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- 83rd Session (2025)
Senate Bill No. 376–Senators Daly and Steinbeck
CHAPTER..........
AN ACT relating to industrial insurance; authorizing an injured
employee with a claim for an occupational lung disease or
occupational heart disease to seek treatment or services from
a physician or chiropractic physician which is not on the
panel of physicians and chiroprac tic physicians maintained
by the Administrator of the Division of Industrial Relations
of the Department of Business and Industry under certain
circumstances; setting forth certain requirements for the
reimbursement of the costs for such treatment or servi ces;
providing for a penalty for failure to comply with those
requirements; authorizing certain notices and other
documents required in certain hearings or appeals relating to
industrial insurance to be provided by means of an electronic
filing system; and providing other matters properly relating
thereto.
Legislative Counsel’s Digest:
Existing law establishes the Nevada Industrial Insurance Act and the Nevada
Occupational Diseases Act, which provide for the payment of compensation to
employees who are inj ured or disabled as a result of an occupational injury or
occupational disease. (Chapters 616A -616D and 617 of NRS) Existing law
provides for the payment of compensation for claims for the occupational diseases
of lung disease and heart disease for certain firefighters, arson investigators and
police officers. (NRS 617.455, 617.457)
Existing law requires the Administrator of the Division of Industrial Relations
of the Department of Business and Industry to maintain a panel of physicians and
chiropractic ph ysicians to treat the injured employees of certain employers under
the Nevada Industrial Insurance Act and the Nevada Occupational Diseases Act.
(NRS 616C.087, 616C.090) Existing law authorizes an injured employee to choose
a treating physician or chiropra ctic physician from the panel unless the insurer of
the injured employee’s employer has entered into certain contracts with an
organization for managed care or with providers of health care, in which case the
injured employee is required to choose a physic ian or chiropractic physician in
accordance with the provisions of the contract. (NRS 616C.090)
Sections 1, 2 and 4 of this bill provide an exception from those requirements to
authorize certain injured employees who have filed a claim for the occupation al
diseases of lung disease or heart disease to seek treatment or other services from a
physician or chiropractic physician of his or her own choice , who meets certain
other requirements, if the panel of treating physicians or chiropractic physicians
maintained by the Administrator contains fewer than 12 physicians or chiropractic
physicians in a discipline or specialization appropriate for the treatment of or the
provision of other servic es related to the occupational disease of the injured
employee who are accepting new patients and available to make an appointment
within 30 days.
Sections 2, 4.1 and 4.3 of this bill also provide that the injured employee or
certain other persons who pay for the treatment or services may seek full
reimbursement for the costs of the treatment or services from the employer of the
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injured employee or certain other persons who are obligated to provide applicable
coverage or benefits to the injured employee by providing a request for
reimbursement, which includes certain specified contents. Section 2 requires a
person from whom reimbursement is sought to fully reimburse the requester not
later than 30 days after receiving notice of the request for reimbursement . Under
section 2, if the person fails to fully reimburse the requester within that time, the
Administrator is required to order the person to pay to the requester an amount that
is equal to two times the amount of the reimbursement which remains unpaid on the
date on which the Administrator issues the order.
Sections 3 and 5 of this bill revise provisions of existing law relating to the
selection of a treating physician or chiropractic physician to reflect the selection of
a physician or chiropractic physician pursuant to section 2.
Existing law authorizes an aggrieved party in a contested case relating to
industrial insurance to: (1) request a hearing before a hearing officer; and (2) appeal
from a decision of a hearing officer or from a determination ma de by certain
parties. (NRS 616C.315, 616C.330, 616C.345, 616C.355) Sections 4.5, 4.7 and 4.9
of this bill authorize certain notices and other documents required in such hearings
and appeals to be provided by means of an electronic filing system that compl ies
with the Nevada Electronic Filing and Conversion Rules adopted by the Nevada
Supreme Court.
EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Section 1. NRS 616B.527 is hereby amended to read as
follows:
616B.527 1. A self-insured employer, an association of self -
insured public or private employers or a private carrier may:
(a) Except as otherwise provided in NRS 616B.5273, enter into
a contract or contracts with one or more organizations for managed
care to provide comprehensive medical and health care services to
employees for injuries and diseases that are compensable pursuant
to chapters 616A to 617, inclusive, of NRS.
(b) Enter into a contract or contracts with providers of health
care, including, without limitation, physicians who provide primary
care, specialists, pharmacies, physical therapists, radiologists,
nurses, diagnostic facilities, laboratories, hospitals and facilities that
provide treatment to outpatients, to provide medical and health care
services to employees for injuries and diseases that are compensable
pursuant to chapters 616A to 617, inclusive, of NRS.
(c) Require employees to obtain medical and health care
services for their industrial injuries from those organizations and
persons with whom the self-insured employer, association or private
carrier has contracted pursuant to paragraphs (a) and (b), or as the
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self-insured employer, association or private carrier otherwise
prescribes.
(d) Except as otherwise provided in subsection 4 of NRS
616C.090 [,] and section 2 of this act, require employees to obtain
the approval of the self -insured employer, association or private
carrier before obtaining medical and health care services for their
industrial injuries from a provider of healt h care who has not been
previously approved by the self -insured employer, association or
private carrier.
2. An organization for managed care with whom a self -insured
employer, association of self-insured public or private employers or
a private carrier has contracted pursuant to this section shall comply
with the provisions of NRS 616B.528, 616B.5285 and 616B.529.
Sec. 2. Chapter 616C of NRS is hereby amended by adding
thereto a new section to read as follows:
1. If an injured employee has filed a claim pursuant to NRS
617.455 or 617.457 and, at the time the claim is filed, the panel of
physicians or chiropractic physicians maintained by the
Administrator pursuant to NRS 616C.090 contains fewer than 12
physicians or chi ropractic physicians in a discipline or
specialization appropriate for the treatment of or the provision of
other services relating to the occupational disease of the injured
employee who are accepting new patients and are available to
meet with the injure d employee within 30 days after the date on
which the injured employee first contacts the physician or
chiropractic physician to request an appointment, the injured
employee may seek treatment or other services related to the
occupational disease of the in jured employee from a physician or
chiropractic physician of his or her choice selected in accordance
with subsection 2.
2. An injured employee may select a physician or chiropractic
physician of his or her choice pursuant to subsection 1 from a list
of all physicians or chiropractic physicians in the relevant
discipline or specialization who have entered into a contract with
an organization for managed care, under a health benefit plan or
otherwise with a health insurer or casualty insurer of the employer
of the injured employee , whether or not the physician or
chiropractic physician has specifically contracted to provide
treatment or other services to employees for injuries and diseases
that are compensable pursuant to chapters 616A to 617, inclusive,
of NRS, or been previously approved pursuant to NRS 616B.527.
3. If an injured employee seeks treatment or services
pursuant to subsection 1, the treatment or services may be paid for
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by the injured employee or a health insurer or casualty insurer on
behalf of the injured employee.
4. Full reimbursement of the amount paid by:
(a) The injured employee who paid for his or her own
treatment or services; or
(b) A health insurer or casualty insurer who paid for treatment
or services on behalf of the injured employee,
pursuant to subsection 3 may be sought by the injured
employee, health insurer or casualty insurer, as applicable, from
the employer of the injured employee or an insurer, organization
for managed care or third -party administrator, as applicable, who
is obligated to provide applicable coverage or benefits to the
injured employee.
5. To seek reimbursement as described in subsection 4, the
injured employee, health insurer or casualty insurer must submit a
request for reimbursement to the employer of the injured employee
or the employer’s insurer, organization for managed care or third-
party administrator, as applicable. The request for reimbursement
must include, without limitation:
(a) The identity of the injured employee for whom the costs of
treatment and services was paid.
(b) A description of the treatment and services provided to the
injured employee.
(c) The identity of the person who paid for the treatment and
services for the injured employee.
(d) The costs of treatment and s ervices for which
reimbursement is being requested.
6. Not later than 30 days after receipt of a request for
reimbursement submitted pursuant to subsection 5, the employer
of the injured employee or the employer’s insurer, organization
for managed care or third-party administrator, as applicable, from
whom reimbursement is sought shall fully reimburse the injured
employee, health insurer or casualty insurer, as applicable, who
paid for treatment and services on behalf of the injured employee
for the amount paid for the treatment or services as set forth in the
request for reimbursement.
7. If the Administrator determines that an insurer,
organization for managed care or third -party administrator has
failed to fully reimburse an injured employee, health i nsurer or
casualty insurer, as applicable, within the time required by
subsection 6, the Administrator shall order the insurer,
organization for managed care or third -party administrator to pay
to the injured employee, health insurer or casualty insurer, a s
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applicable, an amount equal to two times the amount of
reimbursement that remains unpaid on the date on which the
Administrator issues the order.
8. Any amount ordered by the Administrator to be paid
pursuant to subsection 7 is in addition to any amounts for:
(a) Benefits to which the injured employee is entitled under the
claim for the occupational disease set forth in NRS 617.455 or
617.457, as applicable; and
(b) Any fines and penalties imposed by the Administrator
pursuant to NRS 616D.120.
9. As used in this section:
(a) “Casualty insurer” means an 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 an insurer or other organization
providing health coverage or benefits in accordance with state or
federal law.
Sec. 3. NRS 616C.050 is hereby amended to read as follows:
616C.050 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 chiropractic physician and
an alternative treating physic ian or chiropractic physician in
accordance with the provisions of NRS 616C.090 [;] and section 2
of this act;
(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
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(VI) The hours t he 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 12 of NRS
616C.090 that notifies injured employees of their right to select an
alternative treating physician or chiropractic physician. The
Administrator shall adopt regulations for the manner of compliance
by an insurer with the other provisions of subsection 1.
Sec. 4. NRS 616C.090 is hereby amended to read as follows:
616C.090 1. The Administrator shall establish, maintain and
update not less frequently than annually on or before July 1 of each
year, a panel of physicians and chiropractic physicians 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. The Administrator shall maintain the following
information relating to each physician and chiropractic physician on
the panel:
(a) The name of the physician or chiropractic physician.
(b) The title or degree of the physician or chiropractic physician.
(c) The legal name of the practice of the physician or
chiropractic physician and the name under which the practice does
business.
(d) The street address of the location of every office of the
physician or chiropractic physician.
(e) The telephone number of every office of the physician or
chiropractic physician.
(f) Every discipline and specialization practiced by the physician
or chiropractic physician.
(g) Every condition and part of the body which the physician or
chiropractic physician will treat.
2. Every employer whose insurer has not entered into a
contract with an organization for managed care or with providers of
health care pursuant to NRS 616B.527 shall maintain a list of those
physicians and chiropractic physicians on the panel who are
reasonably accessible to his or her employees.
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3. [An] Except as otherwise provided in section 2 of this act,
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 pursuant to NRS 616B.527 may choose a treating
physician or chiropractic physician from the panel of physicians and
chiropractic physicians. If the injured employee is not satisfied with
the first physician or chiropractic physician he or she so chooses, the
injured employee may make an alternative choice of physician or
chiropractic physician from the panel if the choice is made within 90
days after his or her injury. The insurer shall notify the first
physician or chiropractic physician in writing. The notice must be
postmarked within 3 working days after the insurer receives
knowledge of the change. The first physician or chiropractic
physician must be reimbursed only for the services the phy sician or
chiropractic physician, 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 or by order of a h earing officer or
appeals officer. A request for a change of physician or chiropractic
physician must be granted or denied within 10 days after a written
request for such a change is received from the injured employee. If
the insurer takes no action on the request within 10 days, the request
shall be deemed granted. Any request for a change of physician or
chiropractic physician must include the name of the new physician
or chiropractic physician chosen by the injured employee. If the
treating physician or chiropractic physician refers the injured
employee to a specialist for treatment, the insurer shall provide to
the injured employee a list that includes the name of each physician
or chiropractic physician with that specialization who is on the
panel. Not later than 14 days after receiving the list, the injured
employee shall select a physician or chiropractic physician from the
list.
4. [An] Except as otherwise provided in section 2 of this act,
an injured employee whose 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 must choose a treating
physician or chiropractic physician pursuant to the terms of that
contract. If the injured employee is not satisfied with the first
physician or chiropractic physician he or she so chooses, the injured
employee may make an alternative choice of physician or
chiropractic physician pursuant to the terms of the contract with out
the approval of the insurer if the choice is made within 90 days after
his or her injury. Except as otherwise provided in this subsection,
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any further change is subject to the approval of the insurer or by
order of a hearing officer or appeals officer. A request for a change
of physician or chiropractic physician must be granted or denied
within 10 days after a written request for such a change is received
from the injured employee. If the insurer takes no action on the
request within 10 days, the reque st shall be deemed granted. If the
injured employee, after choosing a treating physician or chiropractic
physician, moves to a county which is not served by the
organization for managed care or providers of health care named in
the contract and the insurer determines that it is impractical for the
injured employee to continue treatment with the physician or
chiropractic physician, the injured employee must choose a treating
physician or chiropractic physician who has agreed to the terms of
that contract unl ess the insurer authorizes the injured employee to
choose another physician or chiropractic physician. If the treating
physician or chiropractic physician refers the injured employee to a
specialist for treatment, the insurer shall provide to the injured
employee a list that includes the name of each physician or
chiropractic physician 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 pursuant to NRS
616B.527, as appropriate. Not later than 14 days after receiving the
list, the injured employee shall select a physician or chiropractic
physician from the list. If the employee fails to select a physician or
chiropractic physician, the insurer may select a phys ician
or chiropractic physician with that specialization. If a physician or
chiropractic physician with that specialization is not available
pursuant to the terms of the contract, the organization for managed
care or the provider of health care may select a physician or
chiropractic physician with that specialization.
5. If the injured employee is not satisfied with the physician or
chiropractic physician selected by himself or herself or by the
insurer, the organization for managed care or the provider of health
care pursuant to subsection 4, the injured employee may make an
alternative choice of physician or chiropractic physician pursuant to
the terms of the contract. A change in the treating physician or
chiropractic physician may be made at any time but is subject to the
approval of the insurer or by order of a hearing officer or appeals
officer. A request for a change of physician or chiropractic
physician 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
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chiropractic physician must include the name of the new physician
or chiropractic physician chosen by the injured employee. If the
insurer denies a request for a change in the treating physician or
chiropractic physician 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.
6. 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, chiropractic
physician 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, chir opractic physician or
other person.
7. The Administrator may order necessary changes in a panel
of physicians and chiropractic physicians and shall:
(a) Suspend or remove any physician or chiropractic physician
from a panel for good cause shown in accor dance with NRS
616C.087; and
(b) Remove from being included on a panel as a practitioner of a
discipline or specialization any physician or chiropractic physician
who does not accept and treat injured employees for industrial
injuries or occupational diseases in that discipline or specialization.
8. Any interested person may notify the Administrator, on a
form prescribed by the Administrator, if the person believes that a
physician or chiropractic physician does not accept and treat injured
employees:
(a) Under chapters 616A to 616D, inclusive, or chapter 617 of
NRS for industrial injuries or occupational diseases; or
(b) For industrial injuries or occupational diseases in a discipline
or specialization for which the physician or chiropractic physician is
included on a panel of physicians and chiropractic physicians
maintained by the Administrator pursuant to this section.
9. If the Administrator receives notice pursuant to subsection 8,
the Administrator shall:
(a) Conduct an investigation to determine whether the physician
or chiropractic physician may remain on the panel for a discipline or
specialization; and
(b) Publish or cause to be published on the Internet website of
the Division not later than 90 days after receiving the notice the
results of the investigation.
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10. A physician or chiropractic physician who is removed from
a panel as a practitioner of a discipline or specialization pursuant to
paragraph (b) of subsection 7 may request, on a form prescribed by
the Administrator, to be reinsta ted on a panel for that discipline or
specialization if the physician or chiropractic physician
demonstrates to the satisfaction of the Administrator that he or she
accepts and treats injured employees for that discipline or
specialization.
11. An injured employee may receive treatment by more than
one physician or chiropractic physician:
(a) If the insurer provides written authorization for such
treatment; or
(b) By order of a hearing officer or appeals officer.
12. The Administrator shall design a f orm that notifies injured
employees of their right pursuant to subsections 3, 4 and 5 to select
an alternative treating physician or chiropractic physician and make
the form available to insurers for distribution pursuant to subsection
2 of NRS 616C.050.
Sec. 4.1. NRS 616C.135 is hereby amended to read as follows:
616C.135 1. [A] Except as otherwise provided in section 2
of this act, a provider of health care who accepts a patient as a
referral for the treatment of an i ndustrial 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] Except as otherwise pro vided in section 2 of this act,
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 in surer 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
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section, the Administrator shall impose an administrative fine of not
more than $250 for each violation.
Sec. 4.3. NRS 616C.138 is hereby amended to read as follows:
616C.138 1. Except as otherw ise provided in this section [,]
and section 2 of this act, 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 7.
3. If:
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(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 subs equently accepts
responsibility for payment,
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 c ontracted 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:
(a) A hearing officer, appeals officer or district court issues an
order or otherwise renders a decision requiring an insurer,
organization for managed care, third -party administrator or
employer to pay for treatment or other services provided to an
injured employee;
(b) The insurer, organization for mana ged care, third -party
administrator or employer appeals the order or decision, but is
unable to obtain a stay of the order or decision;
(c) Payment for the treatment or other services provided to the
injured employee is made by the insurer, organization f or managed
care, third -party administrator or employer during the period
between the date of the issuance of the order or decision and the
date of the final resolution of the appeal; and
(d) The appeal is subsequently resolved in favor of the insurer,
organization for managed care, third -party administrator or
employer,
the insurer, organization for managed care, third -party
administrator or employer may recover from any health or casualty
insurer of the injured employee an amount calculated pursuant to
subsection 5. Any recovery from a health or casualty insurer
pursuant to this subsection is subject to the exclusions and
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limitations of the policy of health or casualty insurance covering the
injured employee that relate to the diseases set forth in NRS
617.453, 617.455 and 617.457.
5. An insurer, organization for managed care, third -party
administrator or employer entitled to recover for an amount paid
during the pendency of an appeal pursuant to subsection 4, may
recover from a health or casualty insurer of the injured employee the
lesser of:
(a) The amount actually paid by the insurer, organization for
managed care, third -party administrator or employer during the
period between the issuance of the order and the final resolution of
the appeal;
(b) The amount established for the treatment or services
provided to the injured employee pursuant to NRS 616C.260 or the
usual fee charged by the provider of health care, whichever is less;
(c) The amount provided for the treatment or services provided
to the injured employee on an in -network basis if there is a contract
between the provider of health care and the health or casualty
insurer of the injured employee and the treatment or services are
covered under the terms of the policy of health or casualty insurance
covering the employee; or
(d) The amount provided for the treatment or services provided
to the injured employee on an out -of-network basis pursuant to the
terms of the policy of health or casualty insurance covering the
injured employee if there is not a contract between the provider of
health care and the health or casualty insurer of the injured
employee.
6. If an insurer, organization for managed care, third -party
administrator or employer is entitled to recover for an amount paid
during the pe ndency of an appeal pursuant to subsection 4, upon a
final resolution of the appeal in favor of the insurer, organization for
managed care, third -party administrator or employer, the hearing
officer, appeals officer or district court shall order the injure d
employee to provide to the insurer, organization for managed care,
third-party administrator or employer:
(a) Any documentation in the possession of the injured
employee related to any policy of health or casualty insurance which
may have provided coverage to the injured employee for treatment
or other services provided to the injured employee; and
(b) The identity and contact information of the insurer providing
such health or casualty insurance.
7. If the injured employee or the health or casualty insurer paid
the provider of health care any amount in excess of the amount that
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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 sh all reimburse the injured employee or the health or
casualty insurer for the excess amount.
8. 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.
Sec. 4.5. NRS 616C.330 is hereby amended to read as follows:
616C.330 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 or by means of
an electronic filing system that complies with the Nevada
Electronic Filing and Conversion Rules adopted by the Nevada
Supreme Court 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 nece ssary 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 chiropractic physician of his or her choice who has
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demonstrated special competence to treat the particular medical
condition of the employee, whether or not the physician or
chiropractic physicia n 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 chiropractic physician. The rating physician or
chiropractic physician must be selected at random from the list of
qualified physicians and chiropractic physicians 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 chiropractic physician. 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, chiropractic physician, physician assistant or
advanced practice registered nurse, in addition to the opinion of an
authorized treating physician, chiropractic physician, physician
assistant or advanced practice registered nurse, 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 physi cian or chiropractic physician 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.
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10. The hearing officer shall give notice of the decision to each
party by mail [.] or by means of an electronic filing system that
complies with the Nevada Electronic Filing and Conversion Rules
adopted by the Nevada Supreme Court. 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 wit hin 10 days after the
refusal to grant a stay.
12. References to a physician assistant and an advanced
practice registered nurse in this section are for the purposes of the
examination and treatment of an injured employee which are
authorized to be provi ded by a physician assistant or advanced
practice registered nurse in the exclusive context of an initial
examination and treatment pursuant to NRS 616C.010.
Sec. 4.7. NRS 616C.345 is hereby amended to read as follows:
616C.345 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,
10 and 11, 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 to
12, inclusive, must be filed within 70 days after the date on which
the notice of the insurer’s determination was mailed or, if requested
by the claimant or the person acting on behalf of the clai mant, sent
by facsimile or other electronic transmission the proof of sending
and receipt of which is readily verifiable by the insurer or the
unanswered written request was mailed to the insurer, as applicable.
The failure of an insurer to respond in writ ing to a written request
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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 submi tted 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,
any part y to the dispute may, except as otherwise provided in
subsections 9 to 12, inclusive, 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 of ficer 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:
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(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 pl ace of
convenience to the parties, at the discretion of the appeals officer;
and
(b) Give notice by mail , [or] by personal service or by means of
an electronic filing system that complies with the Nevada
Electronic Filing and Conversion Rules adopted by the Nevada
Supreme Court 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 13, 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,
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 specif ied 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. The period specified in subsection 2 within which a notice
of appeal or a notice of a contested claim must be filed may be
tolled if the insurer fails to mail or, if requested by the claimant or
the person acting on behalf of the claimant, send a determination by
facsimile or other electronic transmission the proof of sending and
receipt of which is readily verifiable.
11. 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.
12. 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
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file the notice. The claimant or employer shall notify the insurer of a
change of address.
13. 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 or by means of
an electronic filing system that complies with the Nevada
Electronic Filing and Conversion Rules adopted by the Nevada
Supreme Court to all parties to the matter and their attorneys or
agents within 10 days after scheduling the hearing.
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 unle ss all
parties agree to the introduction.
Sec. 4.9. NRS 616C.355 is hereby amended to read as follows:
616C.355 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 by
personal service or deliver by means of an electronic filing system
that complies with the Nevada Electronic Filing and Conversion
Rules adopted by the Nevada Supreme Court, 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 gi ven sworn testimony before the
appeals officer, the Administrator or the Administrator’s designee.
Sec. 5. NRS 616C.475 is hereby amended to read as follows:
616C.475 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
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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 cert ified as temporarily
totally disabled by a physician or chiropractic physician.
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 r eceipt 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 chiropractic physician 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 chiropractic physician
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
chiropractic physician 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 chiropractic physician
authorized pursuant to NRS 616B.527 or appropriately chosen
pursuant to subsection 4 or 5 of NRS 616C.090 [.] or section 2 of
this act.
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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.
Sec. 6. The amendatory provisions of this act apply
prospectively with regard to any claim filed pursuant to chapters
616A to 616D, inclusive, or 617 of NRS which is filed on or after
October 1, 2025.
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