person to
represent an employer at hearings of contested cases unless that person is:
(a) Employed full-time by the employer or a trade
association to which the employer belongs that is not formed solely to provide
representation at hearings of contested cases;
(b) An employer’s representative licensed
pursuant to subsection 3 who is not licensed as a third-party administrator;
(c) Admitted to practice law in this State; or
(d) A licensed third-party administrator.
3. The Director of the Department of
Administration shall adopt regulations which include the:
(a) Requirements for licensure of employers’
representatives, including:
(1) The registration of each
representative; and
(2) The filing of a copy of each written
agreement for the compensation of a representative;
(b) Procedure for such licensure; and
(c) Causes for revocation of such a license,
including any applicable action listed in NRS
616D.120 or a violation of this section.
4. Any person who is employed by or
contracts with an employer to represent the employer at hearings regarding
contested claims is an agent of the employer. If the employer’s representative
violates any provision of this chapter or chapter
616A, 616B, 616D or 617
of NRS, the employer is liable for any penalty assessed because of that
violation.
5. An employer shall not make the
compensation of any person representing the employer contingent in any manner
upon the outcome of any contested claim.
6. The Director of the Department of
Administration shall collect in advance and deposit with the State Treasurer
for credit to the State General Fund the following fees for licensure as an
employer’s representative:
(a) Application and license........................................................................................ $78
(b) Triennial renewal of each license.......................................................................... 78
(Added to NRS by 1987, 2140; A 1989, 527; 1993, 737, 2453, 2458; 1995, 2149; 1999, 225; 2013, 420)
NRS 616C.330 Date, time and place for hearing; evaluation of injured
employee; powers and duties of hearing officer; issuance of decision; procedure
for obtaining stay of decision.
1. The hearing officer shall:
(a) Except as otherwise provided in subsection 2
of NRS 616C.315, within 5 days after receiving a
request for a hearing, set the hearing for a date and time within 30 days after
his or her receipt of the request at a place in Carson City, Nevada, or Las
Vegas, Nevada, or upon agreement of one or more of the parties to pay all
additional costs directly related to an alternative location, at any other
place of convenience to the parties, at the discretion of the hearing officer;
(b) Give notice by mail or by personal service to
all interested parties to the hearing at least 15 days before the date and time
scheduled; and
(c) Conduct hearings expeditiously and
informally.
2. The notice must include a statement
that the injured employee may be represented by a private attorney or seek
assistance and advice from the Nevada Attorney for Injured Workers.
3. If necessary to resolve a medical
question concerning an injured employee’s condition or to determine the
necessity of treatment for which authorization for payment has been denied, the
hearing officer may order an independent medical examination, which must not
involve treatment, and refer the employee to a physician or chiropractor of his
or her choice who has demonstrated special competence to treat the particular
medical condition of the employee, whether or not the physician or chiropractor
is on the insurer’s panel of providers of health care. If the medical question
concerns the rating of a permanent disability, the hearing officer may refer
the employee to a rating physician or chiropractor. The rating physician or
chiropractor must be selected in rotation from the list of qualified physicians
and chiropractors maintained by the Administrator pursuant to subsection 2 of NRS 616C.490, unless the insurer and injured employee
otherwise agree to a rating physician or chiropractor. The insurer shall pay
the costs of any medical examination requested by the hearing officer.
4. The hearing officer may consider the
opinion of an examining physician or chiropractor, in addition to the opinion
of an authorized treating physician or chiropractor, in determining the
compensation payable to the injured employee.
5. If an injured employee has requested
payment for the cost of obtaining a second determination of his or her
percentage of disability pursuant to NRS 616C.100,
the hearing officer shall decide whether the determination of the higher
percentage of disability made pursuant to NRS 616C.100
is appropriate and, if so, may order the insurer to pay to the employee an
amount equal to the maximum allowable fee established by the Administrator
pursuant to NRS 616C.260 for the type of service
performed, or the usual fee of that physician or chiropractor for such service,
whichever is less.
6. The hearing officer shall order an
insurer, organization for managed care or employer who provides accident
benefits for injured employees pursuant to NRS
616C.265 to pay to the appropriate person the charges of a provider of
health care if the conditions of NRS 616C.138 are
satisfied.
7. The hearing officer may allow or forbid
the presence of a court reporter and the use of a tape recorder in a hearing.
8. The hearing officer shall render his or
her decision within 15 days after:
(a) The hearing; or
(b) The hearing officer receives a copy of the
report from the medical examination the hearing officer requested.
9. The hearing officer shall render a
decision in the most efficient format developed by the Chief of the Hearings
Division of the Department of Administration.
10. The hearing officer shall give notice
of the decision to each party by mail. The hearing officer shall include with
the notice of the decision the necessary forms for appealing from the decision.
11. Except as otherwise provided in NRS 616C.380, the decision of the hearing officer is
not stayed if an appeal from that decision is taken unless an application for a
stay is submitted by a party. If such an application is submitted, the decision
is automatically stayed until a determination is made on the application. A
determination on the application must be made within 30 days after the filing
of the application. If, after reviewing the application, a stay is not granted
by the hearing officer or an appeals officer, the decision must be complied
with within 10 days after the refusal to grant a stay.
(Added to NRS by 1979, 1040; A 1983, 645; 1985, 669, 864, 1547; 1991, 835, 2418; 1993, 738; 1995, 2150; 1999, 1785, 2217; 2001, 115, 1895; 2003, 2333, 2808; 2005, 238, 1267; 2007, 3352; 2009, 3033)
NRS 616C.335 Award of interest. If
a contested claim for compensation is decided in favor of the claimant, he or
she is entitled to an award of interest at the rate of 9 percent on the amount
of compensation due the claimant from the date the payment on the claim would
be due until the date that payment is made.
(Added to NRS by 1989, 687; A 1989, 2002)—(Substituted
in revision for NRS 616.5418)
NRS 616C.340 Appointment, term, qualifications and salary of appeals officers
and special appeals officers; conflicts of interest; finality of decision by
appeals officer.
1. The Governor shall appoint one or more
appeals officers to conduct hearings and appeals as required pursuant to chapters 616A to 617,
inclusive, of NRS. Each appeals officer shall hold office for 2 years after the
date of his or her appointment and until the successor of the appeals officer
is appointed and has qualified. Each appeals officer is entitled to receive an
annual salary in an amount provided by law and is in the unclassified service
of the State.
2. Each appeals officer must be an
attorney who has been licensed to practice law before all the courts of this
State for at least 2 years. Except as otherwise provided in NRS 7.065, an appeals officer shall not
engage in the private practice of law.
3. If an appeals officer determines that
he or she has a personal interest or a conflict of interest, directly or
indirectly, in any case which is before him or her, the appeals officer shall
disqualify himself or herself from hearing the case.
4. The Governor may appoint one or more
special appeals officers to conduct hearings and appeals as required pursuant
to chapters 616A to 617, inclusive, of NRS. The Governor shall not
appoint an attorney who represents persons in actions related to claims for
compensation to serve as a special appeals officer.
5. A special appeals officer appointed
pursuant to subsection 4 is vested with the same powers as a regular appeals
officer. A special appeals officer may hear any case in which a regular appeals
officer has a conflict, or any case assigned to the special appeals officer by
the senior appeals officer to assist with a backlog of cases. A special appeals
officer is entitled to be paid at an hourly rate, as determined by the
Department of Administration.
6. The decision of an appeals officer is
the final and binding administrative decision on a claim for compensation under
chapters 616A to 616D, inclusive, or chapter 617 of NRS, and the whole record consists of all
evidence taken at the hearing before the appeals officer and any findings of
fact and conclusions of law based thereon.
(Added to NRS by 1973, 1595; A 1975, 764; 1977, 84, 315, 316; 1979, 1055; 1981, 409; 1983, 357, 1010; 1989, 204; 1993, 738; 1997, 3234; 2003, 1672, 2308; 2007, 3353)
NRS 616C.345 Notice of appeal; notice of contested claim; prerequisites to
scheduling of hearing on appeal; effect of appeal on enforcement of decision of
hearing officer; setting of date, time and place for hearing on appeal;
continuances.
1. Any party aggrieved by a decision of
the hearing officer relating to a claim for compensation may appeal from the
decision by, except as otherwise provided in subsections 9 and 10, filing a
notice of appeal with an appeals officer within 30 days after the date of the
decision.
2. A claimant aggrieved by a written
determination of the denial of a claim, in whole or in part, by an insurer, or
the failure of an insurer to respond in writing within 30 days to a written
request of the claimant mailed to the insurer, concerning a claim arising from
the provisions of NRS 617.453, 617.455, 617.457, 617.485 or 617.487 may file a notice of a contested
claim with an appeals officer. The notice must include the information required
pursuant to subsection 3 and, except as otherwise provided in subsections 9 and
11, must be filed within 70 days after the date on which the notice of the
insurer’s determination was mailed by the insurer or the unanswered written
request was mailed to the insurer, as applicable. The failure of an insurer to
respond in writing to a written request for a determination within 30 days
after receipt of such a request shall be deemed by the appeals officer to be a
denial of the request. The insurer shall provide, without cost, the forms
necessary to file a notice of a contested claim to any person who requests
them.
3. A hearing must not be scheduled until
the following information is provided to the appeals officer:
(a) The name of:
(1) The claimant;
(2) The employer; and
(3) The insurer or third-party
administrator;
(b) The number of the claim; and
(c) If applicable, a copy of the letter of
determination being appealed or, if such a copy is unavailable, the date of the
determination and the issues stated in the determination.
4. If a dispute is required to be
submitted to a procedure for resolving complaints pursuant to NRS 616C.305 and:
(a) A final determination was rendered pursuant
to that procedure; or
(b) The dispute was not resolved pursuant to that
procedure within 14 days after it was submitted,
Ê any party to
the dispute may, except as otherwise provided in subsections 9 and 10, file a
notice of appeal within 70 days after the date on which the final determination
was mailed to the employee, or the dependent of the employee, or the unanswered
request for resolution was submitted. Failure to render a written determination
within 30 days after receipt of such a request shall be deemed by the appeals
officer to be a denial of the request.
5. Except as otherwise provided in NRS 616C.380, the filing of a notice of appeal does
not automatically stay the enforcement of the decision of a hearing officer or
a determination rendered pursuant to NRS 616C.305.
The appeals officer may order a stay, when appropriate, upon the application of
a party. If such an application is submitted, the decision is automatically
stayed until a determination is made concerning the application. A
determination on the application must be made within 30 days after the filing
of the application. If a stay is not granted by the officer after reviewing the
application, the decision must be complied with within 10 days after the date
of the refusal to grant a stay.
6. Except as otherwise provided in
subsections 3 and 7, within 10 days after receiving a notice of appeal pursuant
to this section or NRS 616C.220, 616D.140 or 617.401, or within 10 days after receiving
a notice of a contested claim pursuant to subsection 7 of NRS 616C.315, the appeals officer shall:
(a) Schedule a hearing on the merits of the
appeal or contested claim for a date and time within 90 days after receipt of
the notice at a place in Carson City, Nevada, or Las Vegas, Nevada, or upon
agreement of one or more of the parties to pay all additional costs directly
related to an alternative location, at any other place of convenience to the
parties, at the discretion of the appeals officer; and
(b) Give notice by mail or by personal service to
all parties to the matter and their attorneys or agents at least 30 days before
the date and time scheduled.
7. Except as otherwise provided in
subsection 12, a request to schedule the hearing for a date and time which is:
(a) Within 60 days after the receipt of the
notice of appeal or contested claim; or
(b) More than 90 days after the receipt of the
notice or claim,
Ê may be
submitted to the appeals officer only if all parties to the appeal or contested
claim agree to the request.
8. An appeal or contested claim may be
continued upon written stipulation of all parties, or upon good cause shown.
9. The period specified in subsection 1, 2
or 4 within which a notice of appeal or a notice of a contested claim must be
filed may be extended for an additional 90 days if the person aggrieved shows
by a preponderance of the evidence that the person was diagnosed with a
terminal illness or was informed of the death or diagnosis of a terminal
illness of the person’s spouse, parent or child.
10. Failure to file a notice of appeal
within the period specified in subsection 1 or 4 may be excused if the party
aggrieved shows by a preponderance of the evidence that he or she did not
receive the notice of the determination and the forms necessary to appeal the
determination. The claimant, employer or insurer shall notify the hearing
officer of a change of address.
11. Failure to file a notice of a
contested claim within the period specified in subsection 2 may be excused if
the claimant shows by a preponderance of the evidence that he or she did not
receive the notice of the determination and the forms necessary to file the
notice. The claimant or employer shall notify the insurer of a change of
address.
12. Within 10 days after receiving a
notice of a contested claim pursuant to subsection 2, the appeals officer
shall:
(a) Schedule a hearing on the merits of the contested
claim for a date and time within 60 days after his or her receipt of the notice
at a place in Carson City, Nevada, or Las Vegas, Nevada, or upon agreement of
one or more of the parties to pay all additional costs directly related to an
alternative location, at any other place of convenience to the parties, at the
discretion of the appeals officer; and
(b) Give notice by mail or by personal service to
all parties to the matter and their attorneys or agents within 10 days after
scheduling the hearing.
Ê The
scheduled date must allow sufficient time for full disclosure, exchange and
examination of medical and other relevant information. A party may not
introduce information at the hearing which was not previously disclosed to the
other parties unless all parties agree to the introduction.
(Added to NRS by 1979, 1040; A 1981, 1198; 1983, 358; 1985, 50, 669; 1991, 2418; 1993, 739, 2441; 1995, 2151; 1997, 3235; 1999, 2218; 2003, 1672, 2308, 2335, 2810; 2007, 3354; 2009, 1284)
NRS 616C.350 Testimony of physician or chiropractor before appeals officer;
privileged communications.
1. Any physician or chiropractor who
attends an employee within the provisions of chapters
616A to 616D, inclusive, or chapter 617 of NRS in a professional capacity, may be
required to testify before an appeals officer. A physician or chiropractor who
testifies is entitled to receive the same fees as witnesses in civil cases and,
if the appeals officer so orders at his or her own discretion, a fee equal to
that authorized for a consultation by the appropriate schedule of fees for
physicians or chiropractors. These fees must be paid by the insurer.
2. Information gained by the attending
physician or chiropractor while in attendance on the injured employee is not a
privileged communication if:
(a) Required by an appeals officer for a proper
understanding of the case and a determination of the rights involved; or
(b) The information is related to any fraud that
has been or is alleged to have been committed in violation of the provisions of
this chapter or chapter 616A, 616B, 616D
or 617 of NRS.
[Part 52:168:1947; 1943 NCL § 2680.52]—(NRS A 1975,
763; 1977, 314;
1981, 1197,
1471; 1985, 1543; 1993, 715; 1995, 1872, 2023; 1997, 583; 1999, 226)
NRS 616C.355 Use of affidavits or declarations as evidence at hearing; notice
to opposing party; waiver of right to cross-examine affiant or declarant;
effect of waiver. At any time 10
or more days before a scheduled hearing before an appeals officer, the
Administrator or the Administrator’s designee, a party shall mail or deliver to
the opposing party any affidavit or declaration which the party proposes to
introduce into evidence and notice to the effect that unless the opposing
party, within 7 days after the mailing or delivery of such affidavit or declaration,
mails or delivers to the proponent a request to cross-examine the affiant or
declarant, the opposing party’s right to cross-examine the affiant or declarant
is waived and the affidavit or declaration, if introduced into evidence, will
have the same effect as if the affiant or declarant had given sworn testimony
before the appeals officer, the Administrator or the Administrator’s designee.
(Added to NRS by 1975, 761; A 1977, 84; 1981, 1490; 1983, 358; 1993, 740; 1997, 1422; 1999, 1728)
NRS 616C.360 Record of hearing before appeals officer; rules of evidence;
evaluation of injured employee; submission to independent review organization;
powers and duties of appeals officer; transcripts; issuance of decision.
1. A stenographic or electronic record
must be kept of the hearing before the appeals officer and the rules of
evidence applicable to contested cases under chapter
233B of NRS apply to the hearing.
2. The appeals officer must hear any
matter raised before him or her on its merits, including new evidence bearing
on the matter.
3. If there is a medical question or
dispute concerning an injured employee’s condition or concerning the necessity
of treatment for which authorization for payment has been denied, the appeals
officer may:
(a) Order an independent medical examination and
refer the employee to a physician or chiropractor of his or her choice who has
demonstrated special competence to treat the particular medical condition of
the employee, whether or not the physician or chiropractor is on the insurer’s
panel of providers of health care. If the medical question concerns the rating
of a permanent disability, the appeals officer may refer the employee to a
rating physician or chiropractor. The rating physician or chiropractor must be
selected in rotation from the list of qualified physicians or chiropractors
maintained by the Administrator pursuant to subsection 2 of NRS 616C.490, unless the insurer and the injured
employee otherwise agree to a rating physician or chiropractor. The insurer
shall pay the costs of any examination requested by the appeals officer.
(b) If the medical question or dispute is
relevant to an issue involved in the matter before the appeals officer and all
parties agree to the submission of the matter to an independent review
organization, submit the matter to an independent review organization in accordance
with NRS 616C.363 and any regulations adopted by
the Commissioner.
4. The appeals officer may consider the
opinion of an examining physician or chiropractor, in addition to the opinion
of an authorized treating physician or chiropractor, in determining the
compensation payable to the injured employee.
5. If an injured employee has requested
payment for the cost of obtaining a second determination of his or her
percentage of disability pursuant to NRS 616C.100,
the appeals officer shall decide whether the determination of the higher
percentage of disability made pursuant to NRS 616C.100
is appropriate and, if so, may order the insurer to pay to the employee an
amount equal to the maximum allowable fee established by the Administrator
pursuant to NRS 616C.260 for the type of service
performed, or the usual fee of that physician or chiropractor for such service,
whichever is less.
6. The appeals officer shall order an
insurer, organization for managed care or employer who provides accident
benefits for injured employees pursuant to NRS
616C.265 to pay to the appropriate person the charges of a provider of
health care if the conditions of NRS 616C.138 are
satisfied.
7. Any party to the appeal or contested
case or the appeals officer may order a transcript of the record of the hearing
at any time before the seventh day after the hearing. The transcript must be
filed within 30 days after the date of the order unless the appeals officer
otherwise orders.
8. Except as otherwise provided in
subsection 9, the appeals officer shall render a decision:
(a) If a transcript is ordered within 7 days
after the hearing, within 30 days after the transcript is filed; or
(b) If a transcript has not been ordered, within
30 days after the date of the hearing.
9. The appeals officer shall render a
decision on a contested claim submitted pursuant to subsection 2 of NRS 616C.345 within 15 days after:
(a) The date of the hearing; or
(b) If the appeals officer orders an independent
medical examination, the date the appeals officer receives the report of the
examination,
Ê unless both
parties to the contested claim agree to a later date.
10. The appeals officer may affirm, modify
or reverse any decision made by a hearing officer and issue any necessary and
proper order to give effect to his or her decision.
(Added to NRS by 1979, 1040; A 1987, 92; 1991, 2419; 1993, 740; 1999, 1786, 2219; 2001, 115, 1896; 2003, 2336; 2005, 239, 1269; 2007, 3355; 2009, 1286,
3035; 2011, 3422)
NRS 616C.363 External review: Duties of independent review organization;
contents and submission of decision by organization; costs; regulations.
1. Not later than 5 business days after
the date that an independent review organization receives a request for an
external review, the independent review organization shall:
(a) Review the documents and materials submitted
for the external review; and
(b) Notify the injured employee, his or her
employer and the insurer whether the independent review organization needs any
additional information to conduct the external review.
2. The independent review organization
shall render a decision on the matter not later than 15 business days after the
date that it receives all information that is necessary to conduct the external
review.
3. In conducting the external review, the
independent review organization shall consider, without limitation:
(a) The medical records of the insured;
(b) Any recommendations of the physician of the
insured; and
(c) Any other information approved by the
Commissioner for consideration by an independent review organization.
4. In its decision, the independent review
organization shall specify the reasons for its decision. The independent review
organization shall submit a copy of its decision to:
(a) The injured employee;
(b) The employer;
(c) The insurer; and
(d) The appeals officer, if any.
5. The insurer shall pay the costs of the
services provided by the independent review organization.
6. The Commissioner may adopt regulations
to govern the process of external review and to carry out the provisions of
this section. Any regulations adopted pursuant to this section must provide
that:
(a) All parties must agree to the submission of a
matter to an independent review organization before a request for external
review may be submitted;
(b) A party may not be ordered to submit a matter
to an independent review organization; and
(c) The findings and decisions of an independent
review organization are not binding.
(Added to NRS by 2003, 2332; A 2011, 3423)
NRS 616C.365 Reimbursement of employee’s expenses incurred and wages lost as
result of hearing requested by employer or insurer; regulations.
1. If an employer or insurer requests a
hearing before a hearing officer or appeals officer relating to a claim for
compensation, and the hearing results in a decision favorable to the employee,
the employee is entitled to receive reimbursement from the insurer for:
(a) The employee’s actual expenses necessarily
incurred for travel to and from the hearing, if the employee is required to
travel more than 20 miles one way from his or her residence or place of
employment to the hearing; and
(b) Any regular wages lost as a result of his or
her attending the hearing.
2. The Division shall adopt regulations
governing the procedure and forms to be used for the reimbursement provided by
subsection 1.
(Added to NRS by 1985, 1575; A 1993, 1870)—(Substituted
in revision for NRS 616.5428)
NRS 616C.370 Judicial review.
1. No judicial proceedings may be
instituted for compensation for an injury or death under chapters 616A to 616D, inclusive, of NRS unless:
(a) A claim for compensation is filed as provided
in NRS 616C.020; and
(b) A final decision of an appeals officer has
been rendered on such claim.
2. Judicial proceedings instituted for
compensation for an injury or death, under chapters
616A to 616D, inclusive, of NRS are
limited to judicial review of the decision of an appeals officer.
(Added to NRS by 1973, 1596; A 1977, 84, 315, 317; 1993, 740)—(Substituted
in revision for NRS 616.543)
NRS 616C.375 Stay of decision of appeals officer. If
an insurer, employer or claimant, or the representative of an insurer, employer
or claimant, appeals the decision of an appeals officer, that decision is not
stayed unless a stay is granted by the appeals officer or the district court
within 30 days after the date on which the decision was rendered.
(Added to NRS by 1991, 2394)—(Substituted
in revision for NRS 616.5433)
NRS 616C.380 Payment pending appeal when decision not stayed; effect of final
resolution of claim.
1. If a hearing officer, appeals officer
or district court renders a decision on a claim for compensation and the
insurer or employer appeals that decision, but is unable to obtain a stay of
the decision:
(a) Payment of that portion of an award for a
permanent partial disability which is contested must be made in installment
payments until the claim reaches final resolution.
(b) Payment of the award must be made in monthly
installments of 66 2/3 percent of the average wage of the claimant until the
claim reaches final resolution if the claim is for more than 3 months of past
benefits for a temporary total disability or rehabilitation, or for a payment
in lump sum related to past benefits for rehabilitation, such as costs for
purchasing a business or equipment.
2. If the final resolution of the claim is
in favor of the claimant, the remaining amount of compensation to which the
claimant is entitled may be paid in a lump sum if the claimant is otherwise
eligible for such a payment pursuant to NRS 616C.495
and any regulations adopted pursuant thereto. If the final resolution of the
claim is in favor of the insurer or employer, any amount paid to the claimant
in excess of the uncontested amount must be deducted from any future benefits
related to that claim, other than medical benefits, to which the claimant is
entitled. The deductions must be made in a reasonable manner so as not to
create an undue hardship to the claimant.
(Added to NRS by 1989, 687; A 1995, 2152)—(Substituted
in revision for NRS 616.5435)
NRS 616C.385 Costs and attorney’s fees for frivolous petitions for judicial
review. If a party petitions the
district court for judicial review of a final decision of an appeals officer,
the Administrator or the Administrator’s designee, and the petition is found by
the district court to be frivolous or brought without reasonable grounds, the
district court may order costs and a reasonable attorney’s fee to be paid by
the petitioner.
(Added to NRS by 1975, 761; A 1977, 316; 1983, 358; 1993, 741; 1999, 1728)
NRS 616C.390 Reopening claim: General requirements and procedure; limitations;
applicability. Except as otherwise
provided in NRS 616C.392:
1. If an application to reopen a claim to
increase or rearrange compensation is made in writing more than 1 year after
the date on which the claim was closed, the insurer shall reopen the claim if:
(a) A change of circumstances warrants an
increase or rearrangement of compensation during the life of the claimant;
(b) The primary cause of the change of
circumstances is the injury for which the claim was originally made; and
(c) The application is accompanied by the
certificate of a physician or a chiropractor showing a change of circumstances
which would warrant an increase or rearrangement of compensation.
2. After a claim has been closed, the
insurer, upon receiving an application and for good cause shown, may authorize
the reopening of the claim for medical investigation only. The application must
be accompanied by a written request for treatment from the physician or
chiropractor treating the claimant, certifying that the treatment is indicated
by a change in circumstances and is related to the industrial injury sustained
by the claimant.
3. If a claimant applies for a claim to be
reopened pursuant to subsection 1 or 2 and a final determination denying the
reopening is issued, the claimant shall not reapply to reopen the claim until
at least 1 year after the date on which the final determination is issued.
4. Except as otherwise provided in
subsection 5, if an application to reopen a claim is made in writing within 1
year after the date on which the claim was closed, the insurer shall reopen the
claim only if:
(a) The application is supported by medical
evidence demonstrating an objective change in the medical condition of the
claimant; and
(b) There is clear and convincing evidence that
the primary cause of the change of circumstances is the injury for which the
claim was originally made.
5. An application to reopen a claim must
be made in writing within 1 year after the date on which the claim was closed
if:
(a) The claimant was not off work as a result of
the injury; and
(b) The claimant did not receive benefits for a
permanent partial disability.
Ê If an
application to reopen a claim to increase or rearrange compensation is made
pursuant to this subsection, the insurer shall reopen the claim if the
requirements set forth in paragraphs (a), (b) and (c) of subsection 1 are met.
6. If an employee’s claim is reopened
pursuant to this section, the employee is not entitled to vocational
rehabilitation services or benefits for a temporary total disability if, before
the claim was reopened, the employee:
(a) Retired; or
(b) Otherwise voluntarily removed himself or
herself from the workforce,
Ê for reasons
unrelated to the injury for which the claim was originally made.
7. One year after the date on which the
claim was closed, an insurer may dispose of the file of a claim authorized to
be reopened pursuant to subsection 5, unless an application to reopen the claim
has been filed pursuant to that subsection.
8. An increase or rearrangement of
compensation is not effective before an application for reopening a claim is
made unless good cause is shown. The insurer shall, upon good cause shown,
allow the cost of emergency treatment the necessity for which has been
certified by a physician or a chiropractor.
9. A claim that closes pursuant to
subsection 2 of NRS 616C.235 and is not appealed
or is unsuccessfully appealed pursuant to the provisions of NRS 616C.305 and 616C.315
to 616C.385, inclusive, may not be reopened
pursuant to this section.
10. The provisions of this section apply
to any claim for which an application to reopen the claim or to increase or
rearrange compensation is made pursuant to this section, regardless of the date
of the injury or accident to the claimant. If a claim is reopened pursuant to
this section, the amount of any compensation or benefits provided must be
determined in accordance with the provisions of NRS
616C.425.
[56:168:1947; 1943 NCL § 2680.56] + [57:168:1947;
1943 NCL § 2680.57]—(NRS A 1971, 770; 1981, 1198, 1831; 1983, 285, 1294; 1985, 1547; 1993, 741, 2441; 1995, 2152; 1999, 1787; 2005, 1491)
NRS 616C.392 Reopening claim: Circumstances under which insurer is required
to reopen claim for permanent partial disability.
1. An insurer shall reopen a claim to
consider the payment of compensation for a permanent partial disability if:
(a) The claim was closed and the claimant was not
scheduled for an evaluation of the injury in accordance with NRS 616C.490;
(b) The claimant demonstrates by a preponderance
of the evidence that, at the time that the case was closed, the claimant was,
because of the injury, qualified to be scheduled for an evaluation for a
permanent partial disability; and
(c) The insurer has violated a provision of NRS 616D.120 with regard to the claim.
2. The demonstration required
pursuant to paragraph (b) of subsection 1 must be made with documentation that
existed at the time that the case was closed.
3. Notwithstanding any specific statutory
provision to the contrary, the consideration of whether a claimant is entitled
to payment of compensation for a permanent partial disability for a claim that
is reopened pursuant to this section must be made in accordance with the
provisions of the applicable statutory and regulatory provisions that existed
on the date on which the claim was closed, including, without limitation, using
the edition of the American Medical Association’s Guides to the Evaluation
of Permanent Impairment as adopted by the Division pursuant to NRS 616C.110 that was applicable on the date the
claim was closed.
(Added to NRS by 2005, 1491)
COMPENSATION FOR INJURIES AND DEATH
General Provisions
NRS 616C.400 Minimum duration of incapacity.
1. Temporary compensation benefits must
not be paid under chapters 616A to 616D, inclusive, of NRS for an injury which
does not incapacitate the employee for at least 5 consecutive days, or 5
cumulative days within a 20-day period, from earning full wages, but if the
incapacity extends for 5 or more consecutive days, or 5 cumulative days within
a 20-day period, compensation must then be computed from the date of the
injury.
2. The period prescribed in this section
does not apply to:
(a) Accident benefits, whether they are furnished
pursuant to NRS 616C.255 or 616C.265, if the injured employee is otherwise
covered by the provisions of chapters 616A
to 616D, inclusive, of NRS and entitled to
those benefits.
(b) Compensation paid to the injured employee
pursuant to subsection 1 of NRS 616C.477.
[69:168:1947; 1943 NCL § 2680.69]—(NRS A 1975, 254; 1987, 922; 2005, 101)
NRS 616C.405 Limitations on benefits received by employee. Except as otherwise provided in subsection 4
of NRS 616C.440, an employee who is receiving
compensation for:
1. A permanent total disability is not
entitled to compensation for permanent partial disability during the period
when the employee is receiving compensation for the permanent total disability.
2. A temporary total disability is not
entitled to compensation for a permanent partial disability during the period
of temporary total disability.
3. A temporary partial disability is not
entitled to compensation for a permanent partial disability during the period
of temporary partial disability.
(Added to NRS by 1983, 431; A 1995, 2159)—(Substituted
in revision for NRS 616.613)
NRS 616C.408 Restrictive endorsements on checks issued by insurers.
1. An insurer shall not issue a check
pursuant to the provisions of chapters 616A
to 616D, inclusive, or chapter 617 of NRS for the payment of permanent total
disability benefits that includes a restrictive endorsement.
2. An insurer may issue a check pursuant
to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS for the payment of temporary total
disability, temporary partial disability, permanent partial disability,
rehabilitation maintenance benefits or compensation paid pursuant to subsection
1 of NRS 616C.477 that includes a restrictive
endorsement.
3. If an insurer issues a check that
includes a restrictive endorsement pursuant to subsection 2, the restrictive
endorsement must:
(a) Clearly and accurately state the restrictive
conditions; and
(b) Not provide for any condition or restriction
not authorized under the provisions of chapters
616A to 616D, inclusive, or chapter 617 of NRS.
(Added to NRS by 2003, 1247; A 2005, 101)
NRS 616C.409 Direct deposit of compensation.
1. Each employee or dependent of an
employee who receives compensation pursuant to chapters
616A to 616D, inclusive, or chapter 617 of NRS for a permanent total disability,
death or a permanent partial disability that was not paid in a lump sum
pursuant to NRS 616C.495 may submit to the insurer
or third-party administrator who pays the compensation a written notice
directing the insurer or third-party administrator to deposit the compensation
directly into the account of the employee or dependent specified by the
employee or dependent in the written notice.
2. If an insurer or third-party
administrator receives a written notice from an employee or dependent of an
employee pursuant to subsection 1, the insurer or third-party administrator
shall, in lieu of issuing a check, deposit the compensation paid by the insurer
or third-party administrator directly into the account specified by the
employee or dependent in the written notice.
(Added to NRS by 2007, 399)
NRS 616C.410 Prohibition of settlements paid in lump sum; exceptions. Except as otherwise provided by NRS 616C.380, 616C.427, 616C.495, 616C.505, 616C.580 and 616C.595,
the insurer shall not make or allow any lump-sum settlements.
[65:168:1947; A 1949, 659; 1943 NCL § 2680.65]—(NRS A
1959, 204; 1966, 48; 1967, 691; 1971, 320; 1973, 535; 1975, 607; 1981, 1172, 1497; 1983, 430, 646; 1987, 1466; 1989, 688; 1991, 2426; 1993, 754; 2007, 3356)
NRS 616C.412 Purchase of annuity by insurer to ensure payment of claim;
adoption of regulations by Commissioner.
1. An insurer may purchase an annuity to
ensure the payment of a claim filed with the insurer pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS.
2. The Commissioner shall adopt such
regulations as are necessary to carry out the provisions of this section.
(Added to NRS by 1997, 1425)
NRS 616C.415 Written explanation of alternative settlements to be given to
employee or dependents.
1. Every injured employee, widow, widower
or dependent, within the provisions of chapters
616A to 616D, inclusive, of NRS, is
entitled to receive from a qualified employee of the insurer an explanation of
the various alternatives implicit in lump-sum compensation or other settlement
pursuant to those chapters and the long-range effects of a determination made
as to one or the other kind of settlement.
2. The insurer shall provide a written
explanation of the alternatives pursuant to subsection 1.
3. Upon selecting an alternative, the
injured employee, widow, widower or dependent shall provide his or her
selection in writing to the insurer.
(Added to NRS by 1971, 770; A 1981, 1497; 1991, 2426)—(Substituted
in revision for NRS 616.623)
NRS 616C.420 Method of determining average monthly wage. The Administrator shall provide by regulation
for a method of determining average monthly wage.
(Added to NRS by 1981, 1196; A 1981, 1829; 1983, 1296)—(Substituted
in revision for NRS 616.624)
NRS 616C.425 Date of determination of amount of compensation and benefits. Except as otherwise provided by a specific
statute:
1. The amount of compensation and benefits
and the person or persons entitled thereto must be determined as of the date of
the accident or injury to the employee, and their rights thereto become fixed
as of that date.
2. If the employee incurs a subsequent
injury or disability that primarily arises from a previous accident or injury
that arose out of and in the course of his or her employment, the date of the
previous accident or injury must be used to determine the amount of
compensation and benefits to which the claimant is entitled.
[Part 59:168:1947; A 1949, 659; 1951, 485; 1953, 292;
1955, 901]—(NRS A 1961, 278; 1963, 1146; 1971, 321; 1981, 1226; 1985, 1461; 1993, 754; 1995, 2160)—(Substituted
in revision for NRS 616.625)
NRS 616C.427 Challenge to determination of average monthly wage; remedy for
incorrect average monthly wage.
1. Notwithstanding the provisions of
subsection 3 of NRS 616C.315 and except as
otherwise provided in this section, if an injured employee is receiving
compensation based on a calculation of the average monthly wage of the injured
employee as determined pursuant to the regulations adopted by the Administrator
pursuant to NRS 616C.420, the injured employee or
the employer may request a hearing before a hearing officer pursuant to the
provisions of NRS 616C.315 to 616C.385, inclusive, asking for a recalculation of
the average monthly wage of the injured employee.
2. The injured employee is entitled to
have his or her average monthly wage recalculated if the injured employee
proves by a preponderance of the evidence that the insurer calculated the
average monthly wage improperly or incorrectly as a result of:
(a) The use of any improper or incorrect
information or methodology;
(b) The failure to use any proper or correct
information or methodology;
(c) Any error of law or fact; or
(d) Any other error, omission, neglect or
wrongful act.
3. If the injured employee proves that the
insurer calculated his or her average monthly wage improperly or incorrectly,
resulting in an underpayment of compensation:
(a) The insurer shall:
(1) Increase the injured employee’s future
compensation based on the correct average monthly wage; and
(2) Pay the injured employee a lump sum in
an amount equal to the underpayment of compensation for the period during which
the insurer was using the incorrect average monthly wage; and
(b) The remedy provided in paragraph (a) is the
sole remedy for the underpayment and the insurer is not subject to the
imposition of any fine or benefit penalty therefor.
4. If the hearing officer determines that
the calculation of the average monthly wage resulted in an overpayment of
compensation, the insurer may require the injured employee to repay to the
insurer an amount equal to the overpayment received by the injured employee
during any one 30-day period.
5. The average monthly wage of an injured
employee may not be challenged by the insurer, the employer or the injured
employee after the date on which any portion of an award for permanent partial
disability is paid or the claim closes, whichever occurs first.
6. The provisions of this section do not
apply if the issue of the average monthly wage of the injured employee was
previously adjudicated to a final decision in:
(a) A hearing before a hearing officer or appeals
officer pursuant to the provisions of NRS 616C.315
to 616C.385, inclusive; or
(b) Any proceedings for judicial review.
(Added to NRS by 2007, 3342)
Permanent Total Disability
NRS 616C.435 Injuries deemed total and permanent.
1. In cases of the following specified
injuries, in the absence of proof to the contrary, the disability caused
thereby shall be deemed total and permanent:
(a) The total and permanent loss of sight of both
eyes.
(b) The loss by separation of both legs at or
above the knee.
(c) The loss by separation of both arms at or
above the elbow.
(d) An injury to the spine resulting in permanent
and complete paralysis of both legs or both arms, or one leg and one arm.
(e) An injury to the skull resulting in incurable
imbecility or insanity.
(f) The loss by separation of one arm at or above
the elbow, and one leg by separation at or above the knee.
2. The enumeration in subsection 1 is not
exclusive, and in all other cases permanent total disability must be determined
by the insurer in accordance with the facts presented.
[60:168:1947; 1943 NCL § 2680.60]—(NRS A 1981, 1492)—(Substituted
in revision for NRS 616.575)
NRS 616C.440 Amount and duration of compensation; limitations; effect of
previous award of compensation.
1. Except as otherwise provided in this
section and NRS 616C.175, every employee in the
employ of an employer, within the provisions of chapters
616A to 616D, inclusive, of NRS, who is
injured by accident arising out of and in the course of employment, or his or
her dependents as defined in chapters 616A
to 616D, inclusive, of NRS, is entitled to
receive the following compensation for permanent total disability:
(a) In cases of total disability adjudged to be
permanent, compensation per month of 66 2/3 percent of the average monthly
wage.
(b) If there is a previous disability, as the
loss of one eye, one hand, one foot or any other previous permanent disability,
the percentage of disability for a subsequent injury must be determined by
computing the percentage of the entire disability and deducting therefrom the
percentage of the previous disability as it existed at the time of the subsequent
injury, but such a deduction for a previous award for permanent partial
disability must be made in a reasonable manner and must not be more than the
total amount which was paid for the previous award for permanent partial
disability. The total amount of the allowable deduction includes, without
limitation, compensation for a permanent partial disability that was deducted
from:
(1) Any compensation the employee received
for a temporary total disability; or
(2) Any other compensation received by the
employee.
(c) If the character of the injury is such as to
render the employee so physically helpless as to require the service of a
constant attendant, an additional allowance may be made so long as such
requirements continue, but the allowance may not be made while the employee is
receiving benefits for care in a hospital or facility for intermediate care
pursuant to the provisions of NRS 616C.265.
2. Except as otherwise provided in NRS 616B.028 and 616B.029, an injured employee or his or
her dependents are not entitled to accrue or be paid any benefits for a
permanent total disability during the time the injured employee is
incarcerated. The injured employee or his or her dependents are entitled to
receive those benefits when the injured employee is released from incarceration
if the injured employee is certified as permanently totally disabled by a
physician or chiropractor.
3. An employee is entitled to receive
compensation for a permanent total disability only so long as the permanent
total disability continues to exist. The insurer has the burden of proving that
the permanent total disability no longer exists.
4. If an employee who has received
compensation in a lump sum for a permanent partial disability pursuant to NRS 616C.495 is subsequently determined to be
permanently and totally disabled, the insurer of the employee’s employer shall
recover pursuant to this subsection the actual amount of the lump sum paid to
the employee for the permanent partial disability. The insurer shall not
recover from the employee, whether by deductions or single payment, or a
combination of both, more than the actual amount of the lump sum paid to the
employee. To recover the actual amount of the lump sum, the insurer shall:
(a) Unless the employee submits a request
described in paragraph (b), deduct from the compensation for the permanent
total disability an amount that is not more than 10 percent of the rate of
compensation for a permanent total disability until the actual amount of the
lump sum paid to the employee for the permanent partial disability is
recovered; or
(b) Upon the request of the employee, accept in a
single payment from the employee an amount that is equal to the actual amount
of the lump sum paid to the employee for the permanent partial disability, less
the actual amount of all deductions made to date by the insurer from the
employee for repayment of the lump sum.
[Part 59:168:1947; A 1949, 659; 1951, 485; 1953, 292;
1955, 901]—(NRS A 1959, 614; 1961, 278; 1965, 319; 1966, 42; 1969, 472; 1971,
322; 1973, 530; 1985,
1765; 1993,
746; 1995,
2154; 1997,
3347; 1999,
1788; 2003,
481)
NRS 616C.445 Recipient of compensation to report annual earnings; payments
suspended if report not made. Each
former employee receiving benefits for a permanent total disability shall
report annually on the anniversary date of the award to the insurer all of the
former employee’s employment for the prior 12-month period. In the event the
former employee fails to make the report to the insurer within 30 days
following the anniversary date, the insurer shall notify the employer and the
employee that the report has not been received and the insurer may then order
any further payments suspended until the report of employment is filed with the
insurer.
(Added to NRS by 1973, 598; A 1979, 1057; 1981, 1170, 1493)—(Substituted
in revision for NRS 616.583)
NRS 616C.447 Insurer required to make certain accountings to injured employee
who is entitled to compensation for permanent total disability; additional
accountings may be requested by injured employee.
1. An insurer that makes payments of
compensation to an injured employee for a permanent total disability shall
provide to the injured employee an annual accounting in the form of a letter
that sets forth with respect to the payments:
(a) The total amount of the compensation for the
permanent total disability that the injured employee is entitled to receive,
before any deductions are made;
(b) The net amount of the current payment for the
compensation;
(c) The amount of any deduction that is made
against the total amount of the compensation, if any; and
(d) If a deduction is being made against the
total amount of the compensation to repay any previous awards of compensation
for a permanent partial disability:
(1) The amount of the deduction;
(2) The claim number for each of those
awards; and
(3) The balance of each of those awards.
2. An injured employee may request in
writing from the insurer an accounting described in subsection 1. The
accounting must cover the period from the date on which the most recent annual
accounting was provided to the injured employee pursuant to subsection 1 to the
date on which the written request is made. The insurer shall provide the
accounting to the injured employee not later than 30 days after receiving the
written request for the accounting from the injured employee. Any accounting
provided by an insurer to an injured employee pursuant to this subsection must
be provided in addition to, and not in lieu of, the annual accountings required
pursuant to subsection 1.
(Added to NRS by 2005, 1490)
NRS 616C.450 Compensation to injured employee or dependents of injured
employee for permanent total disability or death benefit if injury or
occupational disease occurred before July 1, 1980.
1. An injured employee or the dependents
of an injured employee who are entitled to receive compensation for a permanent
total disability pursuant to NRS 616C.440 or a
death benefit pursuant to NRS 616C.505 for an
industrial injury or occupational disease which occurred before July 1, 1980,
are entitled to receive compensation of not less than $600 each month. If the
compensation is to be received by the dependents of an injured employee, it
must be divided amongst them as provided in chapters
616A to 616D, inclusive, of NRS.
2. A self-insured employer or an
association of self-insured public or private employers shall provide for the
increase in monthly compensation required by subsection 1 for each person who
would be entitled to receive the increase if the provisions of this section
were applicable to the employer or association.
3. A person who is entitled to receive an
increase in his or her monthly compensation pursuant to subsection 1 is not
required to accept that increase.
4. The Administrator shall adopt
regulations to carry out the provisions of this section.
(Added to NRS by 1991, 1946; A 1993, 754, 2444, 2454; 1995, 2160)—(Substituted
in revision for NRS 616.6283)
NRS 616C.453 Additional annual payment to certain claimants and dependents of
claimants who are entitled to receive compensation for permanent total
disability; adoption of regulations to determine amount of payment.
1. If a claimant or a dependent of a
claimant is entitled to receive compensation pursuant to chapters 616A to 617,
inclusive, of NRS for a permanent total disability and the claimant or
dependent is not entitled to an annual increase in that compensation pursuant
to NRS 616C.473, the claimant or dependent is
entitled to an annual payment for that permanent total disability in an amount
determined by the Administrator pursuant to subsection 3, but such annual
payments may not exceed $1,200 per claimant or dependent. Except as otherwise
provided in subsection 5, the total payments made pursuant to this section may
not exceed $500,000 per year.
2. Each year, the Administrator shall
withdraw from the Uninsured Employers’ Claim Account established pursuant to NRS 616A.430 an amount of the income
realized from the investment of the assets in the Account that is necessary to
fund the payments calculated pursuant to subsection 3.
3. The Administrator shall adopt
regulations establishing a method for the equitable distribution of the money
withdrawn from the Account pursuant to subsection 2. The regulations must provide
for payments that result in the largest proportional share of the money being
paid to claimants and dependents who receive the lowest amount of compensation
pursuant to chapters 616A to 617, inclusive, of NRS for the permanent total
disability. The Administrator may adopt any other regulations that are
necessary to carry out the provisions of this section.
4. Except as otherwise provided in
subsection 5, the Administrator shall make the payment required by this section
to each claimant and dependent of the claimant who is entitled to the payment
not later than October 1 of each year. Any payment received by the claimant or
dependent of the claimant pursuant to this section is in addition to any
compensation to which the claimant or dependent of the claimant is otherwise
entitled by law.
5. The Administrator may make a payment
from the Account to a claimant or a dependent of a claimant that would have
been payable in a prior year pursuant to subsection 3 if the Administrator
determines that the claimant or dependent was entitled to the payment pursuant
to subsection 1.
(Added to NRS by 2005, 1316; A 2007, 3356)
NRS 616C.455 Increase in benefits for permanent total disability incurred
before April 9, 1971.
1. Any claimant or dependent of a claimant
who resides in this State and receives compensation for a permanent total
disability caused by an industrial injury or a disablement from an occupational
disease which occurred before April 9, 1971, is entitled to a 65 percent
increase in that compensation, without regard to any limitation on wages
imposed by chapters 616A to 616D, inclusive, of NRS on the amount of that
compensation.
2. The increase must be paid from the
account for pensions for silicosis, diseases related to asbestos and other disabilities.
(Added to NRS by 1973, 538; A 1975, 823; 1979, 1520; 1981, 1226; 1985, 723; 1987, 589; 1991, 1802)—(Substituted
in revision for NRS 616.626)
NRS 616C.460 Additional increase in benefits for permanent total disability
incurred before July 1, 1973. Any
claimant or dependent of a claimant who resides in this State and who receives
compensation pursuant to chapters 616A to 616D, inclusive, of NRS for a permanent total
disability for an injury or a disablement from an occupational disease which
occurred before July 1, 1973, is entitled to a 20 percent increase in that
compensation without regard to any limitation on wages imposed by those
chapters on the amount of that compensation.
(Added to NRS by 1985, 1460)—(Substituted
in revision for NRS 616.6261)
NRS 616C.465 Increase in benefits for permanent total disability incurred on
or after April 9, 1971, or for claimant or dependent not entitled to benefits
for disability from federal social security system.
1. Any claimant or dependent of a claimant
who is receiving compensation pursuant to chapters
616A to 616D, inclusive, of NRS for a
permanent total disability but is not entitled:
(a) To an increase in that compensation pursuant
to NRS 616C.455; or
(b) To any disability income benefits from the
federal social security system,
Ê is entitled
to an increase in that compensation by the same percentage as the increase in
the state average monthly wage from the date of the claimant’s disabling
accident or disease or from July 1, 1973, whichever is later, to July 1, 1980.
2. The increase provided by this section
must not be paid for any period before July 1, 1981.
(Added to NRS by 1981, 1224)—(Substituted
in revision for NRS 616.6262)
NRS 616C.470 Increase in benefits for permanent total disability if claimant
is entitled to benefits for disability from federal social security system.
1. Any claimant who is not entitled to an
increase pursuant to NRS 616C.465 and who receives
less in disability benefits from the federal social security system and
pursuant to chapters 616A to 616D, inclusive, of NRS, combined, than an
amount equal to 80 percent of average current earnings established pursuant to
section 224 of the Social Security Act, as amended (42 U.S.C. § 424a), is
entitled to an increase in his or her compensation for a permanent total
disability of:
(a) The increase provided pursuant to NRS 616C.465; or
(b) The difference between the amount of benefits
the claimant is receiving and 80 percent of the average current earnings,
Ê whichever is
less.
2. The increase provided by this section
must not be paid for any period before July 1, 1981.
(Added to NRS by 1981, 1224)—(Substituted
in revision for NRS 616.6264)
NRS 616C.473 Annual increase in benefits for permanent total disability
incurred on or after January 1, 2004.
1. If a claimant or a dependent of a
claimant is entitled to receive compensation pursuant to chapters 616A to 617,
inclusive, of NRS for a permanent total disability caused by an industrial
injury or a disablement from an occupational disease that occurs on or after
January 1, 2004, the claimant or dependent is entitled to an annual increase in
that compensation in the amount of 2.3 percent. The compensation must be
increased pursuant to this section:
(a) On January 1 of the year immediately after
the year in which the claimant or dependent becomes entitled to receive that
compensation; and
(b) On January 1 of each successive year after
the year specified in paragraph (a) in which the claimant or dependent is
entitled to receive that compensation.
2. Any increase in compensation provided
pursuant to this section is in addition to any increase in compensation to
which a claimant or a dependent of a claimant is otherwise entitled by law.
(Added to NRS by 2003, 490)
Temporary Total Disability
NRS 616C.475 Amount and duration of compensation; limitations; requirements
for certification of disability; offer of light-duty employment.
1. Except as otherwise provided in this
section, NRS 616C.175 and 616C.390,
every employee in the employ of an employer, within the provisions of chapters 616A to 616D, inclusive, of NRS, who is injured by
accident arising out of and in the course of employment, or his or her
dependents, is entitled to receive for the period of temporary total
disability, 66 2/3 percent of the average monthly wage.
2. Except as otherwise provided in NRS 616B.028 and 616B.029, an injured employee or his or
her dependents are not entitled to accrue or be paid any benefits for a
temporary total disability during the time the injured employee is
incarcerated. The injured employee or his or her dependents are entitled to
receive such benefits when the injured employee is released from incarceration
if the injured employee is certified as temporarily totally disabled by a
physician or chiropractor.
3. If a claim for the period of temporary
total disability is allowed, the first payment pursuant to this section must be
issued by the insurer within 14 working days after receipt of the initial
certification of disability and regularly thereafter.
4. Any increase in compensation and
benefits effected by the amendment of subsection 1 is not retroactive.
5. Payments for a temporary total
disability must cease when:
(a) A physician or chiropractor determines that
the employee is physically capable of any gainful employment for which the
employee is suited, after giving consideration to the employee’s education,
training and experience;
(b) The employer offers the employee light-duty
employment or employment that is modified according to the limitations or
restrictions imposed by a physician or chiropractor pursuant to subsection 7;
or
(c) Except as otherwise provided in NRS 616B.028 and 616B.029, the employee is incarcerated.
6. Each insurer may, with each check that
it issues to an injured employee for a temporary total disability, include a
form approved by the Division for the injured employee to request continued
compensation for the temporary total disability.
7. A certification of disability issued by
a physician or chiropractor must:
(a) Include the period of disability and a
description of any physical limitations or restrictions imposed upon the work
of the employee;
(b) Specify whether the limitations or
restrictions are permanent or temporary; and
(c) Be signed by the treating physician or
chiropractor authorized pursuant to NRS
616B.527 or appropriately chosen pursuant to subsection 3 or 4 of NRS 616C.090.
8. If the certification of disability
specifies that the physical limitations or restrictions are temporary, the
employer of the employee at the time of the employee’s accident may offer
temporary, light-duty employment to the employee. If the employer makes such an
offer, the employer shall confirm the offer in writing within 10 days after
making the offer. The making, acceptance or rejection of an offer of temporary,
light-duty employment pursuant to this subsection does not affect the
eligibility of the employee to receive vocational rehabilitation services,
including compensation, and does not exempt the employer from complying with NRS 616C.545 to 616C.575,
inclusive, and 616C.590 or the regulations adopted
by the Division governing vocational rehabilitation services. Any offer of
temporary, light-duty employment made by the employer must specify a position
that:
(a) Is substantially similar to the employee’s
position at the time of his or her injury in relation to the location of the
employment and the hours the employee is required to work;
(b) Provides a gross wage that is:
(1) If the position is in the same
classification of employment, equal to the gross wage the employee was earning
at the time of his or her injury; or
(2) If the position is not in the same
classification of employment, substantially similar to the gross wage the
employee was earning at the time of his or her injury; and
(c) Has the same employment benefits as the
position of the employee at the time of his or her injury.
[Part 59:168:1947; A 1949, 659; 1951, 485; 1953, 292;
1955, 901]—(NRS A 1957, 72; 1959, 201; 1963, 837; 1965, 226; 1966, 43; 1969,
472; 1971, 322; 1973, 531; 1975, 253; 1983, 1295; 1985, 1548; 1991, 2422; 1993, 747, 1870, 2442; 1995, 579, 2155; 1997, 3348; 1999, 1789, 1790; 2001, 1897; 2003, 1673; 2009, 1287)
NRS 616C.477 Compensation for lost wages incurred by employee who receives
medical treatment after returning to work; prohibition against employer
requiring employee to use personal leave for such treatment.
1. Except as otherwise provided in
subsection 2, in addition to any other benefits an injured employee is entitled
to receive pursuant to chapters 616A to 617, inclusive, of NRS, an injured employee who,
as a result of his or her injury, qualified for benefits for a temporary total
disability pursuant to NRS 616C.475 and who receives
medical treatment for that injury after the injured employee returns to work is
entitled to compensation pursuant to this subsection for each hour the injured
employee is absent from the place of employment of the responsible employer to
receive such medical treatment if the injured employee is required to travel
more than 50 miles one way from the place of employment to receive such medical
treatment. An injured employee must be paid compensation pursuant to this
subsection at a rate equal to the compensation paid pursuant to NRS 616C.475 for a temporary total disability. Such
compensation must be calculated based on increments of 4 hours or 8 hours.
2. The provisions of subsection 1 do not apply
to an injured employee who is paid his or her regular hourly rate of pay by his
or her employer for each hour the injured employee is absent from the place of
employment to receive such medical treatment.
3. An employer may not require an injured
employee to use sick leave, annual leave, compensatory leave or any other
personal leave for the injured employee’s absence from the place of employment
to receive medical treatment for the injury after the injured employee returns
to work. The provisions of this subsection apply whether the injured employee
is being paid compensation pursuant to subsection 1 or the injured employee’s
regular hourly rate of pay pursuant to subsection 2.
4. The Administrator shall adopt
regulations to carry out the provisions of this section, including, without
limitation, regulations which establish:
(a) The documentation which an injured employee
or employer is required to submit for the payment of compensation to the
injured employee pursuant to subsection 1;
(b) The method for determining the amount of
compensation to be paid to the injured employee pursuant to subsection 1; and
(c) A definition of “place of employment” as that
term is used in this section.
(Added to NRS by 2005, 99)
NRS 616C.480 Reduction of benefits for previous injury causing permanent
partial disability prohibited. If
an employee who has received compensation in a lump sum for a permanent partial
disability is subsequently injured by an accident arising out of and in the
course of his or her employment and is thereby entitled to receive compensation
for a temporary total disability, the compensation for the subsequent injury
may not be reduced because of the receipt of the lump-sum payment if the
subsequent injury is distinct from the previous injury.
(Added to NRS by 1983, 647)—(Substituted
in revision for NRS 616.587)
Permanent and Temporary Partial Disabilities
NRS 616C.485 Permanent partial disability: Loss of or permanent damage to
teeth. The Administrator shall
adopt, by regulation, a schedule which, in the judgment of the Administrator,
is best calculated to compensate fairly and adequately an injured employee for
the loss of, or permanent damage to, a tooth. The Administrator shall review
the schedule at least once every 2 years to ensure the fairness and
adequateness of the schedule.
[Part 64:168:1947; A 1951, 485]—(NRS A 1989, 333)—(Substituted
in revision for NRS 616.595)
NRS 616C.490 Permanent partial disability: Compensation.
1. Except as otherwise provided in NRS 616C.175, every employee, in the employ of an
employer within the provisions of chapters 616A
to 616D, inclusive, of NRS, who is injured
by an accident arising out of and in the course of employment is entitled to
receive the compensation provided for permanent partial disability. As used in
this section, “disability” and “impairment of the whole person” are equivalent
terms.
2. Within 30 days after receiving from a
physician or chiropractor a report indicating that the injured employee may
have suffered a permanent disability and is stable and ratable, the insurer
shall schedule an appointment with the rating physician or chiropractor
selected pursuant to this subsection to determine the extent of the employee’s
disability. Unless the insurer and the injured employee otherwise agree to a
rating physician or chiropractor:
(a) The insurer shall select the rating physician
or chiropractor from the list of qualified rating physicians and chiropractors
designated by the Administrator, to 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.
(b) Rating physicians and chiropractors must be
selected in rotation from the list of qualified physicians and chiropractors
designated by the Administrator, according to their area of specialization and
the order in which their names appear on the list unless the next physician or
chiropractor is currently an employee of the insurer making the selection, in
which case the insurer must select the physician or chiropractor who is next on
the list and who is not currently an employee of the insurer.
3. If an insurer contacts the treating
physician or chiropractor to determine whether an injured employee has suffered
a permanent disability, the insurer shall deliver to the treating physician or
chiropractor that portion or a summary of that portion of the American Medical
Association’s Guides to the Evaluation of Permanent Impairment as
adopted by the Division pursuant to NRS 616C.110
that is relevant to the type of injury incurred by the employee.
4. At the request of the insurer, the
injured employee shall, before an evaluation by a rating physician or
chiropractor is performed, notify the insurer of:
(a) Any previous evaluations performed to
determine the extent of any of the employee’s disabilities; and
(b) Any previous injury, disease or condition
sustained by the employee which is relevant to the evaluation performed
pursuant to this section.
Ê The notice
must be on a form approved by the Administrator and provided to the injured
employee by the insurer at the time of the insurer’s request.
5. Unless the regulations adopted pursuant
to NRS 616C.110 provide otherwise, a rating
evaluation must include an evaluation of the loss of motion, sensation and
strength of an injured employee if the injury is of a type that might have
caused such a loss. Except in the case of claims accepted pursuant to NRS 616C.180, no factors other than the degree of
physical impairment of the whole person may be considered in calculating the
entitlement to compensation for a permanent partial disability.
6. The rating physician or chiropractor
shall provide the insurer with his or her evaluation of the injured employee.
After receiving the evaluation, the insurer shall, within 14 days, provide the
employee with a copy of the evaluation and notify the employee:
(a) Of the compensation to which the employee is
entitled pursuant to this section; or
(b) That the employee is not entitled to benefits
for permanent partial disability.
7. Each 1 percent of impairment of the
whole person must be compensated by a monthly payment:
(a) Of 0.5 percent of the claimant’s average
monthly wage for injuries sustained before July 1, 1981;
(b) Of 0.6 percent of the claimant’s average
monthly wage for injuries sustained on or after July 1, 1981, and before June
18, 1993;
(c) Of 0.54 percent of the claimant’s average
monthly wage for injuries sustained on or after June 18, 1993, and before
January 1, 2000; and
(d) Of 0.6 percent of the claimant’s average
monthly wage for injuries sustained on or after January 1, 2000.
Ê Compensation
must commence on the date of the injury or the day following the termination of
temporary disability compensation, if any, whichever is later, and must
continue on a monthly basis for 5 years or until the claimant is 70 years of
age, whichever is later.
8. Compensation benefits may be paid
annually to claimants who will be receiving less than $100 a month.
9. Where there is a previous disability,
as the loss of one eye, one hand, one foot, or any other previous permanent
disability, the percentage of disability for a subsequent injury must be
determined by computing the percentage of the entire disability and deducting
therefrom the percentage of the previous disability as it existed at the time
of the subsequent injury.
10. The Division may adopt schedules for
rating permanent disabilities resulting from injuries sustained before July 1,
1973, and reasonable regulations to carry out the provisions of this section.
11. The increase in compensation and
benefits effected by the amendment of this section is not retroactive for
accidents which occurred before July 1, 1973.
12. This section does not entitle any
person to double payments for the death of an employee and a continuation of
payments for a permanent partial disability, or to a greater sum in the
aggregate than if the injury had been fatal.
[63:168:1947; A 1949, 659; 1953, 292]—(NRS A 1959,
204; 1966, 46; 1967, 691; 1969, 475; 1971, 326; 1973, 531; 1975, 605; 1977, 1006; 1979, 1057; 1981, 1170, 1493, 1653; 1983, 428, 1295; 1985, 308, 374; 1987, 78; 1991, 493, 2423, 2424; 1993, 748, 1871; 1995, 579, 2156; 1999, 1791; 2001, 1898; 2009, 3036)
NRS 616C.495 Permanent partial disability: Payments in lump sum.
1. Except as otherwise provided in NRS 616C.380, an award for a permanent partial
disability may be paid in a lump sum under the following conditions:
(a) A claimant injured on or after July 1, 1973,
and before July 1, 1981, who incurs a disability that does not exceed 12
percent may elect to receive his or her compensation in a lump sum. A claimant
injured on or after July 1, 1981, and before July 1, 1995, who incurs a
disability that does not exceed 25 percent may elect to receive his or her
compensation in a lump sum.
(b) The spouse, or in the absence of a spouse,
any dependent child of a deceased claimant injured on or after July 1, 1973,
who is not entitled to compensation in accordance with NRS
616C.505, is entitled to a lump sum equal to the present value of the
deceased claimant’s undisbursed award for a permanent partial disability.
(c) Any claimant injured on or after July 1,
1981, and before July 1, 1995, who incurs a disability that exceeds 25 percent
may elect to receive his or her compensation in a lump sum equal to the present
value of an award for a disability of 25 percent. If the claimant elects to
receive compensation pursuant to this paragraph, the insurer shall pay in
installments to the claimant that portion of the claimant’s disability in
excess of 25 percent.
(d) Any claimant injured on or after July 1,
1995, may elect to receive his or her compensation in a lump sum in accordance
with regulations adopted by the Administrator and approved by the Governor. The
Administrator shall adopt regulations for determining the eligibility of such a
claimant to receive all or any portion of his or her compensation in a lump
sum. Such regulations may include the manner in which an award for a permanent
partial disability may be paid to such a claimant in installments.
Notwithstanding the provisions of NRS
233B.070, any regulation adopted pursuant to this paragraph does not become
effective unless it is first approved by the Governor.
2. If the claimant elects to receive his
or her payment for a permanent partial disability in a lump sum pursuant to
subsection 1, all of the claimant’s benefits for compensation terminate. The
claimant’s acceptance of that payment constitutes a final settlement of all
factual and legal issues in the case. By so accepting the claimant waives all
of his or her rights regarding the claim, including the right to appeal from
the closure of the case or the percentage of his or her disability, except:
(a) The right of the claimant to:
(1) Reopen his or her claim in accordance
with the provisions of NRS 616C.390; or
(2) Have his or her claim considered by
his or her insurer pursuant to NRS 616C.392;
(b) Any counseling, training or other
rehabilitative services provided by the insurer; and
(c) The right of the claimant to receive a
benefit penalty in accordance with NRS
616D.120.
Ê The
claimant, when he or she demands payment in a lump sum, must be provided with a
written notice which prominently displays a statement describing the effects of
accepting payment in a lump sum of an entire permanent partial disability award,
any portion of such an award or any uncontested portion of such an award, and
that the claimant has 20 days after the mailing or personal delivery of the
notice within which to retract or reaffirm the demand, before payment may be
made and the claimant’s election becomes final.
3. Any lump-sum payment which has been
paid on a claim incurred on or after July 1, 1973, must be supplemented if
necessary to conform to the provisions of this section.
4. Except as otherwise provided in this
subsection, the total lump-sum payment for disablement must not be less than
one-half the product of the average monthly wage multiplied by the percentage
of disability. If the claimant received compensation in installment payments
for his or her permanent partial disability before electing to receive payment
for that disability in a lump sum, the lump-sum payment must be calculated for
the remaining payment of compensation.
5. The lump sum payable must be equal to
the present value of the compensation awarded, less any advance payment or lump
sum previously paid. The present value must be calculated using monthly
payments in the amounts prescribed in subsection 7 of NRS
616C.490 and actuarial annuity tables adopted by the Division. The tables
must be reviewed annually by a consulting actuary.
6. If a claimant would receive more money
by electing to receive compensation in a lump sum than the claimant would if he
or she receives installment payments, the claimant may elect to receive the
lump-sum payment.
(Added to NRS by 1983, 430; A 1983, 646, 1296; 1987, 1465; 1989, 687, 1162, 2001, 2002; 1991, 493, 2425; 1993, 749, 1872; 1995, 579, 2157; 2001, 1899; 2003, 1675; 2005, 1493; 2007, 3357)
NRS 616C.500 Temporary partial disability: Compensation.
1. Except as otherwise provided in
subsection 2 and NRS 616C.175, every employee in
the employ of an employer, within the provisions of chapters 616A to 616D, inclusive, of NRS, who is injured by
accident arising out of and in the course of employment, is entitled to receive
for a temporary partial disability the difference between the wage earned after
the injury and the compensation which the injured person would be entitled to
receive if temporarily totally disabled when the wage is less than the
compensation, but for a period not to exceed 24 months during the period of
disability.
2. Except as otherwise provided in NRS 616B.028 and 616B.029, an injured employee or his or
her dependents are not entitled to accrue or be paid any benefits for a
temporary partial disability during the time the employee is incarcerated. The
injured employee or his or her dependents are entitled to receive such benefits
if the injured employee is released from incarceration during the period of
disability specified in subsection 1 and the injured employee is certified as
temporarily partially disabled by a physician or chiropractor.
[61:168:1947; A 1953, 292]—(NRS A 1967, 878; 1973,
533; 1993, 751;
1997, 3349)
Death Benefits
NRS 616C.505 Amount and duration of compensation. If
an injury by accident arising out of and in the course of employment causes the
death of an employee in the employ of an employer, within the provisions of chapters 616A to 616D, inclusive, of NRS, the compensation is
known as a death benefit and is payable as follows:
1. In addition to any other compensation
payable pursuant to chapters 616A to 616D, inclusive, of NRS, burial expenses are
payable in an amount not to exceed $10,000, plus the cost of transporting the
remains of the deceased employee. When the remains of the deceased employee and
the person accompanying the remains are to be transported to a mortuary or
mortuaries, the charge of transportation must be borne by the insurer.
2. Except as otherwise provided in
subsection 3, to the surviving spouse of the deceased employee, 66 2/3 percent
of the average monthly wage is payable until the death of the surviving spouse.
3. If there is a surviving spouse and any
surviving children of the deceased employee who are not the children of the
surviving spouse, the compensation otherwise payable pursuant to subsection 2
must be paid as follows until the entitlement of all children of the deceased
employee to receive compensation pursuant to this subsection ceases:
(a) To the surviving spouse, 50 percent of the
death benefit is payable until the death of the surviving spouse; and
(b) To each child of the deceased employee,
regardless of whether the child is the child of the surviving spouse, the
child’s proportionate share of 50 percent of the death benefit and, except as
otherwise provided in subsection 11, if the child has a guardian, the
compensation the child is entitled to receive may be paid to the guardian.
4. In the event of the subsequent death of
the surviving spouse:
(a) Each surviving child of the deceased
employee, in addition to any amount the child may be entitled to pursuant to
subsection 3, must share equally the compensation theretofore paid to the
surviving spouse but not in excess thereof, and it is payable until the youngest
child reaches the age of 18 years.
(b) Except as otherwise provided in subsection
11, if the children have a guardian, the compensation they are entitled to
receive may be paid to the guardian.
5. If there are any surviving children of
the deceased employee under the age of 18 years, but no surviving spouse, then
each such child is entitled to his or her proportionate share of 66 2/3 percent
of the average monthly wage for the support of the child.
6. Except as otherwise provided in
subsection 7, if there is no surviving spouse or child under the age of 18
years, there must be paid:
(a) To a parent, if wholly dependent for support
upon the deceased employee at the time of the injury causing the death of the
deceased employee, 33 1/3 percent of the average monthly wage.
(b) To both parents, if wholly dependent for
support upon the deceased employee at the time of the injury causing the death
of the deceased employee, 66 2/3 percent of the average monthly wage.
(c) To each brother or sister until he or she
reaches the age of 18 years, if wholly dependent for support upon the deceased
employee at the time of the injury causing the death of the deceased employee,
his or her proportionate share of 66 2/3 percent of the average monthly wage.
7. The aggregate compensation payable
pursuant to subsection 6 must not exceed 66 2/3 percent of the average monthly
wage.
8. In all other cases involving a question
of total or partial dependency:
(a) The extent of the dependency must be
determined in accordance with the facts existing at the time of the injury.
(b) If the deceased employee leaves dependents
only partially dependent upon the earnings of the deceased employee for support
at the time of the injury causing his or her death, the monthly compensation to
be paid must be equal to the same proportion of the monthly payments for the
benefit of persons totally dependent as the amount contributed by the deceased
employee to the partial dependents bears to the average monthly wage of the
deceased employee at the time of the injury resulting in his or her death.
(c) The duration of compensation to partial
dependents must be fixed in accordance with the facts shown, but may not exceed
compensation for 100 months.
9. Compensation payable to a surviving
spouse is for the use and benefit of the surviving spouse and the dependent
children, and the insurer may, from time to time, apportion such compensation
between them in such a way as it deems best for the interest of all dependents.
10. In the event of the death of any
dependent specified in this section before the expiration of the time during
which compensation is payable to the dependent, funeral expenses are payable in
an amount not to exceed $10,000.
11. If a dependent is entitled to receive
a death benefit pursuant to this section and is less than 18 years of age or
incompetent, the legal representative of the dependent shall petition for a
guardian to be appointed for that dependent pursuant to NRS 159.044. An insurer shall not pay any
compensation in excess of $3,000, other than burial expenses, to the dependent
until a guardian is appointed and legally qualified. Upon receipt of a
certified letter of guardianship, the insurer shall make all payments required
by this section to the guardian of the dependent until the dependent is
emancipated, the guardianship terminates or the dependent reaches the age of 18
years, whichever occurs first, unless paragraph (a) of subsection 12 is applicable.
The fees and costs related to the guardianship must be paid from the estate of
the dependent. A guardianship established pursuant to this subsection must be
administered in accordance with chapter 159
of NRS, except that after the first annual review required pursuant to NRS 159.176, a court may elect not to
review the guardianship annually. The court shall review the guardianship at
least once every 3 years. As used in this subsection, “incompetent” has the
meaning ascribed to it in NRS 159.019.
12. Except as otherwise provided in
paragraphs (a) and (b), the entitlement of any child to receive his or her
proportionate share of compensation pursuant to this section ceases when the
child dies, marries or reaches the age of 18 years. A child is entitled to
continue to receive compensation pursuant to this section if the child is:
(a) Over 18 years of age and incapable of
supporting himself or herself, until such time as the child becomes capable of
supporting himself or herself; or
(b) Over 18 years of age and enrolled as a
full-time student in an accredited vocational or educational institution, until
the child reaches the age of 22 years.
13. As used in this section, “surviving
spouse” means a surviving husband or wife who was married to the employee at
the time of the employee’s death.
[Part 59:168:1947; A 1949, 659; 1951, 485; 1953, 292;
1955, 901]—(NRS A 1957, 732; 1959, 614; 1963, 1144; 1965, 264; 1966, 46; 1967,
686; 1969, 476; 1973, 533; 1975, 600; 1979, 764, 1059; 1981, 1495; 1989, 333; 1991, 804; 1993, 751; 1999, 1224; 2007, 679, 3358; 2009, 3037,
3073)
NRS 616C.510 Increased death benefits if injury or disablement occurred
before July 1, 1973.
1. Any widow, widower, surviving child or
surviving dependent parent who resides in this State and who receives death
benefits on account of an industrial injury or a disablement from an
occupational disease which occurred before July 1, 1973, is entitled to a 65
percent increase in those benefits without regard to any limitation on wages
imposed by chapters 616A to 616D, inclusive, of NRS on the amount of those
benefits.
2. The increase must be paid from the
Account for Pensions for Silicosis, Diseases Related to Asbestos and Other
Disabilities.
(Added to NRS by 1973, 538; A 1975, 823; 1979, 1520; 1981, 1227; 1985, 723; 1987, 589; 1991, 1802)—(Substituted
in revision for NRS 616.628)
NRS 616C.515 Additional increase in death benefits if injury or disablement
occurred before July 1, 1973. Any
widow, widower, surviving child or surviving dependent parent who resides in
this State and who receives death benefits pursuant to chapters 616A to 616D, inclusive, of NRS on account of an
industrial injury or a disablement from an occupational disease which occurred
before July 1, 1973, is entitled to a 20 percent increase in those benefits
without regard to any limitation on wages imposed by those chapters on the
amount of those benefits.
(Added to NRS by 1985, 1460)—(Substituted
in revision for NRS 616.6281)
NRS 616C.520 Increased death benefits if injury or disablement occurred on or
after July 1, 1973.
1. Any widow, widower, surviving child or
surviving dependent parent who is receiving death benefits pursuant to chapters 616A to 616D, inclusive, of NRS, but is not entitled
to an increase in those death benefits pursuant to NRS
616C.510, is entitled to an increase in those death benefits by the same
percentage as the increase in the state average monthly wage from the date of
the fatal accident or death caused by occupational disease or from July 1,
1973, whichever is later, to July 1, 1980.
2. The increase provided by this section
must not be paid for any period before July 1, 1981.
(Added to NRS by 1981, 1224)—(Substituted
in revision for NRS 616.6282)
VOCATIONAL REHABILITATION
NRS 616C.530 Priorities for returning injured employee to work. An insurer shall adhere to the following
priorities in returning an injured employee to work:
1. Return the injured employee to the job
the injured employee had before his or her injury.
2. Return the injured employee to a job
with the employer the injured employee worked for before his or her accident
that accommodates any limitation imposed by the injury.
3. Return the injured employee to
employment with another employer in a job that uses the injured employee’s existing
skills.
4. Provide training for the injured
employee while the injured employee is working in another vocation.
5. Provide formal training or education
for the injured employee in another vocation.
(Added to NRS by 1991, 2396)—(Substituted
in revision for NRS 616.378)
NRS 616C.540 Supervision, ratio and review of uncertified counselors;
knowledge of labor market required. An
insurer, or a private person or public agency providing vocational
rehabilitation services to an insurer, shall:
1. Ensure that the work of a vocational
rehabilitation counselor who is not certified is supervised and reviewed by a
certified vocational rehabilitation counselor.
2. Employ at least one certified
vocational rehabilitation counselor for every four vocational rehabilitation
counselors that it employs who are not certified.
3. Employ vocational rehabilitation
counselors who have knowledge of the labor market within the geographical area
where the injured employee resides.
(Added to NRS by 1993, 664; A 1993, 797; 2005, 810)
NRS 616C.542 Prohibiting vocational rehabilitation counselor employed by
entity administering injured employee’s case from providing services to injured
employee without provision of certain written disclosures; right of injured
employee to be assigned alternate counselor.
1. If the employer of a vocational
rehabilitation counselor is also the entity administering an injured employee’s
case, the vocational rehabilitation counselor shall not provide services as a
vocational rehabilitation counselor to the injured employee, including, without
limitation, completing a written assessment pursuant to NRS
616C.550, unless, before the commencement of such services, the injured
employee is provided with a written disclosure that:
(a) Discloses the relationship between the
vocational rehabilitation counselor and the entity administering the injured
employee’s case; and
(b) Informs the injured employee of his or her
right to be assigned an alternate vocational rehabilitation counselor who is
not affiliated with the entity administering the injured employee’s case.
2. After receiving the written disclosure
required pursuant to subsection 1, the injured employee has a right to be
assigned an alternate vocational rehabilitation counselor who is not affiliated
with the entity administering the injured employee’s case. To be assigned an
alternate vocational rehabilitation counselor, the injured employee must submit
a written request to the entity administering the injured employee’s case
before the commencement of vocational rehabilitation services. Not later than
10 days after receiving such a request, the entity administering the injured
employee’s case shall assign the injured employee an alternate vocational
rehabilitation counselor who is not affiliated with the entity administering
the injured employee’s case.
(Added to NRS by 2005, 1491)
NRS 616C.543 Prohibited acts of vocational rehabilitation counselor. A vocational rehabilitation counselor shall
not:
1. Offer payment of compensation in a lump
sum in lieu of the provision of vocational rehabilitation services to an
injured employee:
(a) Without providing written notice of the offer
to the attorney for the injured employee; or
(b) If the injured employee is not represented by
an attorney, without providing a written notice to the employee which satisfies
the requirements of the notice required by paragraph (c) of subsection 3 of NRS 616C.595;
2. Offer any monetary payment to an
injured employee in an amount that is less than the amount authorized by the
insurer;
3. Make any false statement or implication
that an injured employee must make a decision regarding vocational
rehabilitation within a certain period of time;
4. Advise an insured or claimant not to
seek legal counsel; or
5. Provide legal advice to a claimant.
(Added to NRS by 2007, 3343)
NRS 616C.545 Duty of insurer to determine physical limitations on injured
employee’s ability to work. If an
employee does not return to work for 28 consecutive calendar days as a result
of an injury arising out of and in the course of his or her employment or an
occupational disease, the insurer shall contact the treating physician or
chiropractor to determine whether:
1. There are physical limitations on the
injured employee’s ability to work; and
2. The limitations, if any, are permanent
or temporary.
(Added to NRS by 1993, 664)—(Substituted
in revision for NRS 616.51715)
NRS 616C.547 General duties of vocational rehabilitation counselor.
1. The primary obligation of a vocational
rehabilitation counselor is to the injured employee.
2. A vocational rehabilitation counselor
shall not provide services as a vocational rehabilitation counselor, including,
without limitation, completing a written assessment pursuant to NRS 616C.550, if the employer of the vocational
rehabilitation counselor administers the case of the injured employee.
(Added to NRS by 2005, 810)
NRS 616C.550 Written assessment of injured employee.
1. If benefits for a temporary total
disability will be paid to an injured employee for more than 90 days, the
insurer or the injured employee may request a vocational rehabilitation
counselor to prepare a written assessment of the injured employee’s ability or
potential to return to:
(a) The position the employee held at the time
that he or she was injured; or
(b) Any other gainful employment.
2. Before completing the written
assessment, the counselor shall:
(a) Contact the injured employee and:
(1) Identify the injured employee’s
educational background, work experience and career interests; and
(2) Determine whether the injured employee
has any existing marketable skills.
(b) Contact the injured employee’s treating
physician or chiropractor and determine:
(1) Whether the employee has any temporary
or permanent physical limitations;
(2) The estimated duration of the
limitations;
(3) Whether there is a plan for continued
medical treatment; and
(4) When the employee may return to the
position that the employee held at the time of his or her injury or to any
other position. The treating physician or chiropractor shall determine whether
an employee may return to the position that the employee held at the time of
his or her injury.
3. Except as otherwise provided in NRS 616C.542 and 616C.547,
a vocational rehabilitation counselor shall prepare a written assessment not
more than 30 days after receiving a request for a written assessment pursuant
to subsection 1. The written assessment must contain a determination as to
whether the employee is eligible for vocational rehabilitation services
pursuant to NRS 616C.590. If the insurer, with the
assistance of the counselor, determines that the employee is eligible for
vocational rehabilitation services, a plan for a program of vocational
rehabilitation must be completed pursuant to NRS
616C.555.
4. The Division may, by regulation,
require a written assessment to include additional information.
5. If an insurer determines that a written
assessment requested pursuant to subsection 1 is impractical because of the
expected duration of the injured employee’s total temporary disability, the
insurer shall:
(a) Complete a written report which specifies the
insurer’s reasons for the decision; and
(b) Review the claim at least once every 60 days.
6. The insurer shall deliver a copy of the
written assessment or the report completed pursuant to subsection 5 to the
injured employee, his or her employer, the treating physician or chiropractor
and the injured employee’s attorney or representative, if applicable.
7. For the purposes of this section,
“existing marketable skills” include, but are not limited to:
(a) Completion of:
(1) A program at a trade school;
(2) A program which resulted in an
associate’s degree; or
(3) A course of study for certification,
Ê if the
program or course of study provided the skills and training necessary for the
injured employee to be gainfully employed on a reasonably continuous basis in
an occupation that is reasonably available in this State.
(b) Completion of a 2-year or 4-year program at a
college or university which resulted in a degree.
(c) Completion of any portion of a program for a
graduate’s degree at a college or university.
(d) Skills acquired in previous employment,
including those acquired during an apprenticeship or a program for on-the-job
training.
Ê The skills
set forth in paragraphs (a) to (d), inclusive, must have been acquired within
the preceding 7 years and be compatible with the physical limitations of the
injured employee to be considered existing marketable skills.
8. Each written assessment of an injured
employee must be signed by a certified vocational rehabilitation counselor.
(Added to NRS by 1993, 664; A 1993, 2445; 1997, 1438; 2005, 811, 1494)
NRS 616C.555 Plan for program of vocational rehabilitation.
1. A vocational rehabilitation counselor
shall develop a plan for a program of vocational rehabilitation for each
injured employee who is eligible for vocational rehabilitation services
pursuant to NRS 616C.590. The counselor shall work
with the insurer and the injured employee to develop a program that is
compatible with the injured employee’s age, sex and physical condition.
2. If the counselor determines in a
written assessment requested pursuant to NRS 616C.550
that the injured employee has existing marketable skills, the plan must consist
of job placement assistance only. When practicable, the goal of job placement
assistance must be to aid the employee in finding a position which pays a gross
wage that is equal to or greater than 80 percent of the gross wage that the
employee was earning at the time of his or her injury. An injured employee must
not receive job placement assistance for more than 6 months after the date on
which the injured employee was notified that he or she is eligible only for job
placement assistance because:
(a) The injured employee was physically capable
of returning to work; or
(b) It was determined that the injured employee
had existing marketable skills.
3. If the counselor determines in a
written assessment requested pursuant to NRS 616C.550
that the injured employee does not have existing marketable skills, the plan
must consist of a program which trains or educates the injured employee and
provides job placement assistance. Except as otherwise provided in NRS 616C.560, such a program must not exceed:
(a) If the injured employee has incurred a
permanent disability as a result of which permanent restrictions on the ability
of the injured employee to work have been imposed but no permanent physical
impairment rating has been issued, or a permanent disability with a permanent
physical impairment of 1 percent or more but less than 6 percent, 9 months.
(b) If the injured employee has incurred a
permanent physical impairment of 6 percent or more, but less than 11 percent, 1
year.
(c) If the injured employee has incurred a permanent
physical impairment of 11 percent or more, 18 months.
Ê The
percentage of the injured employee’s permanent physical impairment must be
determined pursuant to NRS 616C.490.
4. A plan for a program of vocational
rehabilitation must comply with the requirements set forth in NRS 616C.585.
5. A plan created pursuant to subsection 2
or 3 must assist the employee in finding a job or train or educate the employee
and assist the employee in finding a job that is a part of an employer’s
regular business operations and from which the employee will gain skills that
would generally be transferable to a job with another employer.
6. A program of vocational rehabilitation
must not commence before the treating physician or chiropractor, or an
examining physician or chiropractor determines that the injured employee is
capable of safely participating in the program.
7. If, based upon the opinion of a
treating or an examining physician or chiropractor, the counselor determines
that an injured employee is not eligible for vocational rehabilitation
services, the counselor shall provide a copy of the opinion to the injured
employee, the injured employee’s employer and the insurer.
8. A plan for a program of vocational
rehabilitation must be signed by a certified vocational rehabilitation
counselor.
9. If an initial program of vocational
rehabilitation pursuant to this section is unsuccessful, an injured employee
may submit a written request for the development of a second program of
vocational rehabilitation which relates to the same injury. An insurer shall
authorize a second program for an injured employee upon good cause shown.
10. If a second program of vocational
rehabilitation pursuant to subsection 9 is unsuccessful, an injured employee
may submit a written request for the development of a third program of
vocational rehabilitation which relates to the same injury. The insurer, with
the approval of the employer who was the injured employee’s employer at the
time of his or her injury, may authorize a third program for the injured
employee. If such an employer has terminated operations, the employer’s
approval is not required for authorization of a third program. An insurer’s
determination to authorize or deny a third program of vocational rehabilitation
may not be appealed.
11. The Division shall adopt regulations
to carry out the provisions of this section. The regulations must specify the
contents of a plan for a program of vocational rehabilitation.
(Added to NRS by 1993, 665; A 1993, 797, 2447, 2456; 1995, 2147; 1999, 1793; 2001, 1901; 2005, 1495)
NRS 616C.560 Extension of program for vocational rehabilitation.
1. A program for vocational rehabilitation
developed pursuant to subsection 3 of NRS 616C.555
may be extended:
(a) Without condition or limitation, by the
insurer at the insurer’s sole discretion; or
(b) In accordance with this section if:
(1) The injured employee makes a written
request to extend the program not later than 30 days after the program has been
completed; and
(2) There are exceptional circumstances
which make it unlikely that the injured employee will obtain suitable gainful
employment as a result of vocational rehabilitation which is limited to the
period for which the injured employee is eligible.
Ê An insurer’s
determination to grant or deny an extension pursuant to paragraph (a) may not
be appealed.
2. If an injured employee has incurred a
permanent physical impairment of less than 11 percent:
(a) The total length of the program, including
any extension, must not exceed 2 years.
(b) “Exceptional circumstances” shall be deemed
to exist for the purposes of paragraph (b) of subsection 1, if:
(1) The injured employee lacks work
experience, training, education or other transferable skills for an occupation
which the injured employee is physically capable of performing; or
(2) Severe physical restrictions as a
result of the industrial injury have been imposed by a physician which
significantly limit the employee’s occupational opportunities.
3. If an injured employee has incurred a
permanent physical impairment of 11 percent or more:
(a) The total length of the program, including
any extension, must not exceed 2 1/2 years.
(b) “Exceptional circumstances” shall be deemed
to exist for the purposes of paragraph (b) of subsection 1, if the injured
employee has suffered:
(1) The total and permanent loss of sight
of both eyes;
(2) The loss by separation of a leg at or
above the knee;
(3) The loss by separation of a hand at or
above the wrist;
(4) An injury to the head or spine which
results in permanent and complete paralysis of both legs, both arms or a leg
and an arm;
(5) An injury to the head which results in
a severe cognitive functional impairment which may be established by a
nationally recognized form of objective psychological testing;
(6) The loss by separation of an arm at or
above the elbow and the loss by separation of a leg at or above the knee;
(7) An injury consisting of second or
third degree burns on 50 percent or more of the body, both hands or the face;
(8) A total bilateral loss of hearing;
(9) The total loss or significant and
permanent impairment of speech; or
(10) A permanent physical impairment of 50
percent or more determined pursuant to NRS 616C.490,
if the severity of the impairment limits the injured employee’s gainful
employment to vocations that are primarily intellectual and require a longer
program of education.
4. The insurer shall deliver a copy of its
decision granting or denying an extension to the injured employee and the
employer. Except as otherwise provided in this section, the decision shall be
deemed to be a final determination of the insurer for the purposes of NRS 616C.315.
(Added to NRS by 1993, 666; A 1993, 2448; 1997, 1440; 1999, 1794; 2007, 3360)
NRS 616C.570 On-the-job training as component of plan for program of
vocational rehabilitation.
1. A plan for a program of vocational
rehabilitation developed pursuant to NRS 616C.555
may include a program for on-the-job training, if the training is suitable for
the injured employee.
2. Before an injured employee may
participate in a program for on-the-job training, the insurer and the employer
must execute a written agreement which contains an explanation of the training
and a schedule for that training.
3. Except as otherwise provided in
subsection 4, the insurer may pay not more than 50 percent of the wages of an
injured employee who is participating in a program for on-the-job training. An
insurer contributing toward the wages of an injured employee shall pay the
employee within 10 days after the employee submits documentation of his or her
payroll to the insurer. The insurer shall not contribute to the wages of the
injured employee for more than the period authorized for the particular
employee pursuant to subsection 3 of NRS 616C.555
or 616C.560.
4. The insurer shall, within 30 days after
receipt of a request for payment, reimburse the training employer for the wages
paid by the training employer to the injured employee pursuant to this section
if:
(a) After the successful completion of the
training, the training employer continues to employ the injured employee for at
least 90 days in a position which requires the training so obtained; or
(b) The injured employee:
(1) Within 30 days after his or her successful
completion of the training, obtains employment which requires the skills
obtained by him or her as a direct result of the training provided by the
training employer; and
(2) Retains that or similar employment for
at least 6 months after the completion of the training.
(Added to NRS by 1993, 667; A 1993, 2449)—(Substituted
in revision for NRS 616.51745)
NRS 616C.575 Payment of vocational rehabilitation maintenance.
1. The Division shall, by regulation,
prescribe when:
(a) Vocational rehabilitation maintenance must be
paid to an injured employee; and
(b) Vocational rehabilitation maintenance must
cease to be paid to an injured employee.
Ê An injured
employee must not receive vocational rehabilitation maintenance after the
injured employee’s program of vocational rehabilitation ends pursuant to NRS 616C.555.
2. As used in this section, “vocational
rehabilitation maintenance” means the amount of compensation paid to an injured
employee while the injured employee is participating in a program of vocational
rehabilitation developed pursuant to NRS 616C.555.
(Added to NRS by 1993, 668)—(Substituted
in revision for NRS 616.5175)
NRS 616C.580 Provision of services outside of State; limited lump-sum payment
in lieu of services.
1. Except as otherwise provided in this
section, vocational rehabilitation services must not be provided outside of
this State.
2. An injured employee who:
(a) Resides outside of this State, within 50
miles from any border of this State, on the date of injury; or
(b) Was injured while temporarily employed in
this State by an employer subject to the provisions of chapters 616A to 617,
inclusive, of NRS who can demonstrate that, on the date of injury, his or her
permanent residence was outside of this State,
Ê may receive
vocational rehabilitation services at a location within 50 miles from his or
her residence if such services are available at such a location.
3. An injured employee who:
(a) Is eligible for vocational rehabilitation
services pursuant to NRS 616C.590; and
(b) Resides outside of this State but does not
qualify to receive vocational rehabilitation services outside of this State
pursuant to subsection 2,
Ê may execute
a written agreement with the insurer which provides for the payment of
compensation in a lump sum in lieu of the provision of vocational
rehabilitation services pursuant to NRS 616C.595.
The amount of the lump sum must not exceed $20,000.
4. An injured employee who resides outside
of this State but does not qualify to receive vocational rehabilitation
services outside of this State pursuant to subsection 2 may receive the
vocational rehabilitation services to which the injured employee is entitled
pursuant to NRS 616C.545 to 616C.575, inclusive, and 616C.590
if the injured employee relocates to:
(a) This State; or
(b) A location within 50 miles from any border of
this State,
Ê at his or
her own expense, if such services are available at such a location.
5. An injured employee who resides in this
State may receive vocational rehabilitation services outside of this State at a
location within 50 miles from the residence of the injured employee if such
services are available at such a location. An insurer may not unreasonably deny
a request made by an injured employee pursuant to this subsection to receive
vocational rehabilitation services outside of this State.
6. An injured employee may receive
vocational rehabilitation services in any state that borders this State if the
injured employee demonstrates that the services are available in a more
cost-effective manner than are available in this State. Any vocational
rehabilitation services provided pursuant to this subsection must be monitored
by a vocational rehabilitation counselor in this State.
(Added to NRS by 1993, 668; A 1999, 1795; 2001, 1902; 2005, 209; 2007, 3361)
NRS 616C.585 Limit on goods and services which may be provided; exceptions.
1. Except as otherwise provided in
subsection 2, vocational rehabilitation services ordered by an insurer, a
hearing officer or an appeals officer must not include the following goods and
services:
(a) A motor vehicle.
(b) Repairs to an injured employee’s motor
vehicle.
(c) Tools and equipment normally provided to the
injured employee by his or her employer during the course of his or her
employment.
(d) Care for the injured employee’s children.
2. An injured employee is entitled to
receive the goods and services set forth in subsection 1 only if the insurer of
the injured employee determines that such goods and services are reasonably
necessary.
3. Vocational rehabilitation services
ordered by an insurer may include the formal education of the injured employee
only if:
(a) The priorities set forth in NRS 616C.530 for returning an injured employee to
work are followed;
(b) The education is recommended by a plan for a
program of vocational rehabilitation developed pursuant to NRS 616C.555; and
(c) A written proposal concerning the probable
economic benefits to the employee and the necessity of the education is
submitted to the insurer.
(Added to NRS by 1993, 668; A 1997, 1441)
NRS 616C.590 Eligibility for services; effect of incarceration; effect of
refusing services offered by insurer; effect of inability of insurer to locate
injured employee.
1. Except as otherwise provided in this
section, an injured employee is not eligible for vocational rehabilitation
services, unless:
(a) The treating physician or chiropractor
approves the return of the injured employee to work but imposes permanent
restrictions that prevent the injured employee from returning to the position
that the employee held at the time of his or her injury;
(b) The injured employee’s employer does not
offer employment that:
(1) The employee is eligible for
considering the restrictions imposed pursuant to paragraph (a);
(2) Provides a gross wage that is equal to
or greater than 80 percent of the gross wage that the employee was earning at
the time of injury; and
(3) Has the same employment benefits as
the position of the employee at the time of his or her injury; and
(c) The injured employee is unable to return to
gainful employment with any other employer at a gross wage that is equal to or
greater than 80 percent of the gross wage that the employee was earning at the
time of his or her injury.
2. If the treating physician or
chiropractor imposes permanent restrictions on the injured employee for the
purposes of paragraph (a) of subsection 1, he or she shall specify in writing:
(a) The medically objective findings upon which
his or her determination is based; and
(b) A detailed description of the restrictions.
Ê The treating
physician or chiropractor shall deliver a copy of the findings and the
description of the restrictions to the insurer.
3. If there is a question as to whether the
restrictions imposed upon the injured employee are permanent, the employee may
receive vocational rehabilitation services until a final determination
concerning the duration of the restrictions is made.
4. Vocational rehabilitation services must
cease as soon as the injured employee is no longer eligible for the services
pursuant to subsection 1.
5. An injured employee is not entitled to
vocational rehabilitation services solely because the position that the
employee held at the time of his or her injury is no longer available.
6. An injured employee or the dependents
of the injured employee are not entitled to accrue or be paid any money for
vocational rehabilitation services during the time the injured employee is
incarcerated.
7. Any injured employee eligible for
compensation other than accident benefits may not be paid those benefits if the
injured employee refuses counseling, training or other vocational
rehabilitation services offered by the insurer. Except as otherwise provided in
NRS 616B.028 and 616B.029, an injured employee shall be
deemed to have refused counseling, training and other vocational rehabilitation
services while the injured employee is incarcerated.
8. If an insurer cannot locate an injured
employee for whom it has ordered vocational rehabilitation services, the
insurer may close his or her claim 21 days after the insurer determines that the
employee cannot be located. The insurer shall make a reasonable effort to
locate the employee.
9. The reappearance of the injured
employee after his or her claim has been closed does not automatically
reinstate his or her eligibility for vocational rehabilitation benefits. If the
employee wishes to re-establish his or her eligibility for those benefits, the
injured employee must file a written application with the insurer to reinstate
the claim. The insurer shall reinstate the employee’s claim if good cause is
shown for the employee’s absence.
(Added to NRS by 1973, 362; A 1979, 1042; 1981, 1459; 1985, 1541; 1991, 491, 2401; 1993, 703; 1997, 1441, 3350; 1999, 444; 2001, 1903; 2003, 1676)
NRS 616C.595 Agreements for payment of compensation in lump sum in lieu of
provision of vocational rehabilitation services.
1. If an injured employee is eligible for
vocational rehabilitation services pursuant to NRS
616C.590, the insurer and the injured employee may, at any time during the
employee’s eligibility for such services, execute a written agreement providing
for the payment of compensation in a lump sum in lieu of the provision of
vocational rehabilitation services. An insurer’s refusal to execute such an
agreement may not be appealed.
2. If the insurer and the injured employee
execute an agreement pursuant to subsection 1, the acceptance of the payment of
compensation in a lump sum by the injured employee extinguishes the right of
the injured employee to receive vocational rehabilitation services under the
injured employee’s claim. Except as otherwise required by federal law, an
injured employee shall not receive vocational rehabilitation services from any
state agency after the injured employee accepts payment of compensation in a
lump sum pursuant to this section.
3. Before executing an agreement pursuant
to subsection 1, an insurer shall:
(a) Order an assessment of and counseling
concerning the vocational skills of the injured employee, unless the provisions
of subsection 3 of NRS 616C.580 are applicable;
(b) Consult with the employer of the injured
employee; and
(c) Provide a written notice to the injured
employee that contains the following statements:
(1) That the injured employee is urged to
seek assistance and advice from the Nevada Attorney for Injured Workers or to
consult with a private attorney before signing the agreement.
(2) That the injured employee may rescind
the agreement within 20 days after the injured employee signs it.
(3) That the 20-day period pursuant to
subparagraph (2) may not be waived.
(4) That acceptance by the injured
employee of payment of compensation in a lump sum in lieu of the provision of
vocational rehabilitation services extinguishes the right of the injured
employee to receive such services.
4. Except as otherwise provided in NRS 616C.580, any payment of compensation in a lump
sum in lieu of the provision of vocational rehabilitation services must not be
less than 40 percent of the maximum amount of vocational rehabilitation
maintenance due to the injured employee pursuant to NRS
616C.555.
5. No payment of compensation in a lump
sum may be made pursuant to this section until the 20-day period provided for
the rescission of the agreement has expired.
(Added to NRS by 1991, 2396; A 1993, 753; 1995, 2159; 2005, 210; 2007, 3362)
NRS 616C.597 Response to request for payment of compensation in lump sum in
lieu of provision of vocational rehabilitation services.
1. Except as otherwise provided in
subsection 2, an insurer shall, within 30 days after receiving a written
request from an injured employee for payment of compensation in a lump sum in
lieu of the provision of vocational rehabilitation services, respond in writing
to the request and, if the insurer agrees to the request, include in the
response:
(a) The amount of the lump sum that the insurer
is offering to pay;
(b) A statement that the injured employee has 30
days after the date of the written response to accept or reject the lump-sum
offer; and
(c) A statement indicating that, if the injured
employee rejects the lump-sum offer, the injured employee must continue working
with his or her vocational rehabilitation counselor in accordance with the
provisions of this chapter and the regulations adopted pursuant thereto.
2. An insurer need only respond to a
written request from an injured employee for payment of compensation in a lump
sum in lieu of the provision of vocational rehabilitation services if the
injured employee is eligible for vocational rehabilitation services.
(Added to NRS by 2007, 3344)
NRS 616C.600 Orders for self-employment or payment of compensation in lump
sum for vocational rehabilitation prohibited; agreements concerning
self-employment authorized.
1. A hearing officer or appeals officer
shall not order self-employment for an injured employee or the payment of
compensation in a lump sum for vocational rehabilitation.
2. An insurer, an employer and an injured
employee may execute an agreement concerning self-employment.
(Added to NRS by 1991, 2394)—(Substituted
in revision for NRS 616.573)
CATASTROPHIC INJURIES
NRS 616C.700 Duties of insurer who accepts a claim for catastrophic injury;
life care plan.
1. Notwithstanding any other provision of
this chapter, if an insurer accepts a claim for a catastrophic injury, the
insurer shall:
(a) As soon as reasonably practicable after the
date of acceptance of the claim, assign the claim to a qualified adjuster,
nurse and vocational rehabilitation counselor;
(b) Within 120 days after the date on which the
treating physician determines that the condition of the injured employee has
stabilized and that the injured employee requires a life care plan, develop a
life care plan in consultation with the adjuster, nurse and vocational
rehabilitation counselor assigned to the claim pursuant to paragraph (a); and
(c) Pay benefits and provide the proper medical
services to the injured employee during the entire period of the development
and implementation of the life care plan.
2. A life care plan which is developed
pursuant to subsection 1 must ensure the prompt, efficient and proper provision
of medical services to the injured employee.
3. In developing a life care plan for an
injured employee, the insurer, in consultation with the adjuster, nurse and
vocational rehabilitation counselor assigned to the claim pursuant to paragraph
(a) of subsection 1, shall assess the following:
(a) The number of home or hospital visits
determined to be necessary or appropriate by the registered nurse and
vocational rehabilitation counselor;
(b) The life expectancy of the injured employee;
(c) The medical needs of the injured employee,
including, without limitation:
(1) Surgery;
(2) Prescription medication;
(3) Physical therapy; and
(4) Maintenance therapy;
(d) The effect, if any, of any preexisting
medical condition; and
(e) The potential of the injured employee for
rehabilitation, taking into account:
(1) The injured employee’s medical
condition, age, educational level, work experience and motivation; and
(2) Any other relevant factors.
4. A life care plan developed pursuant to
paragraph (b) of subsection 1 must include, without limitation, a schedule for
the adjuster, nurse and vocational rehabilitation counselor assigned to the
claim pursuant to paragraph (a) of subsection 1 to meet or communicate with the
injured employee, if practicable, and the treating physician to determine the
need for, without limitation:
(a) Special medical attention or treatment;
(b) Psychological counseling or testing; and
(c) Any medical device, including, without
limitation:
(1) A wheelchair;
(2) A prosthesis; and
(3) A specially equipped or designed motor
vehicle.
5. A life care plan developed pursuant to
paragraph (b) of subsection 1 must include a plan of action for treatment or
vocational rehabilitation of the injured employee or consideration of the
possible permanent total disability of the injured employee.
6. In addition to any claim determination
affecting the rights of an injured employee under his or her claim, or
responses to requests on behalf of the injured employee for specific action or
information on the claim or any other contact that may occur, an insurer shall:
(a) Schedule a personal meeting concerning the
status of the claim to take place at least once per calendar month between the
adjuster assigned to the claim pursuant to paragraph (a) of subsection 1 and
the injured employee or a family member or designated representative of the
injured employee; or
(b) If a personal meeting described in paragraph
(a) is not practicable, provide a written report concerning the status of the
claim and soliciting requests and information at least once per calendar month
to the injured employee or a family member or designated representative of the
injured employee. The report must be mailed to the injured employee or a family
member or designated representative of the injured employee by first-class mail.
7. Except as otherwise provided in this
subsection, a life care plan developed pursuant to paragraph (b) of subsection
1 must be based on the condition of the injured employee at the time the life
care plan is established. If there is a substantial or significant change in
the condition or prognosis of the injured employee, the insurer shall amend the
life care plan to reflect the change in the condition or prognosis of the
injured employee.
(Added to NRS by 2009, 2779;
A 2011, 718)
NRS 616C.703 Injured employee may request insurer to administer claim as for
catastrophic injury; insurer to issue determination.
1. An injured employee may submit to an
insurer a written request for a determination that his or her injury should be
administered as a claim for a catastrophic injury.
2. If an employee submits a written
request to an insurer pursuant to subsection 1, the insurer shall issue a
written determination concerning the request not later than 30 days after
receipt of the request.
(Added to NRS by 2011, 718)
NRS 616C.707 Insurer to designate claim as for catastrophic injury if injury
later satisfies requirements for catastrophic injury. An
insurer that did not originally accept a claim as a claim for a catastrophic
injury shall designate the claim as a claim for a catastrophic injury if at any
time after the claim is accepted the injury satisfies the requirements for a
catastrophic injury.
(Added to NRS by 2011, 718)
NRS 616C.710 Rescission or revision of determination of catastrophic injury. An insurer that has accepted a claim for a
catastrophic injury may thereafter rescind or revise its original determination
that the injury is a catastrophic injury if:
1. Medical evidence supports the
rescission or revision;
2. The injured employee is stable and
ratable; or
3. Other circumstances warrant such a
rescission or revision.
(Added to NRS by 2009, 2779)
NRS 616C.720 Requirements for adjuster who administers claim for catastrophic
injury. An adjuster who
administers a claim for a catastrophic injury must:
1. Have at least 4 years of experience in
adjusting workers’ compensation claims for lost time; or
2. Have at least 2 years of experience in
adjusting workers’ compensation claims for lost time and work under the direct
supervision of an adjuster who has at least 4 years of experience in adjusting
such claims.
(Added to NRS by 2009, 2779;
A 2011, 720)
