Nevada Administrative Code
Chapter 616C - Industrial Insurance: Benefits for Injury or Death
DETERMINATION AND PAYMENT OF BENEFITS
Claims for Compensation
Section 616C.088 - File of employees' claims: Maintenance; contents; retention
Universal Citation: NV Admin Code 616C.088
Current through December 31, 2024
1. Each file of a claim concerning an industrial injury or occupational disease that is maintained by an insurer or third-party administrator must contain:
(a)
The employer's report of the industrial injury or occupational
disease.
(b) The claim for
compensation and any medical report associated with that claim that is issued
after the claim is filed with the insurer.
(c) All:
(1)
Applications for a stay concerning a decision on a claim for compensation made
to a hearing officer, appeals officer or a court of competent
jurisdiction;
(2) Written orders or
decisions on a claim for compensation entered by a hearing officer, appeals
officer or a court of competent jurisdiction;
(3) Written determinations made by an
insurer, third-party administrator or an organization for managed care
concerning a claim for compensation and, if any determination is sent or served
by electronic transmission, proof of a successful transmission of that
determination and receipt thereof by the injured employee or any person acting
on his or her behalf;
(4) Written
settlement agreements or stipulations made between the injured employee and his
or her employer or the insurer of the employer concerning a claim for
compensation; and
(5) Except as
otherwise provided in subparagraph (2) of paragraph (f), other documents which
affect the amount, timing or denial of the payment of compensation. As used in
this subparagraph, "payment of compensation" has the meaning ascribed to it in
subsection 2 of NAC
616D.305.
(d) A record of all compensation paid to the
injured employee and all payments made to any other person in connection with
the claim, for:
(1) Accident
benefits;
(2) Temporary partial
disability;
(3) Temporary total
disability;
(4) Permanent partial
disability;
(5) Permanent total
disability;
(6) Death benefits;
and
(7) Vocational rehabilitation,
and the amount of the expected total incurred costs and the
justification.
(e) A copy
of any notice of termination of benefits which has been sent to the injured
employee.
(f) Copies of all
correspondence and other documents pertaining to the claim, including, without
limitation, copies of:
(1) All medical bills
incurred by the injured employee and received by the insurer; and
(2) Any notices sent to the injured employee
to inform him or her of the right to a review or appeal, but not including
records of any privileged communication between the insurer and its attorney or
of any investigation conducted by or on behalf of the insurer concerning a
possible violation of
NRS
616D.300.
(g) All ratings performed by any physician or
chiropractic physician.
(h) A
summary of conversations or oral negotiations, or both, conducted by the
insurer or the third-party administrator with the injured employee, the legal
counsel who represents the injured employee or any other party other than the
physician or chiropractic physician of the injured employee, if action is
requested or taken.
(i) After the
claim is closed, the log of oral communications relating to the medical
disposition of a claim that must be maintained by an insurer or third-party
administrator pursuant to
NRS
616D.330.
2. Each file of a claim must be retained for 2 years after the death of the injured employee.
Added to NAC by Div. of Industrial Insurance Regulation, eff. 10-26-83; A 2-22-88; 8-30-91; A by Div. of Industrial Relations by R167-97, 1-30-98; R098-98, 12-18-98; A by R130-14, eff. 9/9/2016; A by R134-20A, eff. 9/20/2022; Added to NAC by Div. of Industrial Relations by R134-20RA, eff. 12/19/2022; A by R032-21A, eff. 8/1/2023
NRS 616A.400
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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