Nevada Administrative Code
Chapter 616C - Industrial Insurance: Benefits for Injury or Death
DETERMINATION AND PAYMENT OF BENEFITS
Claims for Compensation
Section 616C.080 - Duties of physician, chiropractor or medical facility required to file claim

Universal Citation: NV Admin Code 616C.080

Current through December 31, 2024

1. A health care provider who is required to file a claim for compensation pursuant to NRS 616C.040, or a physician assistant or advanced practice registered nurse at a medical facility who has been delegated the duty to file a claim for compensation pursuant to subsection 2 of NRS 616C.040, shall:

(a) Require the injured employee to complete the upper portion of the form designated in NAC 616A.480 as Form C-4, Employee's Claim for Compensation/Report of Initial Treatment, including, without limitation, the name, address and telephone number of the employer of the injured employee and the name of the insurer or third-party administrator of the employer;

(b) Contact the employer or the insurer or third-party administrator of the employer to confirm the name and address of the insurer or third-party administrator;

(c) Send a copy of the completed Form C-4 to the employer and to the insurer or third-party administrator of the employer; and

(d) Maintain, together with the completed Form C-4, documentation of the steps taken by the health care provider to verify that the insurer or third-party administrator is the insurer or third-party administrator of the employer.

2. If the health care provider is unable to confirm whether an insurer or third-party administrator is the insurer or third-party administrator of the employer within 3 working days after first providing treatment to an injured employee for a particular injury, the health care provider shall:

(a) Contact the nearest office of the Division by telephone at (702) 486-9000 for Las Vegas, Nevada, or at (775) 684-7260 for Carson City, Nevada; and

(b) If requested by the Division, provide a copy of the completed Form C-4 and documentation of the steps taken to verify that the insurer or third-party administrator is the insurer or third-party administrator of the employer.

3. As used in this section, "health care provider" means a physician, chiropractic physician, physician assistant or advanced practice registered nurse.

Added to NAC by Div. of Industrial Relations by R150-04, eff. 11-17-2005; A by R032-21A, eff. 8/1/2023

NRS 616A.400, 616C.040

Disclaimer: These regulations may not be the most recent version. Nevada may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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