Current through December 31, 2024
1.
After receipt of a claim for compensation, the insurer or third-party
administrator shall give written notice of its determination to accept or deny
the claim to the injured employee, the attorney or other authorized
representative of the injured employee or his or her dependents and, if the
injured employee's employer is not self-insured, to the injured employee's
employer.
2. If the insurer or
third-party administrator denies the claim in whole or in part:
(a) The insurer or third-party administrator
shall, pursuant to NRS 616C.065, notify the
Administrator of the denial.
(b)
The notice of denial to the injured employee, the attorney or other authorized
representative of the injured employee or his or her dependents must include:
(1) A written statement of the right to
request a hearing on the matter before a hearing officer and a form for
requesting a hearing; and
(2) A
specific statement of the reasons for the denial of the claim.
(c) The insurer or third-party
administrator shall provide a copy of each notice of denial it gives pursuant
to paragraph (b) to:
(1) The physician,
chiropractic physician, physician assistant or advanced practice registered
nurse who provided an examination and treatment of the injured employee in the
context of an initial examination and treatment pursuant to
NRS
616C.010; and
(2) The injured employee's treating physician
or chiropractic physician.
(d) The notice of denial required to be given
to the Administrator pursuant to paragraph (a) must include:
(1) A copy of the notice of denial given to
the injured employee, the attorney or other authorized representative of the
injured employee or his or her dependents; and
(2) A copy of Form C-4, Employee's Claim for
Compensation/Report of Initial Treatment, that was completed by the injured
employee or his or her dependents.
3. If the insurer or third-party
administrator accepts the claim, the notice of acceptance provided to the
injured employee, the attorney or other authorized representative of the
injured employee or his or her dependents must include:
(a) Written notice of acceptance of the
claim;
(b) A copy of Form D-53,
Alternative Choice of Physician or Chiropractor; and
(c) Either:
(1) If established and available, the
Internet address of the website of the insurer or third-party administrator at
which the injured employee, the attorney or other authorized representative of
the injured employee or his or her dependents can obtain a list of providers of
health care who are authorized to provide health care services to the injured
employee; or
(2) Notification that,
pursuant to NAC
616C.030, the injured employee,
the attorney or other authorized representative of the injured employee, his or
her dependents or the treating physician or chiropractic physician of the
injured employee may, upon written request, obtain a list of providers of
health care who are authorized to provide health care services to the injured
employee.
4. A
written notice of determination issued by an insurer or third-party
administrator must include:
(b) The name of the
employer;
(c) The name of the
insurer;
(d) The name of the
third-party administrator, if applicable;
(e) The date of the injury;
(f) The date of the written notice of
determination;
(g) Notice that the
injured employee may, pursuant to subsection 1 or 3 of
NRS
616C.315, request a hearing or appeal the
determination within 70 days after the determination is issued by the insurer;
and
(h) The addresses of the
offices of the Hearings Division of the Department of Administration located in
Carson City and Las Vegas.
Added to NAC by Div. of
Industrial Insurance Regulation, eff. 10-26-83; A 6-29-84; 2-22-88; 8-30-91; A
by Div. of Industrial Relations by R006-97, 12-9-97; R098-98, 12-18-98;
R105-00, 1-18-2001, eff. 3-1-2001; A by
R130-14,
eff. 9/9/2016; A by
R032-21A,
eff. 8/1/2023
NRS 616A.400,
616C.065
