USA Statutes : nevada
Title : Title 53 - LABOR AND INDUSTRIAL RELATIONS
Chapter : CHAPTER 616C - INDUSTRIAL INSURANCE: BENEFITS FOR INJURIES OR DEATH
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)
1. Whenever any accident occurs to any employee, he shall
forthwith report the accident and the injury resulting therefrom to his
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 may furnish
the names, addresses and telephone numbers of one or more physicians or
chiropractors, but may not require the employee to select any particular
physician or chiropractor. 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 his physical condition.
3. Further medical attention, except as otherwise provided in NRS
616C.265 , must be authorized by the
insurer.
4. 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.
[Part 52:168:1947; 1943 NCL § 2680.52]—(NRS A 1981, 1167, 1471;
1983, 478; 1985, 1543)—(Substituted in revision for NRS 616.360)
1. An employee or, in the event of the employee’s death, one of
his dependents, 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 his dependent to describe briefly the
accident that caused the injury or death.
(b) Be signed by the injured employee or by a person on his behalf,
or in the event of the employee’s death, by one of his dependents 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 his
dependent 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
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.
[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 )
1. Except as otherwise provided in subsection 2, an injured
employee, or a person acting on his behalf, 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 employment; or
(b) The employee was off work as a result of an injury arising out
of and in the course of his 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 his
behalf, 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)
1. Except as otherwise provided in subsection 2, an employee or,
in the event of the death of the employee, his dependent, is barred from
recovering compensation pursuant to the provisions of chapters 616A
to 616D ,
inclusive, of NRS if he 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 his control
prevented him 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)
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)
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)
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
)
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 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 his 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 his 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 )
1. An insurer shall provide to each claimant:
(a) Upon written request, one copy of any medical information
concerning his 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 him 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 his injury or
disease; or
(VI) The hours he is absent from the place of
employment to receive medical treatment pursuant to NRS 616C.477 ;
(6) Receive services for rehabilitation if his injury
prevents him 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 7 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 )
1. Except as otherwise provided in NRS 617.485 and 617.487 ,
if a police officer or a salaried or volunteer firefighter is exposed to
a contagious disease:
(a) Upon battery by an offender; or
(b) While performing the duties of a police officer or firefighter,
Ê the employer of the police officer or firefighter shall create and
maintain a report concerning the exposure that includes, without
limitation, the name of each police officer or firefighter, as
applicable, who was exposed to the contagious disease and the name of
each person, if any, to whom the police officer or firefighter 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 or a salaried or volunteer firefighter after the
commencement of his employment reveal that the police officer or
firefighter tested positive for exposure to tuberculosis, the police
officer or firefighter is eligible, during his 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 or a salaried or volunteer
firefighter is terminated, voluntarily or involuntarily, the employer of
the police officer or firefighter, regardless of whether the police
officer or firefighter has been exposed to a contagious disease during
his employment and regardless of whether the employer has created or
maintained a report concerning any exposure of the police officer or
firefighter 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 or firefighter a purified
protein derivative skin test to screen for exposure to tuberculosis,
unless the police officer or firefighter 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 or firefighter tested positive for exposure to tuberculosis, the
police officer or firefighter is eligible, during his 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 or
firefighter 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 or firefighter 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 or firefighter
has any other contagious disease or the antibodies associated with a
contagious disease, the police officer or firefighter is eligible, during
his 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 or a salaried or
volunteer firefighter 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 )
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 , he must not be paid for
any services rendered to the injured employee after the date of his
removal.
(Added to NRS by 1979, 651; A 1981, 1168, 1488; 1983, 325; 1985,
1546; 1991, 2417; 1993, 733; 1999, 1776 )
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) Commence payment of a claim for compensation; or
(b) Deny the claim and notify the claimant and Administrator that
the claim has been denied.
Ê Payments made by an insurer pursuant to this section are not an
admission of liability for the claim or any portion of the claim.
2. 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 him 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
.
(Added to NRS by 1995, 2001; A 2001, 2738 )
1. A person is conclusively presumed to be totally dependent upon
an injured or deceased employee if the person is a natural, posthumous or
adopted child, whether legitimate or illegitimate, under the age of 18
years, or over that age if physically or mentally incapacitated from wage
earning, and there is no surviving parent. 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.
2. 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.
3. 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 )
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
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
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 his 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)
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 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 his 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 so chooses, he may make an alternative choice of
physician or chiropractor from the panel if the choice is made within 90
days after his 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 he
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 his 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 so
chooses, he may make an alternative choice of physician or chiropractor
pursuant to the terms of the contract if the choice is made within 90
days after his injury. If the injured employee, after choosing his
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. 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.
5. 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.
6. An injured employee may receive treatment by more than one
physician or chiropractor if the insurer provides written authorization
for such treatment.
7. The Administrator shall design a form that notifies injured
employees of their right pursuant to subsections 2 and 3 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 )
The physician or chiropractor shall inform the
injured employee of his 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 )
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, he
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
)
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)
1. For the purposes of NRS 616B.557 , 616B.578 , 616B.587 , 616C.490 and 617.459 :
(a) Not later than August 1, 2003, the Division shall adopt
regulations incorporating the American Medical Association’s Guides to
the Evaluation of Permanent Impairment, 5th edition, by reference. The
regulations:
(1) Must become effective on October 1, 2003; and
(2) Must be applied to all examinations for a permanent
partial disability that are conducted on or after October 1, 2003,
regardless of the date of the injury, until regulations incorporating the
6th edition by reference have become effective pursuant to paragraph (b).
(b) Beginning with the 6th edition and continuing for each edition
thereafter, the Division shall adopt regulations incorporating the most
recent edition of the American Medical Association’s Guides to the
Evaluation of Permanent Impairment by reference. The regulations:
(1) Must become effective not later than 18 months after the
most recent edition is published by the American Medical Association; and
(2) 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, until regulations
incorporating the next edition by reference have become effective
pursuant to this paragraph.
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 edition of the American Medical
Association’s Guides to the Evaluation of Permanent Impairment most
recently adopted by the Division;
(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 man in calculating the entitlement to
compensation.
3. If the edition of the American Medical Association’s Guides to
the Evaluation of Permanent Impairment most recently adopted by the
Division 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 )
1. Except as otherwise provided in subsection 2, a physician or
advanced practitioner of nursing 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 practitioner of nursing is not required
to comply with the provisions of subsection 1 if:
(a) He 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)—(Substituted in revision for NRS
616.5023)
Any provision of this chapter or chapter 616A
, 616B , 616D
or 617 of NRS
must not prevent an employee from providing for treatment for his
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 )
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)
The insurer shall not authorize the payment of any
money to a physician or chiropractor for services rendered by him 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)
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 )
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, he shall notify the provider of health care of his
request for the additional information within 20 calendar days after he
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 he 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 he
receives the additional information. If the bill for accident benefits is
approved, the insurer shall pay the bill within 20 calendar days after he
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 )
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 he 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 )
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 )
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 himself for 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, his physical condition and
his 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 him, 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, his
right 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
1. An injured employee or his dependents are not entitled to
receive compensation pursuant to the provisions of chapters 616A to 616D , inclusive,
of NRS unless the employee or his dependents establish by a preponderance
of the evidence that the employee’s injury arose out of and in the course
of his 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 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 employment.
(Added to NRS by 1993, 662)—(Substituted in revision for NRS
616.5015)
1. An insurer shall not provide compensation to or for an employee
or his dependents 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 his 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)
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 )
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 )
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)
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)
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 his current or past employment; and
(b) Subsequently sustains an injury by accident arising out of and
in the course of his employment which aggravates, precipitates or
accelerates his 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 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
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 )
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 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 )
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
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) He 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 employment; and
(c) The stress was not caused by his layoff, the termination of his
employment or any disciplinary action taken against him.
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)
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 reestablish 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)
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, he, or his dependents in case of his death, 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 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 )
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 he, or
his dependents in case of his 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
dependents in case of death, until such employee, his 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)
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 he, or his
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 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 his 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 )
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, is not, before the issuance and delivery of
the check, assignable, is exempt from attachment, garnishment and
execution, and does not pass to any other person by operation of law. 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 at the date of death of the employee
is payable to his dependents 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 )
1. The insurer shall notify a dependent of a deceased employee who
is residing outside of the United States by certified mail at his last
known address 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 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 )
1. If an injured employee or, in the event of his death, his
dependents, bring an action in tort against his 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 his
dependents 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
employer’s 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 his dependents 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
his dependents 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 his employer
for his 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 his dependents, may
take proceedings against that person to recover damages, but the amount
of the compensation the injured employee or his dependents 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 his dependents,
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 his 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 him, or in the case of death his
dependents, to receive proceeds under his employer’s policy of uninsured
or underinsured vehicle coverage:
(a) The injured employee, or in the case of death his dependents,
may take proceedings to recover those proceeds, but the amount of
compensation the injured employee or his dependents 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 his dependents,
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 his dependents 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 his dependents under a policy of uninsured or
underinsured vehicle coverage purchased by the employee.
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 his dependents.
5. In any case where the insurer or the Administrator is
subrogated to the rights of the injured employee or of his 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 death his dependents, 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 his dependents.
7. An injured employee, or in the case of death his dependents, or
the attorney or representative of the injured employee or his dependents,
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 his dependents, or the attorney or
representative of the injured employee or his dependents; 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 his
dependents 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 his dependents, or the attorney or
representative of the injured employee or his dependents, 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 death by his dependents, 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 favor
in this case, he is not required to repay his employer, the insurer or
the Administrator any amount paid to him or paid on his behalf by his
employer, the insurer or the Administrator.
If you decide that the plaintiff is entitled to judgment against
the defendant, you shall find his damages 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 )
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) He was hired in this State or he is regularly employed in this
State;
(b) He suffers an accident or injury which arises out of and in the
course of his employment:
(1) In this State; or
(2) While on temporary assignment outside the State for not
more than 12 months;
(c) He files a claim for compensation with the Division; and
(d) He 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 he 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, the employer has the burden
of proving that he provided mandatory industrial insurance coverage for
the employee or that he 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 his behalf, 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 in a court of competent jurisdiction.
(b) In any civil action brought 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, 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 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. In addition to any other liabilities provided for in this
section, the Administrator may impose an administrative fine of not more
than $10,000 against an employer if the employer fails to provide
mandatory coverage required by the provisions of chapters 616A to 616D , inclusive,
of NRS.
(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 )
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 his 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)
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.
(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 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 system at the time of his injury for which the employee did not have
a current and lawful prescription issued in his name or that he 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 50.315 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 his death is caused by, or insofar as his
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 recovery, or refuses to submit to such
medical or surgical treatment as is necessary to promote his recovery,
his 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 his 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 )
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. The notice must include a statement that if the
claimant does not agree with the determination, he has a right to request
a resolution of the dispute pursuant to NRS 616C.305 and 616C.315 to 616C.385 , inclusive. 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 he sends, by first-class
mail addressed to the last known address of the claimant, written notice
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.
(Added to NRS by 1979, 707; A 1981, 1140, 1492; 1989, 333; 1991,
2421; 1993, 746; 1997, 1437; 1999, 1783 , 2416 ; 2001, 115 )
ACCIDENT BENEFITS
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 employment, he is quadriplegic, paraplegic or has had a part of his
body amputated; and
(b) He cannot be fitted with a prosthetic device which allows him
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 )
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)
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 )
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 him with such information
as he 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 he 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 )
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
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 his 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 employer, but may seek professional
medical services of his 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 his 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
)
1. Every employer who has elected to provide accident benefits for
his 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)
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 has made arrangements, the
Administrator may, upon application of the employee, or upon his 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
)
The Administrator may
withdraw his approval of an employer’s providing accident benefits for
his 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 his 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 him from the employer;
5. Violates any of his 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
)
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 he 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
1. The Chief of the Hearings Division shall:
(a) Prescribe by regulation the qualifications and training
required before a person may, pursuant to chapters 616A to 616D , inclusive,
or chapter 617 of NRS, serve as a hearing
officer. Training for a hearing officer must include techniques of
mediation.
(b) Provide for the expediting of the hearing of cases that involve
the termination or denial of compensation.
2. 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.
3. 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 )
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 has a personal interest
or a conflict of interest, directly or indirectly, in any case which is
before him, he shall disqualify himself 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)
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, he 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
)
[Effective through
December 31, 2006.]
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.
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)—(Substituted in revision for NRS 616.541)
[Effective January 1, 2007.]
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 , effective January 1, 2007)
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 and 616C.305 , 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 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. 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 he 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.
5. The hearing before the hearing officer must be conducted as
expeditiously and informally as is practicable.
6. 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.
(Added to NRS by 1979, 1040; A 1981, 1490; 1983, 1294; 1985, 668;
1991, 834, 2417; 1993, 736; 1999, 3380 ; 2001, 2256 ; 2003, 2333 )
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 employer, the
association or the private carrier, he 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)
1. It is unlawful for any person to represent an employee before a
hearings officer, or in any negotiations, settlements, hearings or other
meetings with an insurer concerning the employee’s claim or possible
claim, unless he is:
(a) Employed full-time by the employee’s labor organization;
(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 him 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 )
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 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 refer the employee to a physician or chiropractor of his choice who
has demonstrated special competence to treat the particular medical
condition of the employee. 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. If an injured employee has requested payment for the cost of
obtaining a second determination of his 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.
5. 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.
6. The hearing officer may allow or forbid the presence of a court
reporter and the use of a tape recorder in a hearing.
7. The hearing officer shall render his decision within 15 days
after:
(a) The hearing; or
(b) He receives a copy of the report from the medical examination
he requested.
8. The hearing officer shall render his decision in the most
efficient format developed by the Chief of the Hearings Division of the
Department of Administration.
9. The hearing officer shall give notice of his decision to each
party by mail. He shall include with the notice of his decision the
necessary forms for appealing from the decision.
10. 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 )
If a contested claim for
compensation is decided in favor of the claimant, he is entitled to an
award of interest at the rate of 9 percent on the amount of compensation
due him, 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)
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 appointment and until his successor 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 has a personal
interest or a conflict of interest, directly or indirectly, in any case
which is before him, he shall disqualify himself 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 him 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 determination of 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 )
1. Any party aggrieved by a decision of the hearing officer
relating to a claim for compensation may appeal from the decision by
filing a notice of appeal with an appeals officer within 30 days after
the date of the decision.
2. 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.
3. 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 file a notice of appeal within 70 days
after the date on which the final determination was mailed to the
employee, or his dependent, 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.
4. 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.
5. Except as otherwise provided in subsections 2 and 6, 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 6 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 his 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.
6. 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.
7. An appeal or contested claim may be continued upon written
stipulation of all parties, or upon good cause shown.
8. Failure to file a notice of appeal within the period specified
in subsection 1 or 3 may be excused if the party aggrieved shows by a
preponderance of the evidence that he 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.
(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 )
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 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 )
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 he 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, his 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 )
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 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) Refer the employee to a physician or chiropractor of his choice
who has demonstrated special competence to treat the particular medical
condition of the employee. 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 external review organization,
submit the matter to an external review organization in accordance with
NRS 616C.363 and any regulations
adopted by the Commissioner.
4. If an injured employee has requested payment for the cost of
obtaining a second determination of his 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.
5. 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.
6. Any party to the appeal 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.
7. The appeals officer shall render his 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.
8. The appeals officer may affirm, modify or reverse any decision
made by the hearing officer and issue any necessary and proper order to
give effect to his 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 )
1. Not later than 5 business days after the date that an external
review organization receives a request for an external review, the
external review organization shall:
(a) Review the documents and materials submitted for the external
review; and
(b) Notify the injured employee, his employer and the insurer
whether the external review organization needs any additional information
to conduct the external review.
2. The external 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 external 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 external review organization.
4. In its decision, the external review organization shall specify
the reasons for its decision. The external 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
external 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
external review organization before a request for external review may be
submitted;
(b) A party may not be ordered to submit a matter to an external
review organization; and
(c) The findings and decisions of an external review organization
are not binding.
(Added to NRS by 2003, 2332 )
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) His actual expenses necessarily incurred for travel to and from
the hearing, if he is required to travel more than 20 miles one way from
his residence or place of employment to the hearing; and
(b) Any regular wages lost as a result of his 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)
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)
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)
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)
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 )
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, he
is not entitled to vocational rehabilitation services or benefits for a
temporary total disability if, before his claim was reopened, he:
(a) Retired; or
(b) Otherwise voluntarily removed himself 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 )
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
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 )
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 he 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)
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 )
Except as otherwise provided by NRS 616C.380 , 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)—(Substituted in revision for NRS 616.620)
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)
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 selection in writing to the
insurer.
(Added to NRS by 1971, 770; A 1981, 1497; 1991, 2426)—(Substituted
in revision for NRS 616.623)
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)
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 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)
1. If an employee who is entitled to compensation under chapters
616A to 616D ,
inclusive, of NRS for temporary total disability, permanent partial
disability or permanent total disability becomes entitled to federal
disability insurance benefits under section 202 or 223 of the Social
Security Act, as amended (42 U.S.C §§ 402 and 423, respectively), the
employee’s compensation under chapters 616A
to 616D , inclusive, of NRS must be reduced
by the amount of the federal benefits being received by him.
2. This section must not be applied to reduce the employee’s
compensation under chapters 616A to 616D
, inclusive, of NRS to any greater extent
than his federal benefits would have otherwise been reduced by the Social
Security Administration under section 224 of the Social Security Act, as
amended (42 U.S.C. § 424a). After any reduction pursuant to this section,
the combination of his state compensation and federal benefits must be at
least as much as the greater of:
(a) The benefits payable pursuant to chapters 616A to 616D , inclusive,
of NRS (without the reduction); or
(b) The benefits payable under the Social Security Act (without any
reduction).
3. After a reduced amount of compensation for an employee has been
established pursuant to this section, no further reduction in his
compensation may be made because he receives an increase in his benefits
under the Social Security Act as the result of an adjustment based on an
increase in the cost of living.
4. No compensation may be reduced pursuant to this section until
the Social Security Administration has determined the amount of benefits
payable to the employee under section 202 or 223 of the Social Security
Act and he has begun to receive those benefits.
5. If an employee:
(a) Fails to report the amount of benefits which he is receiving
under section 202 or 223 of the Social Security Act, within 30 days after
he is requested in writing by the insurer to make that report; or
(b) Fails to provide the insurer with a written authorization for
the Social Security Administration to release information on the
employee’s average current earnings and the amount of benefits to which
he is entitled, within 30 days after he is requested to provide that
authorization,
Ê the insurer may reduce by 50 percent the compensation which the
employee would otherwise receive pursuant to chapters 616A to 616D , inclusive,
of NRS. Any compensation which is withheld pursuant to this subsection
must be paid to the employee when he has furnished the report or
authorization as requested.
6. If the provisions of section 224 of the Social Security Act are
amended:
(a) To allow an employee to receive more compensation under
chapters 616A to 616D , inclusive, of NRS without any reduction in
benefits payable under section 202 or 223 of the Social Security Act; or
(b) To lower the maximum sum of compensation payable under chapters
616A to 616D ,
inclusive, of NRS and benefits payable under section 202 or 223 of the
Social Security Act,
Ê the reduction imposed by this section must be increased or decreased
correspondingly.
7. No reduction in compensation may be made under this section for
any period of entitlement which:
(a) Occurs before January 1, 1982;
(b) Occurs before the employee has been given a written notice by
mail of the intended reduction; or
(c) Includes any week after the week in which the employee becomes
62 years of age.
(Added to NRS by 1981, 1224; A 1981, 1538)—(Substituted in revision
for NRS 616.6285)
Permanent Total Disability
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)
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 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 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 dependents are entitled to receive those benefits
when the injured employee is released from incarceration if he 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 )
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 his 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)
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 )
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 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)
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. 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. 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.
(Added to NRS by 2005, 1316 )
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)
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)
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)
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 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 he 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)
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
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 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 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 dependents are entitled to receive such benefits
when the injured employee is released from incarceration if he 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 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 his 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 injury in relation to the location of the employment and the hours
he 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 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 injury; and
(c) Has the same employment benefits as the position of the
employee at the time of his 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 )
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 injury, qualified for benefits for a temporary total
disability pursuant to NRS 616C.475
and who receives medical treatment for his injury after he returns to
work is entitled to compensation pursuant to this subsection for each
hour he is absent from the place of employment of the responsible
employer to receive such medical treatment if he 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 regular hourly rate of pay by his employer for
each hour he 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
his absence from the place of employment to receive medical treatment for
his injury after he returns to work. The provisions of this subsection
apply whether the injured employee is being paid compensation pursuant to
subsection 1 or his 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 )
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 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
The Administrator shall adopt, by regulation, a
schedule which, in his judgment, 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)
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 man” 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. No factors other than the degree of physical impairment of the
whole man 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 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 he is entitled pursuant to this
section; or
(b) That he is not entitled to benefits for permanent partial
disability.
7. Each 1 percent of impairment of the whole man 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 )
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 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 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 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 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 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 payment for a permanent
partial disability in a lump sum pursuant to subsection 1, all of his
benefits for compensation terminate. His acceptance of that payment
constitutes a final settlement of all factual and legal issues in the
case. By so accepting he waives all of his rights regarding the claim,
including the right to appeal from the closure of the case or the
percentage of his disability, except:
(a) His right to:
(1) Reopen his claim in accordance with the provisions of
NRS 616C.390 ; or
(2) Have his claim considered by his insurer pursuant to NRS
616C.392 ;
(b) Any counseling, training or other rehabilitative services
provided by the insurer; and
(c) His right to receive a benefit penalty in accordance with NRS
616D.120 .
Ê The claimant must be advised in writing of the provisions of this
subsection when he demands his payment in a lump sum, and has 20 days
after the mailing or personal delivery of the notice within which to
retract or reaffirm his demand, before payment may be made and his
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 permanent partial disability before electing to receive his
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 he would if he receives installment
payments, he 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 )
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 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 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 he 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
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 $5,000. 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. To the surviving spouse of the deceased employee, 66 2/3
percent of the average monthly wage is payable until his death or
remarriage, with 2 years’ compensation payable in one lump sum upon
remarriage.
3. In the event of the subsequent death of the surviving spouse:
(a) Each surviving child of the deceased employee 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.
4. Upon the remarriage of a surviving spouse with children:
(a) The surviving spouse must be paid 2 years’ compensation in one
lump sum and further benefits must cease; and
(b) Each child must be paid 15 percent of the average monthly wage,
up to a maximum family benefit of 66 2/3 percent of the average monthly
wage.
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 proportionate share of 66 2/3 percent of the average
monthly wage for his support.
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 his death, 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 his death, 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 his death, his 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 his earnings for support at the time of the injury causing
his 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 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 him, funeral expenses are payable in an amount not to exceed
$5,000.
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 proportionate share of
compensation pursuant to this section ceases when he dies, marries or
reaches the age of 18 years. A child is entitled to continue to receive
compensation pursuant to this section if he is:
(a) Over 18 years of age and incapable of supporting himself, until
such time as he becomes capable of supporting himself; or
(b) Over 18 years of age and enrolled as a full-time student in an
accredited vocational or educational institution, until he 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 )
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)
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)
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
An insurer shall adhere to the following priorities in returning an
injured employee to work:
1. Return the injured employee to the job he had before his injury.
2. Return the injured employee to a job with the employer he
worked for before his accident that accommodates any limitation imposed
by his injury.
3. Return the injured employee to employment with another employer
in a job that uses his existing skills.
4. Provide training for the injured employee while he 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)
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 )
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 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 )
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 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)
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 )
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 he held at the time that he 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 he
held at the time of his injury or to any other position. The treating
physician or chiropractor shall determine whether an employee may return
to the position that he held at the time of his 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 his 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 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 )
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 he was earning at the time of his injury. An injured
employee must not receive job placement assistance for more than 6 months
after the date on which he was notified that he is eligible only for job
placement assistance because:
(a) He was physically capable of returning to work; or
(b) It was determined that he 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 his ability 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 him
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 injury, may authorize a third program for the injured
employee. If such an employer has terminated operations, his 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 )
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 his sole
discretion; or
(b) In accordance with this section if:
(1) The injured employee makes a written request to extend
the program within 30 days after he receives written notification that he
is eligible for vocational rehabilitation services; 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 he 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 he 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
)
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
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 successful completion of the
training, obtains employment which requires the skills obtained by him 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)
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 his 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 he 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)
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 permanent
residence was outside of this State,
Ê may receive vocational rehabilitation services at a location within 50
miles from his 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 he is entitled pursuant to NRS 616C.545 to 616C.575 , inclusive, and 616C.590 if he relocates to:
(a) This State; or
(b) A location within 50 miles from any border of this State,
Ê at his 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 his residence 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.
(Added to NRS by 1993, 668; A 1999, 1795 ; 2001, 1902 ; 2005, 209 )
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 employer during the course of his 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 his insurer 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)
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 he held
at the time of his 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
his injury; and
(3) Has the same employment benefits as the position of the
employee at the time of his 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 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 shall specify in writing:
(a) The medically objective findings upon which his 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 he held at the
time of his injury is no longer available.
6. An injured employee or his dependents 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 he 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 he is incarcerated.
8. If an insurer cannot locate an injured employee for whom it has
ordered vocational rehabilitation services, the insurer may close his
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 claim has
been closed does not automatically reinstate his eligibility for
vocational rehabilitation benefits. If the employee wishes to reestablish
his eligibility for those benefits, he must file a written application
with the insurer to reinstate his 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 )
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 his right to receive
vocational rehabilitation services under his claim. Except as otherwise
required by federal law, an injured employee shall not receive vocational
rehabilitation services from any state agency after he 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 he 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 his right to receive such services.
4. 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
)
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)
