[Rev. 11/21/2013 12:38:12 PM--2013]

CHAPTER 616C - INDUSTRIAL INSURANCE: BENEFITS FOR INJURIES OR DEATH

REPORTS OF INJURIES AND CLAIMS FOR COMPENSATION

NRS 616C.005        Forms for reporting injuries: Insurer to distribute revised forms to employers periodically; Administrator to make revised forms available to physicians and chiropractors.

NRS 616C.010        Employee to report accident and injury to employer; examination of employee; employee leasing company to provide to leased employees instructions regarding reporting of injuries.

NRS 616C.015        Notice of injury or death: Requirements; availability of form; retention; notice by leased employee.

NRS 616C.020        Claim for compensation: Requirements for injured employee, dependent or representative to file claim; form.

NRS 616C.025        Recovery of compensation barred if notice of injury or claim for compensation is not filed; exceptions.

NRS 616C.030        Dependent of injured employee barred from filing claim for compensation if untimely or previously denied.

NRS 616C.035        Application for death benefit.

NRS 616C.040        Claim for compensation: Duty of treating physician or chiropractor to file or delegate duty to medical facility; electronic filing; form and contents; maintenance of forms; penalty.

NRS 616C.045        Report of industrial injury or occupational disease: Duty of employer to file; electronic filing; form and contents; penalty.

NRS 616C.050        Information required to be provided by insurer to claimant.

NRS 616C.052        Exposure of police officer, firefighter or arson investigator to contagious disease: Reporting and testing requirements; eligibility for compensation.

NRS 616C.055        Use of fee schedules which unfairly discriminate among physicians and chiropractors prohibited; payment for services rendered by physician or chiropractor after removal from panel prohibited.

NRS 616C.065        Duty of insurer to accept or deny claim; new determination; penalty; failure of insurer to indicate acceptance or denial of claim; written determination. [Effective through December 31, 2014, and after that date unless the provisions of Senate Joint Resolution No. 14 (2011) are approved and ratified by the voters at the 2014 General Election.]

NRS 616C.065        Duty of insurer to accept or deny claim; new determination; penalty; failure of insurer to indicate acceptance or denial of claim; written determination. [Effective January 1, 2015, if the provisions of Senate Joint Resolution No. 14 (2011) are approved and ratified by the voters at the 2014 General Election.]

NRS 616C.070        Persons who are conclusively presumed to be totally dependent on injured or deceased employee; exception.

NRS 616C.075        Effect of employee’s refusal to submit to physical examination after accident.

TREATMENT AND RATING OF INJURED EMPLOYEES

NRS 616C.085        Duties of employer when employee injured: First aid; reimbursement.

NRS 616C.090        Selection of physician or chiropractor: Powers and duties of Administrator; selection and alternate selection from established panel or pursuant to contract; responsibility for charges.

NRS 616C.095        Duty of physician or chiropractor to advise injured employee of rights.

NRS 616C.100        Additional determination of percentage of disability permitted if cost paid by injured employee; authority of injured employee to seek reimbursement of cost; results of determination may be offered at hearing or conference.

NRS 616C.105        Requirements for designation of chiropractor to rate permanent partial disabilities.

NRS 616C.110        American Medical Association’s Guides to the Evaluation of Permanent Impairment: Duty of Division to adopt Guides by regulation.

NRS 616C.115        Prescription of generic drugs required; exceptions.

NRS 616C.120        Employee may elect treatment through prayer in lieu of medical treatment.

NRS 616C.125        Insurer may contract with suppliers for provision of services and goods to injured employees.

NRS 616C.130        Insurer’s payment to physician or chiropractor attending injured employee conditioned upon receipt of itemized statement and certificate.

NRS 616C.135        Liability of insurer for payment of charges for treatment related to industrial injury or occupational disease; acceptance of payment by provider of health care from injured employee or health or casualty insurer for treatment that was erroneously denied.

NRS 616C.136        Action by insurer on bill from provider of health care; payment of interest; request for additional information; compliance with requirements.

NRS 616C.137        Denial of payment for unrelated services: Requirements for notification; liability of injured employee; appeal.

NRS 616C.138        Payment of provider of health care upon insurer’s denial of authorization or responsibility for treatment or other services provided; reimbursement of injured employee or health or casualty insurer; recovery of excess amount paid to provider of health care.

NRS 616C.140        Medical examination of claimant; effect of refusal to submit to examination; communications not privileged.

DETERMINATION AND PAYMENT OF BENEFITS

NRS 616C.150        Compensation prohibited unless preponderance of evidence establishes that injury arose out of and in course of employment; rebuttable presumption if notice of injury is filed after termination of employment.

NRS 616C.155        Payment of compensation by insurer prohibited before required; recovery of overpayment by insurer.

NRS 616C.157        Request for prior authorization: Time to respond; effect of failure to respond in timely manner.

NRS 616C.160        Newly developed injury or disease: Inclusion in original claim for compensation; limitation.

NRS 616C.165        Determination of responsibility of insurer for undisputed claim for compensation; reimbursement of insurer initially providing compensation to injured employee.

NRS 616C.170        Resolution of disputes between insurers if benefits are claimed against more than one insurer; adoption of regulations by Administrator; appeal of decision of Administrator; payment of benefits until determination of responsibility by Administrator.

NRS 616C.175        Employment-related aggravation of preexisting condition which is not employment related; aggravation of employment-related injury by incident which is not employment related.

NRS 616C.177        Medical records concerning preexisting condition: Authority of insurer to request records; injured employee required to release records under certain circumstances.

NRS 616C.180        Injury or disease caused by stress.

NRS 616C.185        Compensation for mastectomy and reconstructive surgery.

NRS 616C.190        Compensation of employee injured out of State.

NRS 616C.195        Acceptance of compensation or benefits by employee injured out of State constitutes release of employer and waiver of remedy at common law or statutory remedy provided in another state.

NRS 616C.200        Commencement of action in another state to recover damages or compensation by employee injured out of State constitutes irrevocable waiver of compensation due under Nevada law; satisfaction of foreign judgment against Nevada employer.

NRS 616C.205        Compensation not assignable; exempt from attachment, garnishment and execution; accrued compensation payable to dependents.

NRS 616C.210        Compensation of nonresident alien dependents; notification of dependent required.

NRS 616C.215        Actions and proceedings to recover damages in tort or from proceeds of vehicle insurance: Reduction of compensation by amount of recovery; rights of injured employee or dependents and of insurer or Administrator; notification and payment of insurer or Administrator; instructions to jury; calculation of employer’s premium.

NRS 616C.220        Compensation from Uninsured Employers’ Claim Account: Administration and payment of claims; eligibility of employee; liability of employer; powers and duties of Division; appeals; collection.

NRS 616C.223        Application for entry of summary judgment: Conditions; notice to employer; filing requirements; entry of judgment; service of judgment; recordation of judgment; lien upon property of employer; extension of lien.

NRS 616C.225        Misrepresentation or concealment of fact to obtain benefits: Insurer entitled to reimbursement or deduction from benefits; appeal of determination; alternative remedies.

NRS 616C.230        Grounds for denial, reduction or suspension of compensation; evidence of and examination for use of alcohol or controlled substance.

NRS 616C.232        Denial of compensation for temporary total disability because of discharge for misconduct.

NRS 616C.235        Closure of claim by insurer: Procedure; notice; special procedure if medical benefits less than $300.

ACCIDENT BENEFITS

NRS 616C.245        Injured employee entitled to accident benefits; limitation on receipt of modified motor vehicle as accident benefit; regulations establishing maximum benefit.

NRS 616C.250        Establishment, revision and compliance with standards of care for provision of accident benefits.

NRS 616C.255        Premium for accident benefits paid by employer; accident benefits provided by private carrier; separate account for accident benefits.

NRS 616C.260        Fees and charges for accident benefits: Restrictions; establishment and revision of schedule; powers and duties of Administrator; penalty for refusal to provide information; regulations.

NRS 616C.265        Election by employer to provide accident benefits; reporting requirements; payment of assessments.

NRS 616C.270        Employers to notify Administrator when injured employee receives medical services.

NRS 616C.275        Change of physicians, chiropractors or other requirements; cost of change borne by insurer; cause of action of injured employee assigned to private carrier.

NRS 616C.280        Withdrawal of approval for employer to provide accident benefits: Grounds supporting withdrawal.

NRS 616C.285        Withdrawal of approval for employer to provide accident benefits: Request for hearing; notice of decision.

CONTESTED CLAIMS

NRS 616C.295        Duties of Chief of Hearings Division: Adoption of regulations establishing codes of conduct for hearing officers and appeals officers, standards for initial training and continuing education and qualifications for hearing officers; expediting of certain cases; annual report.

NRS 616C.300        Hearing officers: Appointment; salary; disqualification from particular case.

NRS 616C.305        Procedure for appeal of final determination of organization for managed care which has contracted with insurer.

NRS 616C.310        Contested cases: Procedures; format; redaction of personal identifying information; representation of insurer or employer by legal counsel or other agent.

NRS 616C.315        Request for hearing; forms for request to be provided by insurer; prerequisites to scheduling of hearing; expeditious and informal hearing required; direct submission to appeals officer.

NRS 616C.320        Resolution of disputed decision of self-insured employer or employer who is member of association of self-insured public or private employers or insured by private carrier.

NRS 616C.325        Representation of employee and employer before hearings officer or appeals officer or in negotiations with insurer; licensure of employer’s representative; employer liable for representative’s violations; compensation of employer’s representative must not be contingent on outcome.

NRS 616C.330        Date, time and place for hearing; evaluation of injured employee; powers and duties of hearing officer; issuance of decision; procedure for obtaining stay of decision.

NRS 616C.335        Award of interest.

NRS 616C.340        Appointment, term, qualifications and salary of appeals officers and special appeals officers; conflicts of interest; finality of decision by appeals officer.

NRS 616C.345        Notice of appeal; notice of contested claim; prerequisites to scheduling of hearing on appeal; effect of appeal on enforcement of decision of hearing officer; setting of date, time and place for hearing on appeal; continuances.

NRS 616C.350        Testimony of physician or chiropractor before appeals officer; privileged communications.

NRS 616C.355        Use of affidavits or declarations as evidence at hearing; notice to opposing party; waiver of right to cross-examine affiant or declarant; effect of waiver.

NRS 616C.360        Record of hearing before appeals officer; rules of evidence; evaluation of injured employee; submission to independent review organization; powers and duties of appeals officer; transcripts; issuance of decision.

NRS 616C.363        External review: Duties of independent review organization; contents and submission of decision by organization; costs; regulations.

NRS 616C.365        Reimbursement of employee’s expenses incurred and wages lost as result of hearing requested by employer or insurer; regulations.

NRS 616C.370        Judicial review.

NRS 616C.375        Stay of decision of appeals officer.

NRS 616C.380        Payment pending appeal when decision not stayed; effect of final resolution of claim.

NRS 616C.385        Costs and attorney’s fees for frivolous petitions for judicial review.

NRS 616C.390        Reopening claim: General requirements and procedure; limitations; applicability.

NRS 616C.392        Reopening claim: Circumstances under which insurer is required to reopen claim for permanent partial disability.

COMPENSATION FOR INJURIES AND DEATH

General Provisions

NRS 616C.400        Minimum duration of incapacity.

NRS 616C.405        Limitations on benefits received by employee.

NRS 616C.408        Restrictive endorsements on checks issued by insurers.

NRS 616C.409        Direct deposit of compensation.

NRS 616C.410        Prohibition of settlements paid in lump sum; exceptions.

NRS 616C.412        Purchase of annuity by insurer to ensure payment of claim; adoption of regulations by Commissioner.

NRS 616C.415        Written explanation of alternative settlements to be given to employee or dependents.

NRS 616C.420        Method of determining average monthly wage.

NRS 616C.425        Date of determination of amount of compensation and benefits.

NRS 616C.427        Challenge to determination of average monthly wage; remedy for incorrect average monthly wage.

 

Permanent Total Disability

NRS 616C.435        Injuries deemed total and permanent.

NRS 616C.440        Amount and duration of compensation; limitations; effect of previous award of compensation.

NRS 616C.445        Recipient of compensation to report annual earnings; payments suspended if report not made.

NRS 616C.447        Insurer required to make certain accountings to injured employee who is entitled to compensation for permanent total disability; additional accountings may be requested by injured employee.

NRS 616C.450        Compensation to injured employee or dependents of injured employee for permanent total disability or death benefit if injury or occupational disease occurred before July 1, 1980.

NRS 616C.453        Additional annual payment to certain claimants and dependents of claimants who are entitled to receive compensation for permanent total disability; adoption of regulations to determine amount of payment.

NRS 616C.455        Increase in benefits for permanent total disability incurred before April 9, 1971.

NRS 616C.460        Additional increase in benefits for permanent total disability incurred before July 1, 1973.

NRS 616C.465        Increase in benefits for permanent total disability incurred on or after April 9, 1971, or for claimant or dependent not entitled to benefits for disability from federal social security system.

NRS 616C.470        Increase in benefits for permanent total disability if claimant is entitled to benefits for disability from federal social security system.

NRS 616C.473        Annual increase in benefits for permanent total disability incurred on or after January 1, 2004.

 

Temporary Total Disability

NRS 616C.475        Amount and duration of compensation; limitations; requirements for certification of disability; offer of light-duty employment.

NRS 616C.477        Compensation for lost wages incurred by employee who receives medical treatment after returning to work; prohibition against employer requiring employee to use personal leave for such treatment.

NRS 616C.480        Reduction of benefits for previous injury causing permanent partial disability prohibited.

 

Permanent and Temporary Partial Disabilities

NRS 616C.485        Permanent partial disability: Loss of or permanent damage to teeth.

NRS 616C.490        Permanent partial disability: Compensation.

NRS 616C.495        Permanent partial disability: Payments in lump sum.

NRS 616C.500        Temporary partial disability: Compensation.

 

Death Benefits

NRS 616C.505        Amount and duration of compensation.

NRS 616C.510        Increased death benefits if injury or disablement occurred before July 1, 1973.

NRS 616C.515        Additional increase in death benefits if injury or disablement occurred before July 1, 1973.

NRS 616C.520        Increased death benefits if injury or disablement occurred on or after July 1, 1973.

VOCATIONAL REHABILITATION

NRS 616C.530        Priorities for returning injured employee to work.

NRS 616C.540        Supervision, ratio and review of uncertified counselors; knowledge of labor market required.

NRS 616C.542        Prohibiting vocational rehabilitation counselor employed by entity administering injured employee’s case from providing services to injured employee without provision of certain written disclosures; right of injured employee to be assigned alternate counselor.

NRS 616C.543        Prohibited acts of vocational rehabilitation counselor.

NRS 616C.545        Duty of insurer to determine physical limitations on injured employee’s ability to work.

NRS 616C.547        General duties of vocational rehabilitation counselor.

NRS 616C.550        Written assessment of injured employee.

NRS 616C.555        Plan for program of vocational rehabilitation.

NRS 616C.560        Extension of program for vocational rehabilitation.

NRS 616C.570        On-the-job training as component of plan for program of vocational rehabilitation.

NRS 616C.575        Payment of vocational rehabilitation maintenance.

NRS 616C.580        Provision of services outside of State; limited lump-sum payment in lieu of services.

NRS 616C.585        Limit on goods and services which may be provided; exceptions.

NRS 616C.590        Eligibility for services; effect of incarceration; effect of refusing services offered by insurer; effect of inability of insurer to locate injured employee.

NRS 616C.595        Agreements for payment of compensation in lump sum in lieu of provision of vocational rehabilitation services.

NRS 616C.597        Response to request for payment of compensation in lump sum in lieu of provision of vocational rehabilitation services.

NRS 616C.600        Orders for self-employment or payment of compensation in lump sum for vocational rehabilitation prohibited; agreements concerning self-employment authorized.

CATASTROPHIC INJURIES

NRS 616C.700        Duties of insurer who accepts a claim for catastrophic injury; life care plan.

NRS 616C.703        Injured employee may request insurer to administer claim as for catastrophic injury; insurer to issue determination.

NRS 616C.707        Insurer to designate claim as for catastrophic injury if injury later satisfies requirements for catastrophic injury.

NRS 616C.710        Rescission or revision of determination of catastrophic injury.

NRS 616C.720        Requirements for adjuster who administers claim for catastrophic injury.

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REPORTS OF INJURIES AND CLAIMS FOR COMPENSATION

      NRS 616C.005  Forms for reporting injuries: Insurer to distribute revised forms to employers periodically; Administrator to make revised forms available to physicians and chiropractors.  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)

      NRS 616C.010  Employee to report accident and injury to employer; examination of employee; employee leasing company to provide to leased employees instructions regarding reporting of injuries.

      1.  Whenever any accident occurs to any employee, the employee shall forthwith report the accident and the injury resulting therefrom to his or her 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 shall:

      (a) If the employer’s insurer has entered into a contract with an organization for managed care or with providers of health care pursuant to NRS 616B.527, furnish the names, addresses and telephone numbers of:

             (1) Two or more physicians or chiropractors who are qualified to conduct the examination and who are available pursuant to the terms of the contract, if there are two or more such physicians or chiropractors within 30 miles of the employee’s place of employment; or

             (2) One or more physicians or chiropractors who are qualified to conduct the examination and who are available pursuant to the terms of the contract, if there are not two or more such physicians or chiropractors within 30 miles of the employee’s place of employment.

      (b) If the employer’s insurer has not entered into a contract with an organization for managed care or with providers of health care pursuant to NRS 616B.527, furnish the names, addresses and telephone numbers of:

             (1) Two or more physicians or chiropractors who are qualified to conduct the examination, if there are two or more such physicians or chiropractors within 30 miles of the employee’s place of employment; or

             (2) One or more physicians or chiropractors who are qualified to conduct the examination, if there are not two or more such physicians or chiropractors within 30 miles of the employee’s place of employment.

      3.  From among the names furnished by the employer pursuant to subsection 2, the employee shall select one of those physicians or chiropractors to conduct the examination, but the employer shall not require the employee to select a particular physician or chiropractor from among the names furnished by the employer. 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 the employee’s physical condition except as required by NRS 616C.177.

      4.  Further medical attention, except as otherwise provided in NRS 616C.265, must be authorized by the insurer.

      5.  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.

      6.  An employee leasing company must provide to each employee covered under an employee leasing contract instructions on how to notify the leasing company supervisor and client company of an injury in plain, clear language placed in conspicuous type in a specifically labeled area of instructions given to the employee.

      [Part 52:168:1947; 1943 NCL § 2680.52]—(NRS A 1981, 1167, 1471; 1983, 478; 1985, 1543; 2007, 3344; 2009, 1130)

      NRS 616C.015  Notice of injury or death: Requirements; availability of form; retention; notice by leased employee.

      1.  An employee or, in the event of the employee’s death, one of the dependents of the employee, 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 the dependent of the employee to describe briefly the accident that caused the injury or death.

      (b) Be signed by the injured employee or by a person on behalf of the employee, or in the event of the employee’s death, by one of the dependents of the employee 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 the dependent of the employee 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 or her 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.

      6.  The claim of a leased employee is not barred if the leased employee gives notice to his or her client company supervisor, rather than to his or her leasing company supervisor. Notification of an injury by a leased employee to his or her client company supervisor shall be deemed sufficient notice of injury to the employer.

      [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; 2009, 1131)

      NRS 616C.020  Claim for compensation: Requirements for injured employee, dependent or representative to file claim; form.

      1.  Except as otherwise provided in subsection 2, an injured employee, or a person acting on behalf of the employee, 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 or her employment; or

      (b) The employee was off work as a result of an injury arising out of and in the course of his or her 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 behalf of the employee, 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)

      NRS 616C.025  Recovery of compensation barred if notice of injury or claim for compensation is not filed; exceptions.

      1.  Except as otherwise provided in subsection 2, an employee or, in the event of the death of the employee, a dependent of the employee, is barred from recovering compensation pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS if the employee or dependent, as applicable, 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 the control of the employee prevented the employee 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)

      NRS 616C.030  Dependent of injured employee barred from filing claim for compensation if untimely or previously denied.  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)

      NRS 616C.035  Application for death benefit.  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)

      NRS 616C.040  Claim for compensation: Duty of treating physician or chiropractor to file or delegate duty to medical facility; electronic filing; form and contents; maintenance of forms; penalty.

      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)

      NRS 616C.045  Report of industrial injury or occupational disease: Duty of employer to file; electronic filing; form and contents; penalty.

      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 or her 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 the employer’s 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 the employer’s 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)

      NRS 616C.050  Information required to be provided by insurer to claimant.

      1.  An insurer shall provide to each claimant:

      (a) Upon written request, one copy of any medical information concerning the claimant’s injury or illness.

      (b) A statement which contains information concerning the claimant’s right to:

             (1) Receive the information and forms necessary to file a claim;

             (2) Select a treating physician or 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 the claimant before the appeals officer;

             (4) File a complaint with the Administrator;

             (5) When applicable, receive compensation for:

                   (I) Permanent total disability;

                   (II) Temporary total disability;

                   (III) Permanent partial disability;

                   (IV) Temporary partial disability;

                   (V) All medical costs related to the claimant’s injury or disease; or

                   (VI) The hours the claimant is absent from the place of employment to receive medical treatment pursuant to NRS 616C.477;

             (6) Receive services for rehabilitation if the claimant’s injury prevents him or her from returning to gainful employment;

             (7) Review by a hearing officer of any determination or rejection of a claim by the insurer within the time specified by statute; and

             (8) Judicial review of any final decision within the time specified by statute.

      2.  The insurer’s statement must include a copy of the form designed by the Administrator pursuant to subsection 8 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; 2009, 1277)

      NRS 616C.052  Exposure of police officer, firefighter or arson investigator to contagious disease: Reporting and testing requirements; eligibility for compensation.

      1.  Except as otherwise provided in NRS 617.485 and 617.487, if a police officer, a salaried or volunteer firefighter or an arson investigator is exposed to a contagious disease:

      (a) Upon battery by an offender; or

      (b) While performing the duties of a police officer, firefighter or arson investigator,

Ê the employer of the police officer, firefighter or arson investigator shall create and maintain a report concerning the exposure that includes, without limitation, the name of each police officer, firefighter or arson investigator, as applicable, who was exposed to the contagious disease and the name of each person, if any, to whom the police officer, firefighter or arson investigator 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, a salaried or volunteer firefighter or an arson investigator after the commencement of employment reveal that the police officer, firefighter or arson investigator tested positive for exposure to tuberculosis, the police officer, firefighter or arson investigator is eligible, during his or her 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, a salaried or volunteer firefighter or an arson investigator is terminated, voluntarily or involuntarily, the employer of the police officer, firefighter or arson investigator, regardless of whether the police officer, firefighter or arson investigator has been exposed to a contagious disease during his or her employment and regardless of whether the employer has created or maintained a report concerning any exposure of the police officer, firefighter or arson investigator 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, firefighter or arson investigator a purified protein derivative skin test to screen for exposure to tuberculosis, unless the police officer, firefighter or arson investigator 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, firefighter or arson investigator tested positive for exposure to tuberculosis, the police officer, firefighter or arson investigator is eligible, during his or her 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, firefighter or arson investigator 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, firefighter or arson investigator 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, firefighter or arson investigator has any other contagious disease or the antibodies associated with a contagious disease, the police officer, firefighter or arson investigator is eligible, during his or her 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, a salaried or volunteer firefighter or an arson investigator 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; 2009, 543)

      NRS 616C.055  Use of fee schedules which unfairly discriminate among physicians and chiropractors prohibited; payment for services rendered by physician or chiropractor after removal from panel prohibited.

      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, the physician or chiropractor, as applicable, must not be paid for any services rendered to the injured employee after the date of the removal.

      (Added to NRS by 1979, 651; A 1981, 1168, 1488; 1983, 325; 1985, 1546; 1991, 2417; 1993, 733; 1999, 1776)

      NRS 616C.065  Duty of insurer to accept or deny claim; new determination; penalty; failure of insurer to indicate acceptance or denial of claim; written determination. [Effective through December 31, 2014, and after that date unless the provisions of Senate Joint Resolution No. 14 (2011) are approved and ratified by the voters at the 2014 General Election.]

      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) Accept a claim for compensation, notify the claimant or the person acting on behalf of the claimant that the claim has been accepted and commence payment of the claim; or

      (b) Deny the claim and notify the claimant or the person acting on behalf of the claimant and the Administrator that the claim has been denied.

      2.  If an insurer is ordered by the Administrator, a hearing officer, an appeals officer, a district court or the Supreme Court of Nevada to make a new determination, including, without limitation, a new determination regarding the acceptance or denial of a claim for compensation, the insurer shall make the new determination within 30 days after the date on which the insurer has been ordered to do so.

      3.  Payments made by an insurer pursuant to this section are not an admission of liability for the claim or any portion of the claim.

      4.  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 the claimant 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.

      5.  The insurer shall notify the claimant or the person acting on behalf of the claimant that a claim has been accepted or denied pursuant to subsection 1 or 2 by:

      (a) Mailing its written determination to the claimant or the person acting on behalf of the claimant; and

      (b) If the claim has been denied, in whole or in part, obtaining a certificate of mailing.

      6.  The failure of the insurer to obtain a certificate of mailing as required by paragraph (b) of subsection 5 shall be deemed to be a failure of the insurer to mail the written determination of the denial of a claim as required by this section.

      7.  The failure of the insurer to indicate the acceptance or denial of a claim for a part of the body or condition does not constitute a denial or acceptance thereof.

      8.  Upon request, the insurer shall provide a copy of the certificate of mailing, if any, to the claimant or the person acting on behalf of the claimant.

      9.  For the purposes of this section, the insurer shall mail the written determination to:

      (a) The mailing address of the claimant or the person acting on behalf of the claimant that is provided on the form prescribed by the Administrator for filing the claim; or

      (b) Another mailing address if the claimant or the person acting on behalf of the claimant provides to the insurer written notice of another mailing address.

      10.  As used in this section, “certificate of mailing” means a receipt that provides evidence of the date on which the insurer presented its written determination to the United States Postal Service for mailing.

      (Added to NRS by 1995, 2001; A 2001, 2738; 2007, 3345; 2009, 1278, 3031)

      NRS 616C.065  Duty of insurer to accept or deny claim; new determination; penalty; failure of insurer to indicate acceptance or denial of claim; written determination. [Effective January 1, 2015, if the provisions of Senate Joint Resolution No. 14 (2011) are approved and ratified by the voters at the 2014 General Election.]

      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) Accept a claim for compensation, notify the claimant or the person acting on behalf of the claimant that the claim has been accepted and commence payment of the claim; or

      (b) Deny the claim and notify the claimant or the person acting on behalf of the claimant and the Administrator that the claim has been denied.

      2.  If an insurer is ordered by the Administrator, a hearing officer, an appeals officer, a district court, the Court of Appeals or the Supreme Court of Nevada to make a new determination, including, without limitation, a new determination regarding the acceptance or denial of a claim for compensation, the insurer shall make the new determination within 30 days after the date on which the insurer has been ordered to do so.

      3.  Payments made by an insurer pursuant to this section are not an admission of liability for the claim or any portion of the claim.

      4.  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 the claimant 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.

      5.  The insurer shall notify the claimant or the person acting on behalf of the claimant that a claim has been accepted or denied pursuant to subsection 1 or 2 by:

      (a) Mailing its written determination to the claimant or the person acting on behalf of the claimant; and

      (b) If the claim has been denied, in whole or in part, obtaining a certificate of mailing.

      6.  The failure of the insurer to obtain a certificate of mailing as required by paragraph (b) of subsection 5 shall be deemed to be a failure of the insurer to mail the written determination of the denial of a claim as required by this section.

      7.  The failure of the insurer to indicate the acceptance or denial of a claim for a part of the body or condition does not constitute a denial or acceptance thereof.

      8.  Upon request, the insurer shall provide a copy of the certificate of mailing, if any, to the claimant or the person acting on behalf of the claimant.

      9.  For the purposes of this section, the insurer shall mail the written determination to:

      (a) The mailing address of the claimant or the person acting on behalf of the claimant that is provided on the form prescribed by the Administrator for filing the claim; or

      (b) Another mailing address if the claimant or the person acting on behalf of the claimant provides to the insurer written notice of another mailing address.

      10.  As used in this section, “certificate of mailing” means a receipt that provides evidence of the date on which the insurer presented its written determination to the United States Postal Service for mailing.

      (Added to NRS by 1995, 2001; A 2001, 2738; 2007, 3345; 2009, 1278, 3031; 2013, 1794, effective January 1, 2015, if the provisions of Senate Joint Resolution No. 14 (2011) are approved and ratified by the voters at the 2014 General Election)

      NRS 616C.070  Persons who are conclusively presumed to be totally dependent on injured or deceased employee; exception.

      1.  A person is conclusively presumed to be totally dependent upon an injured or deceased employee if:

      (a) The person is a natural, posthumous or adopted child, whether legitimate or illegitimate, under the age of 18 years; or

      (b) The person is a natural, posthumous or adopted child, there is no surviving parent and the person is:

             (1) Over the age of 18 years and physically or mentally incapacitated from wage earning; or

             (2) Over the age of 18 years but under the age of 22 years and enrolled as a full-time student in an accredited vocational or educational institution.

      2.  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.

      3.  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.

      4.  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; 2007, 3346; 2009, 3072)

      NRS 616C.075  Effect of employee’s refusal to submit to physical examination after accident.  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

      NRS 616C.085  Duties of employer when employee injured: First aid; reimbursement.

      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 or her 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 the employer’s 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)

      NRS 616C.090  Selection of physician or chiropractor: Powers and duties of Administrator; selection and alternate selection from established panel or pursuant to contract; responsibility for charges.

      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 or her 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 a 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 or she so chooses, the injured employee may make an alternative choice of physician or chiropractor from the panel if the choice is made within 90 days after his or her 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 the physician or chiropractor, as applicable, rendered to the injured employee up to and including the date of notification. Except as otherwise provided in this subsection, any further change is subject to the approval of the insurer, 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 a 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 or she so chooses, the injured employee may make an alternative choice of physician or chiropractor pursuant to the terms of the contract without the approval of the insurer if the choice is made within 90 days after his or her injury. If the injured employee, after choosing a 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.  If the injured employee is not satisfied with the physician or chiropractor selected by himself or herself or by the insurer, the organization for managed care or the provider of health care services pursuant to subsection 3, the injured employee may make an alternative choice of physician or chiropractor pursuant to the terms of the contract. A change in the treating physician or chiropractor may be made at any time but 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 insurer denies a request for a change in the treating physician or chiropractor under this subsection, the insurer must include in a written notice of denial to the injured employee the specific reason for the denial of the request.

      5.  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.

      6.  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.

      7.  An injured employee may receive treatment by more than one physician or chiropractor if the insurer provides written authorization for such treatment.

      8.  The Administrator shall design a form that notifies injured employees of their right pursuant to subsections 2, 3 and 4 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; 2009, 1279)

      NRS 616C.095  Duty of physician or chiropractor to advise injured employee of rights.  The physician or chiropractor shall inform the injured employee of the injured employee’s 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)

      NRS 616C.100  Additional determination of percentage of disability permitted if cost paid by injured employee; authority of injured employee to seek reimbursement of cost; results of determination may be offered at hearing or conference.

      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, the employee 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)

      NRS 616C.105  Requirements for designation of chiropractor to rate permanent partial disabilities.  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)

      NRS 616C.110  American Medical Association’s Guides to the Evaluation of Permanent Impairment: Duty of Division to adopt Guides by regulation.

      1.  For the purposes of NRS 616B.557, 616B.578, 616B.587, 616C.490 and 617.459, not later than August 1, 2003, the Division shall adopt regulations incorporating the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fifth Edition, by reference. The regulations:

      (a) Must provide that the American Medical Association’s Guides to the Evaluation of Permanent Impairment, Fifth Edition, must be applied to all examinations; and

      (b) 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.

      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 Fifth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment;

      (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 person in calculating the entitlement to compensation.

      3.  If the Fifth Edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment 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; 2009, 3032)

      NRS 616C.115  Prescription of generic drugs required; exceptions.

      1.  Except as otherwise provided in subsection 2, a physician or advanced practice registered nurse 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 practice registered nurse is not required to comply with the provisions of subsection 1 if:

      (a) The physician or advanced practice registered nurse 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; A 2013, 2092)

      NRS 616C.120  Employee may elect treatment through prayer in lieu of medical treatment.  Any provision of this chapter or chapter 616A, 616B, 616D or 617 of NRS must not prevent an employee from providing for treatment for the employee’s 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)

      NRS 616C.125  Insurer may contract with suppliers for provision of services and goods to injured employees.  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)

      NRS 616C.130  Insurer’s payment to physician or chiropractor attending injured employee conditioned upon receipt of itemized statement and certificate.  The insurer shall not authorize the payment of any money to a physician or chiropractor for services rendered by the physician or chiropractor, as applicable, 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)

      NRS 616C.135  Liability of insurer for payment of charges for treatment related to industrial injury or occupational disease; acceptance of payment by provider of health care from injured employee or health or casualty insurer for treatment that was erroneously denied.

      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)

      NRS 616C.136  Action by insurer on bill from provider of health care; payment of interest; request for additional information; compliance with requirements.

      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, the insurer shall notify the provider of health care of his or her request for the additional information within 20 calendar days after the insurer 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 the provider of health care 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 the insurer receives the additional information. If the bill for accident benefits is approved, the insurer shall pay the bill within 20 calendar days after the insurer 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)

      NRS 616C.137  Denial of payment for unrelated services: Requirements for notification; liability of injured employee; appeal.

      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 the injured employee 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)

      NRS 616C.138  Payment of provider of health care upon insurer’s denial of authorization or responsibility for treatment or other services provided; reimbursement of injured employee or health or casualty insurer; recovery of excess amount paid to provider of health care.

      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)

      NRS 616C.140  Medical examination of claimant; effect of refusal to submit to examination; communications not privileged.

      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 to a 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, the employee’s physical condition and the employee’s 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 the employee, 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, the right of the employee 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

      NRS 616C.150  Compensation prohibited unless preponderance of evidence establishes that injury arose out of and in course of employment; rebuttable presumption if notice of injury is filed after termination of employment.

      1.  An injured employee or the dependents of the injured employee are not entitled to receive compensation pursuant to the provisions of chapters 616A to 616D, inclusive, of NRS unless the employee or the dependents establish by a preponderance of the evidence that the employee’s injury arose out of and in the course of his or her 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 or her 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 or her employment.

      (Added to NRS by 1993, 662)—(Substituted in revision for NRS 616.5015)

      NRS 616C.155  Payment of compensation by insurer prohibited before required; recovery of overpayment by insurer.

      1.  An insurer shall not provide compensation to or for an employee or the dependents of the employee 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 the injured employee’s 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)

      NRS 616C.157  Request for prior authorization: Time to respond; effect of failure to respond in timely manner.

      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)

      NRS 616C.160  Newly developed injury or disease: Inclusion in original claim for compensation; limitation.  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)

      NRS 616C.165  Determination of responsibility of insurer for undisputed claim for compensation; reimbursement of insurer initially providing compensation to injured employee.  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)

      NRS 616C.170  Resolution of disputes between insurers if benefits are claimed against more than one insurer; adoption of regulations by Administrator; appeal of decision of Administrator; payment of benefits until determination of responsibility by Administrator.

      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)

      NRS 616C.175  Employment-related aggravation of preexisting condition which is not employment related; aggravation of employment-related injury by incident which is not employment related.

      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 the employee’s current or past employment; and

      (b) Subsequently sustains an injury by accident arising out of and in the course of his or her employment which aggravates, precipitates or accelerates the 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 or her 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 or her 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)

      NRS 616C.177  Medical records concerning preexisting condition: Authority of insurer to request records; injured employee required to release records under certain circumstances.

      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 or her 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)

      NRS 616C.180  Injury or disease caused by stress.

      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 or her 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) The employee 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 or her employment; and

      (c) The stress was not caused by his or her layoff, the termination of his or her employment or any disciplinary action taken against him or her.

      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)

      NRS 616C.185  Compensation for mastectomy and reconstructive surgery.

      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 re-establish 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)

      NRS 616C.190  Compensation of employee injured out of State.

      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, the employee, or the dependents of the employee in case of the death of the employee, 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 or she 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)

      NRS 616C.195  Acceptance of compensation or benefits by employee injured out of State constitutes release of employer and waiver of remedy at common law or statutory remedy provided in another state.

      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 the employee, or the dependents of the employee in case of his or her 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 or her dependents in case of death, until such employee, the employee’s 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)

      NRS 616C.200  Commencement of action in another state to recover damages or compensation by employee injured out of State constitutes irrevocable waiver of compensation due under Nevada law; satisfaction of foreign judgment against Nevada employer.

      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 the employee, or the employee’s 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 or her 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 the employee’s 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)

      NRS 616C.205  Compensation not assignable; exempt from attachment, garnishment and execution; accrued compensation payable to dependents.  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:

      1.  Is not assignable before the issuance and delivery of the check or the deposit of any payment for compensation pursuant to NRS 616C.409;

      2.  Is exempt from attachment, garnishment and execution; and

      3.  Does not pass to any other person by operation of law.

Ê 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 or for which payment was not made pursuant to NRS 616C.409 at the date of death of the employee is payable to the dependents of the employee 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; 2007, 400)

      NRS 616C.210  Compensation of nonresident alien dependents; notification of dependent required.

      1.  The insurer shall notify a dependent of a deceased employee who is residing outside of the United States by certified mail at the last known address of the dependent 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 or her 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)

      NRS 616C.215  Actions and proceedings to recover damages in tort or from proceeds of vehicle insurance: Reduction of compensation by amount of recovery; rights of injured employee or dependents and of insurer or Administrator; notification and payment of insurer or Administrator; instructions to jury; calculation of employer’s premium.

      1.  If an injured employee or, in the event of his or her death, the dependents of the employee, bring an action in tort against his or her 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 the dependents of the employee 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 Employers’ 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 the dependents of the employee 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 the dependents of the employee 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 the employer for the 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 the dependents of the employee, may take proceedings against that person to recover damages, but the amount of the compensation the injured employee or the dependents of the employee 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 the dependents of the employee, 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 the employee’s 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 the employee, or in the case of death the dependents of the employee, to receive proceeds under his or her employer’s policy of uninsured or underinsured vehicle coverage:

      (a) The injured employee, or in the case of death the dependents of the employee, may take proceedings to recover those proceeds, but the amount of compensation the injured employee or the dependents of the employee 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 the dependents of the employee, 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 the dependents of the employee 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 the dependents of the employee under a policy of uninsured or underinsured vehicle coverage purchased by the employee.

      (c) Any provision in the employer’s policy of uninsured or underinsured vehicle coverage which has the effect of:

             (1) Limiting the rights of the injured employee or the dependents of the employee to recover proceeds under the policy because of the receipt of any compensation pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter 617 of NRS;

             (2) Limiting the rights of subrogation of the insurer or Administrator provided by paragraph (b); or

             (3) Excluding coverage which inures to the direct or indirect benefit of the insurer or Administrator,

Ê is void.

      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 the dependents of the employee.

      5.  In any case where the insurer or the Administrator is subrogated to the rights of the injured employee or of the employee’s 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 or her death the dependents of the employee, 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 the dependents of the employee.

      7.  An injured employee, or in the case of death the dependents of the employee, or the attorney or representative of the injured employee or the dependents of the employee, 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 the dependents of the employee, or the attorney or representative of the injured employee or the dependents of the employee; 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 the dependents of the employee 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 the dependents of the employee, or the attorney or representative of the injured employee or the dependents of the employee, 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 or her death by the dependents of the employee, 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 or her favor in this case, the plaintiff is not required to repay his or her employer, the insurer or the Administrator any amount paid to the plaintiff or paid on the behalf of the plaintiff by the plaintiff’s employer, the insurer or the Administrator.

       If you decide that the plaintiff is entitled to judgment against the defendant, you shall find damages for the plaintiff 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; 2007, 3346)

      NRS 616C.220  Compensation from Uninsured Employers’ Claim Account: Administration and payment of claims; eligibility of employee; liability of employer; powers and duties of Division; appeals; collection.

      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) The employee was hired in this State or is regularly employed in this State;

      (b) The employee suffers an accident or injury which arises out of and in the course of his or her employment:

             (1) In this State; or

             (2) While on temporary assignment outside the State for not more than 12 months;

      (c) The employee files a claim for compensation with the Division; and

      (d) The employee 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 the employee 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 and NRS 616C.223, the employer has the burden of proving that the employer provided mandatory industrial insurance coverage for the employee or that the employer 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 behalf of the employer, 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 or filing an application for the entry of summary judgment pursuant to NRS 616C.223 in a court of competent jurisdiction. For the purposes of this paragraph, the payments made by the Division that are described in subsection 5 are presumed to be:

             (1) Justified by the circumstances of the claim;

             (2) Made in accordance with applicable law; and

             (3) Reasonable and necessary.

      (b) In any civil action or application for the entry of summary judgment filed pursuant to NRS 616C.223 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 or filing an application for the entry of summary judgment pursuant to NRS 616C.223, 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 or her 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.  If the Division has not obtained a civil judgment or an entry of summary judgment pursuant to NRS 616C.223 and the Division assigns a debt that arises under this section to the State Controller for collection pursuant to NRS 353C.195, the State Controller may bring an action in his or her own name in a court of competent jurisdiction to recover any amount that the Division is authorized to recover pursuant to this section.

      (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; 2009, 1182; 2011, 893)

      NRS 616C.223  Application for entry of summary judgment: Conditions; notice to employer; filing requirements; entry of judgment; service of judgment; recordation of judgment; lien upon property of employer; extension of lien.

      1.  Except as otherwise provided in this subsection, if an employer fails to pay to the Division any amount due pursuant to NRS 616C.220, the Division may, after the date on which the debt became due, file with the office of the clerk of a court of competent jurisdiction an application for the entry of summary judgment against the employer for the amount due. The Division may not enforce a judgment against an employer if an appeal requested by the employer pursuant to NRS 616C.220 is pending.

      2.  If the Division intends to file an application for the entry of summary judgment, the Division shall, not less than 15 days before the date on which the application is filed, notify the employer of the Division’s intention to file the application. The notification must be sent by certified mail to the last known address of the employer and must include the name of the employee for whom the claim was paid, the amount sought to be recovered and the date on which the application will be filed with the court.

      3.  An application for the entry of summary judgment must:

      (a) Be accompanied by a certificate which specifies:

             (1) The amount owed by the employer, including any attorney’s fees, interest and administrative costs due;

             (2) The name and address of the employer; and

             (3) That the Division has complied with the applicable provisions of law relating to the determination of the amount required to be paid; and

      (b) Include:

             (1) A request that judgment be entered against the employer for the amount specified in the certificate; and

             (2) Evidence that the employer was notified of the application for the entry of summary judgment in accordance with subsection 2.

      4.  The court clerk, upon the filing of an application for the entry of summary judgment which complies with the requirements set forth in this section, shall forthwith enter a judgment against the employer in the amount of the debt, plus any attorney’s fees, interest and administrative costs, as set forth in the certificate. The Division shall serve a copy of the judgment, together with a copy of the application and the certificate, upon the employer against whom the judgment is entered, either by personal service or by mailing a copy to the last known address of the employer.

      5.  An abstract of the judgment entered pursuant to subsection 4, or a copy thereof, may be recorded in the office of the county recorder of any county.

      6.  From the time of its recordation, the judgment constitutes a lien upon all real and personal property situated in the county that is owned by the employer, or which the employer may afterward acquire, until the lien expires. The lien has the force, effect and priority of a judgment lien and continues for 6 years after the date of the judgment so entered by the court clerk unless sooner released or otherwise discharged.

      7.  Within 6 years after the date of the recording of the judgment or within 6 years after the date of the last extension of the lien pursuant to this subsection, the lien may be extended by recording an affidavit of renewal in the office of the county recorder. From the date of recording, the lien is extended for 6 years to all real and personal property situated in the county that is owned by the employer or acquired by the employer afterwards, unless the lien is sooner released or otherwise discharged.

      (Added to NRS by 2011, 891)

      NRS 616C.225  Misrepresentation or concealment of fact to obtain benefits: Insurer entitled to reimbursement or deduction from benefits; appeal of determination; alternative remedies.

      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 an 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)

      NRS 616C.230  Grounds for denial, reduction or suspension of compensation; evidence of and examination for use of alcohol or controlled substance.

      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 or herself.

      (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 or her 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 or her system at the time of his or her injury for which the employee did not have a current and lawful prescription issued in the employee’s name or that the employee 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 50.310, 50.315 or 50.320 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 the employee’s death is caused by, or insofar as the employee’s 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 or her recovery, or refuses to submit to such medical or surgical treatment as is necessary to promote his or her recovery, the employee’s 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 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; 2009, 1280)

      NRS 616C.232  Denial of compensation for temporary total disability because of discharge for misconduct.

      1.  If an injured employee is discharged from his or her employment as a result of misconduct, an insurer may deny compensation for temporary total disability to the injured employee because of that discharge for misconduct only if the insurer proves by a preponderance of the evidence that:

      (a) The injured employee was discharged from his or her employment solely for the employee’s misconduct and not for any reason relating to the employee’s claim for compensation; and

      (b) It is the injured employee’s discharge from his or her employment for misconduct, and not the injury, that is the sole cause for the injured employee’s inability to return to work with the preinjury employer.

      2.  An insurer waives its rights under subsection 1 if the insurer does not make a determination to deny or suspend compensation to the injured employee within 70 days after the date on which the insurer learns that the injured employee has been discharged for misconduct.

      3.  An insurer may not deny any compensation pursuant to this section except for compensation for temporary total disability pursuant to subsection 1.

      4.  Discharge from employment for reasons other than gross misconduct does not limit an injured employee’s entitlement to receive benefits for temporary total disability.

      (Added to NRS by 2007, 3343; A 2009, 1281, 3033)

      NRS 616C.235  Closure of claim by insurer: Procedure; notice; special procedure if medical benefits less than $300.

      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 and, if the insurer has been notified that the claimant is represented by an attorney, to the attorney for the claimant by first-class mail addressed to the last known address of the attorney. The notice must include, on a separate page, a statement describing the effects of closing a claim pursuant to this section and a statement that if the claimant does not agree with the determination, the claimant has a right to request a resolution of the dispute pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive, including, without limitation, a statement which prominently displays the limit on the time that the claimant has to request a resolution of the dispute as set forth in NRS 616C.315. 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 the insurer sends, by first-class mail addressed to the last known address of the claimant, written notice that includes a statement which prominently displays 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.

      5.  In addition to the requirements of this section, an insurer shall include in the written notice described in subsection 2:

      (a) If an evaluation for a permanent partial disability has been scheduled pursuant to NRS 616C.490, a statement to that effect; or

      (b) If an evaluation for a permanent partial disability will not be scheduled pursuant to NRS 616C.490, a statement explaining that the reason is because the insurer has determined there is no possibility of a permanent impairment of any kind.

      (Added to NRS by 1979, 707; A 1981, 1140, 1492; 1989, 333; 1991, 2421; 1993, 746; 1997, 1437; 1999, 1783, 2416; 2001, 115; 2007, 3349; 2009, 1282)

ACCIDENT BENEFITS

      NRS 616C.245  Injured employee entitled to accident benefits; limitation on receipt of modified motor vehicle as accident benefit; regulations establishing maximum benefit.

      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 or her employment, the injured employee is quadriplegic, paraplegic or has had a part of his or her body amputated; and

      (b) The injured employee cannot be fitted with a prosthetic device which allows the employee 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)

      NRS 616C.250  Establishment, revision and compliance with standards of care for provision of accident benefits.

      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)

      NRS 616C.255  Premium for accident benefits paid by employer; accident benefits provided by private carrier; separate account for accident benefits.

      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)

      NRS 616C.260  Fees and charges for accident benefits: Restrictions; establishment and revision of schedule; powers and duties of Administrator; penalty for refusal to provide information; regulations.

      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 the Administrator with such information as the Administrator 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 the Administrator 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)

      NRS 616C.265  Election by employer to provide accident benefits; reporting requirements; payment of assessments.

      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 or her 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 that employer’s 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 or her employer, but may seek professional medical services of the employee’s 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 the employer’s 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)

      NRS 616C.270  Employers to notify Administrator when injured employee receives medical services.

      1.  Every employer who has elected to provide accident benefits for his or her 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)

      NRS 616C.275  Change of physicians, chiropractors or other requirements; cost of change borne by insurer; cause of action of injured employee assigned to private carrier.

      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 or she has made arrangements, the Administrator may, upon application of the employee, or upon the Administrator’s 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)

      NRS 616C.280  Withdrawal of approval for employer to provide accident benefits: Grounds supporting withdrawal.  The Administrator may withdraw his or her approval of an employer’s providing accident benefits for his or her 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 the employee’s 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 the employee from the employer;

      5.  Violates any of the Administrator’s 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)

      NRS 616C.285  Withdrawal of approval for employer to provide accident benefits: Request for hearing; notice of decision.

      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 the employer 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

      NRS 616C.295  Duties of Chief of Hearings Division: Adoption of regulations establishing codes of conduct for hearing officers and appeals officers, standards for initial training and continuing education and qualifications for hearing officers; expediting of certain cases; annual report.

      1.  The Chief of the Hearings Division shall adopt regulations establishing:

      (a) A code of conduct for hearing officers who conduct hearings in contested cases for compensation under chapters 616A to 617, inclusive, of NRS; and

      (b) A code of conduct for appeals officers who conduct hearings and appeals as required pursuant to chapters 616A to 617, inclusive, of NRS.

      2.  The codes of conduct established pursuant to subsection 1 must be designed to ensure fairness and impartiality, and to avoid the appearance of impropriety.

      3.  The Chief of the Hearings Division shall adopt regulations establishing:

      (a) Standards for the initial training and continuing education of hearing officers who conduct hearings in contested cases for compensation under chapters 616A to 617, inclusive, of NRS; and

      (b) Standards for the initial training and continuing education of appeals officers who conduct hearings and appeals as required pursuant to chapters 616A to 617, inclusive, of NRS.

      4.  The standards established pursuant to subsection 3 must, without limitation, include training and continuing education in:

      (a) The provisions of chapters 616A to 617, inclusive, of NRS;

      (b) Dispute resolution; and

      (c) Mediation.

      5.  The Chief of the Hearings Division shall:

      (a) Prescribe by regulation the qualifications required before a person may, pursuant to chapters 616A to 617, inclusive, of NRS, serve as a hearing officer.

      (b) Provide for the expediting of the hearing of cases that involve the termination or denial of compensation.

      6.  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.

      7.  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; 2007, 3350)

      NRS 616C.300  Hearing officers: Appointment; salary; disqualification from particular case.

      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 or she has a personal interest or a conflict of interest, directly or indirectly, in any case which is before him or her, the hearing officer shall disqualify himself or herself 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)

      NRS 616C.305  Procedure for appeal of final determination of organization for managed care which has contracted with insurer.

      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, the person 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)

      NRS 616C.310  Contested cases: Procedures; format; redaction of personal identifying information; representation of insurer or employer by legal counsel or other agent.

      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)

      NRS 616C.315  Request for hearing; forms for request to be provided by insurer; prerequisites to scheduling of hearing; expeditious and informal hearing required; direct submission to appeals officer.

      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, 616C.305 and 616C.427, 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, except as otherwise provided in subsections 4 and 5, 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.  The period specified in subsection 3 within which a request for a hearing must be filed may be extended for an additional 90 days if the person aggrieved shows by a preponderance of the evidence that the person was diagnosed with a terminal illness or was informed of the death or diagnosis of a terminal illness of his or her spouse, parent or child.

      5.  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 the person 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.

      6.  The hearing before the hearing officer must be conducted as expeditiously and informally as is practicable.

      7.  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.

      8.  A claimant may, with regard to a contested claim arising from the provisions of NRS 617.453, 617.455, 617.457, 617.485 or 617.487 as described in subsection 2 of NRS 616C.345, submit the contested claim directly to an appeals officer pursuant to subsection 2 of NRS 616C.345 without the agreement of any other party.

      (Added to NRS by 1979, 1040; A 1981, 1490; 1983, 1294; 1985, 668; 1991, 834, 2417; 1993, 736; 1999, 3380; 2001, 2256; 2003, 2333; 2007, 3351; 2009, 1283)

      NRS 616C.320  Resolution of disputed decision of self-insured employer or employer who is member of association of self-insured public or private employers or insured by private carrier.  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 or her employer, the association or the private carrier, the employee 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)

      NRS 616C.325  Representation of employee and employer before hearings officer or appeals officer or in negotiations with insurer; licensure of employer’s representative; employer liable for representative’s violations; compensation of employer’s representative must not be contingent on outcome.

      1.  It is unlawful for any person to represent an employee before a hearing officer, or in any negotiations, settlements, hearings or other meetings with an insurer concerning the employee’s claim or possible claim, unless the person is:

      (a) Employed by the employee’s labor organization and is not an independent contractor;

      (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 the employer 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; 2013, 420)

      NRS 616C.330  Date, time and place for hearing; evaluation of injured employee; powers and duties of hearing officer; issuance of decision; procedure for obtaining stay of decision.

      1.  The hearing officer shall:

      (a) Except as otherwise provided in subsection 2 of NRS 616C.315, within 5 days after receiving a request for a hearing, set the hearing for a date and time within 30 days after his or her receipt of the request at a place in Carson City, Nevada, or Las Vegas, Nevada, or upon agreement of one or more of the parties to pay all additional costs directly related to an alternative location, at any other place of convenience to the parties, at the discretion of the hearing officer;

      (b) Give notice by mail or by personal service 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 order an independent medical examination, which must not involve treatment, and refer the employee to a physician or chiropractor of his or her choice who has demonstrated special competence to treat the particular medical condition of the employee, whether or not the physician or chiropractor is on the insurer’s panel of providers of health care. If the medical question concerns the rating of a permanent disability, the hearing officer may refer the employee to a rating physician or 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.  The hearing officer may consider the opinion of an examining physician or chiropractor, in addition to the opinion of an authorized treating physician or chiropractor, in determining the compensation payable to the injured employee.

      5.  If an injured employee has requested payment for the cost of obtaining a second determination of his or her percentage of disability pursuant to NRS 616C.100, the hearing officer shall decide whether the determination of the higher percentage of disability made pursuant to NRS 616C.100 is appropriate and, if so, may order the insurer to pay to the employee an amount equal to the maximum allowable fee established by the Administrator pursuant to NRS 616C.260 for the type of service performed, or the usual fee of that physician or chiropractor for such service, whichever is less.

      6.  The hearing officer shall order an insurer, organization for managed care or employer who provides accident benefits for injured employees pursuant to NRS 616C.265 to pay to the appropriate person the charges of a provider of health care if the conditions of NRS 616C.138 are satisfied.

      7.  The hearing officer may allow or forbid the presence of a court reporter and the use of a tape recorder in a hearing.

      8.  The hearing officer shall render his or her decision within 15 days after:

      (a) The hearing; or

      (b) The hearing officer receives a copy of the report from the medical examination the hearing officer requested.

      9.  The hearing officer shall render a decision in the most efficient format developed by the Chief of the Hearings Division of the Department of Administration.

      10.  The hearing officer shall give notice of the decision to each party by mail. The hearing officer shall include with the notice of the decision the necessary forms for appealing from the decision.

      11.  Except as otherwise provided in NRS 616C.380, the decision of the hearing officer is not stayed if an appeal from that decision is taken unless an application for a stay is submitted by a party. If such an application is submitted, the decision is automatically stayed until a determination is made on the application. A determination on the application must be made within 30 days after the filing of the application. If, after reviewing the application, a stay is not granted by the hearing officer or an appeals officer, the decision must be complied with 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; 2007, 3352; 2009, 3033)

      NRS 616C.335  Award of interest.  If a contested claim for compensation is decided in favor of the claimant, he or she is entitled to an award of interest at the rate of 9 percent on the amount of compensation due the claimant 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)

      NRS 616C.340  Appointment, term, qualifications and salary of appeals officers and special appeals officers; conflicts of interest; finality of decision by appeals officer.

      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 or her appointment and until the successor of the appeals officer 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 or she has a personal interest or a conflict of interest, directly or indirectly, in any case which is before him or her, the appeals officer shall disqualify himself or herself 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 the special appeals officer 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 decision on 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; 2007, 3353)

      NRS 616C.345  Notice of appeal; notice of contested claim; prerequisites to scheduling of hearing on appeal; effect of appeal on enforcement of decision of hearing officer; setting of date, time and place for hearing on appeal; continuances.

      1.  Any party aggrieved by a decision of the hearing officer relating to a claim for compensation may appeal from the decision by, except as otherwise provided in subsections 9 and 10, filing a notice of appeal with an appeals officer within 30 days after the date of the decision.

      2.  A claimant aggrieved by a written determination of the denial of a claim, in whole or in part, by an insurer, or the failure of an insurer to respond in writing within 30 days to a written request of the claimant mailed to the insurer, concerning a claim arising from the provisions of NRS 617.453, 617.455, 617.457, 617.485 or 617.487 may file a notice of a contested claim with an appeals officer. The notice must include the information required pursuant to subsection 3 and, except as otherwise provided in subsections 9 and 11, 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 in writing to a written request for a determination within 30 days after receipt of such a request shall be deemed by the appeals officer to be a denial of the request. The insurer shall provide, without cost, the forms necessary to file a notice of a contested claim to any person who requests them.

      3.  A hearing must not be scheduled until the following information is provided to the appeals officer:

      (a) The name of:

             (1) The claimant;

             (2) The employer; and

             (3) The insurer or third-party administrator;

      (b) The number of the claim; and

      (c) If applicable, a copy of the letter of determination being appealed or, if such a copy is unavailable, the date of the determination and the issues stated in the determination.

      4.  If a dispute is required to be 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, except as otherwise provided in subsections 9 and 10, file a notice of appeal within 70 days after the date on which the final determination was mailed to the employee, or the dependent of the employee, or the unanswered request for resolution was submitted. Failure to render a written determination within 30 days after receipt of such a request shall be deemed by the appeals officer to be a denial of the request.

      5.  Except as otherwise provided in NRS 616C.380, the filing of a notice of appeal does not automatically stay the enforcement of the decision of a hearing officer or a determination rendered pursuant to NRS 616C.305. The appeals officer may order a stay, when appropriate, upon the application of a party. If such an application is submitted, the decision is automatically stayed until a determination is made concerning the application. A determination on the application must be made within 30 days after the filing of the application. If a stay is not granted by the officer after reviewing the application, the decision must be complied with within 10 days after the date of the refusal to grant a stay.

      6.  Except as otherwise provided in subsections 3 and 7, within 10 days after receiving a notice of appeal pursuant to this section or NRS 616C.220, 616D.140 or 617.401, or within 10 days after receiving a notice of a contested claim pursuant to subsection 7 of NRS 616C.315, the appeals officer shall:

      (a) Schedule a hearing on the merits of the appeal or contested claim for a date and time within 90 days after receipt of the notice at a place in Carson City, Nevada, or Las Vegas, Nevada, or upon agreement of one or more of the parties to pay all additional costs directly related to an alternative location, at any other 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.

      7.  Except as otherwise provided in subsection 12, 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.

      8.  An appeal or contested claim may be continued upon written stipulation of all parties, or upon good cause shown.

      9.  The period specified in subsection 1, 2 or 4 within which a notice of appeal or a notice of a contested claim must be filed may be extended for an additional 90 days if the person aggrieved shows by a preponderance of the evidence that the person was diagnosed with a terminal illness or was informed of the death or diagnosis of a terminal illness of the person’s spouse, parent or child.

      10.  Failure to file a notice of appeal within the period specified in subsection 1 or 4 may be excused if the party aggrieved shows by a preponderance of the evidence that he or she did not receive the notice of the determination and the forms necessary to appeal the determination. The claimant, employer or insurer shall notify the hearing officer of a change of address.

      11.  Failure to file a notice of a contested claim within the period specified in subsection 2 may be excused if the claimant shows by a preponderance of the evidence that he or she did not receive the notice of the determination and the forms necessary to file the notice. The claimant or employer shall notify the insurer of a change of address.

      12.  Within 10 days after receiving a notice of a contested claim pursuant to subsection 2, the appeals officer shall:

      (a) Schedule a hearing on the merits of the contested claim for a date and time within 60 days after his or her receipt of the notice at a place in Carson City, Nevada, or Las Vegas, Nevada, or upon agreement of one or more of the parties to pay all additional costs directly related to an alternative location, at any other place of convenience to the parties, at the discretion of the appeals officer; and

      (b) Give notice by mail or by personal service to all parties to the matter and their attorneys or agents within 10 days after scheduling the hearing.

Ê The scheduled date must allow sufficient time for full disclosure, exchange and examination of medical and other relevant information. A party may not introduce information at the hearing which was not previously disclosed to the other parties unless all parties agree to the introduction.

      (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; 2007, 3354; 2009, 1284)

      NRS 616C.350  Testimony of physician or chiropractor before appeals officer; privileged communications.

      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 or her 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)

      NRS 616C.355  Use of affidavits or declarations as evidence at hearing; notice to opposing party; waiver of right to cross-examine affiant or declarant; effect of waiver.  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 the party proposes to introduce into evidence and notice to the effect that unless the opposing party, within 7 days after the mailing or delivery of such affidavit or declaration, mails or delivers to the proponent a request to cross-examine the affiant or declarant, the opposing party’s right to cross-examine the affiant or declarant is waived and the affidavit or declaration, if introduced into evidence, will have the same effect as if the affiant or declarant had 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)

      NRS 616C.360  Record of hearing before appeals officer; rules of evidence; evaluation of injured employee; submission to independent review organization; powers and duties of appeals officer; transcripts; issuance of decision.

      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 or her 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) Order an independent medical examination and refer the employee to a physician or chiropractor of his or her choice who has demonstrated special competence to treat the particular medical condition of the employee, whether or not the physician or chiropractor is on the insurer’s panel of providers of health care. 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 independent review organization, submit the matter to an independent review organization in accordance with NRS 616C.363 and any regulations adopted by the Commissioner.

      4.  The appeals officer may consider the opinion of an examining physician or chiropractor, in addition to the opinion of an authorized treating physician or chiropractor, in determining the compensation payable to the injured employee.

      5.  If an injured employee has requested payment for the cost of obtaining a second determination of his or her percentage of disability pursuant to NRS 616C.100, the 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.

      6.  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.

      7.  Any party to the appeal or contested case 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.

      8.  Except as otherwise provided in subsection 9, the appeals officer shall render a 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.

      9.  The appeals officer shall render a decision on a contested claim submitted pursuant to subsection 2 of NRS 616C.345 within 15 days after:

      (a) The date of the hearing; or

      (b) If the appeals officer orders an independent medical examination, the date the appeals officer receives the report of the examination,

Ê unless both parties to the contested claim agree to a later date.

      10.  The appeals officer may affirm, modify or reverse any decision made by a hearing officer and issue any necessary and proper order to give effect to his or her 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; 2007, 3355; 2009, 1286, 3035; 2011, 3422)

      NRS 616C.363  External review: Duties of independent review organization; contents and submission of decision by organization; costs; regulations.

      1.  Not later than 5 business days after the date that an independent review organization receives a request for an external review, the independent review organization shall:

      (a) Review the documents and materials submitted for the external review; and

      (b) Notify the injured employee, his or her employer and the insurer whether the independent review organization needs any additional information to conduct the external review.

      2.  The independent 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 independent 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 independent review organization.

      4.  In its decision, the independent review organization shall specify the reasons for its decision. The independent 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 independent 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 independent review organization before a request for external review may be submitted;

      (b) A party may not be ordered to submit a matter to an independent review organization; and

      (c) The findings and decisions of an independent review organization are not binding.

      (Added to NRS by 2003, 2332; A 2011, 3423)

      NRS 616C.365  Reimbursement of employee’s expenses incurred and wages lost as result of hearing requested by employer or insurer; regulations.

      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) The employee’s actual expenses necessarily incurred for travel to and from the hearing, if the employee is required to travel more than 20 miles one way from his or her residence or place of employment to the hearing; and

      (b) Any regular wages lost as a result of his or her 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)

      NRS 616C.370  Judicial review.

      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)

      NRS 616C.375  Stay of decision of appeals officer.  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)

      NRS 616C.380  Payment pending appeal when decision not stayed; effect of final resolution of claim.

      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)

      NRS 616C.385  Costs and attorney’s fees for frivolous petitions for judicial review.  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)

      NRS 616C.390  Reopening claim: General requirements and procedure; limitations; applicability.  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, the employee is not entitled to vocational rehabilitation services or benefits for a temporary total disability if, before the claim was reopened, the employee:

      (a) Retired; or

      (b) Otherwise voluntarily removed himself or herself 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)

      NRS 616C.392  Reopening claim: Circumstances under which insurer is required to reopen claim for permanent partial disability.

      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

      NRS 616C.400  Minimum duration of incapacity.

      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)

      NRS 616C.405  Limitations on benefits received by employee.  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 the employee 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)

      NRS 616C.408  Restrictive endorsements on checks issued by insurers.

      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)

      NRS 616C.409  Direct deposit of compensation.

      1.  Each employee or dependent of an employee who receives compensation pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS for a permanent total disability, death or a permanent partial disability that was not paid in a lump sum pursuant to NRS 616C.495 may submit to the insurer or third-party administrator who pays the compensation a written notice directing the insurer or third-party administrator to deposit the compensation directly into the account of the employee or dependent specified by the employee or dependent in the written notice.

      2.  If an insurer or third-party administrator receives a written notice from an employee or dependent of an employee pursuant to subsection 1, the insurer or third-party administrator shall, in lieu of issuing a check, deposit the compensation paid by the insurer or third-party administrator directly into the account specified by the employee or dependent in the written notice.

      (Added to NRS by 2007, 399)

      NRS 616C.410  Prohibition of settlements paid in lump sum; exceptions.  Except as otherwise provided by NRS 616C.380, 616C.427, 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; 2007, 3356)

      NRS 616C.412  Purchase of annuity by insurer to ensure payment of claim; adoption of regulations by Commissioner.

      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)

      NRS 616C.415  Written explanation of alternative settlements to be given to employee or dependents.

      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 or her selection in writing to the insurer.

      (Added to NRS by 1971, 770; A 1981, 1497; 1991, 2426)—(Substituted in revision for NRS 616.623)

      NRS 616C.420  Method of determining average monthly wage.  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)

      NRS 616C.425  Date of determination of amount of compensation and benefits.  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 or her 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)

      NRS 616C.427  Challenge to determination of average monthly wage; remedy for incorrect average monthly wage.

      1.  Notwithstanding the provisions of subsection 3 of NRS 616C.315 and except as otherwise provided in this section, if an injured employee is receiving compensation based on a calculation of the average monthly wage of the injured employee as determined pursuant to the regulations adopted by the Administrator pursuant to NRS 616C.420, the injured employee or the employer may request a hearing before a hearing officer pursuant to the provisions of NRS 616C.315 to 616C.385, inclusive, asking for a recalculation of the average monthly wage of the injured employee.

      2.  The injured employee is entitled to have his or her average monthly wage recalculated if the injured employee proves by a preponderance of the evidence that the insurer calculated the average monthly wage improperly or incorrectly as a result of:

      (a) The use of any improper or incorrect information or methodology;

      (b) The failure to use any proper or correct information or methodology;

      (c) Any error of law or fact; or

      (d) Any other error, omission, neglect or wrongful act.

      3.  If the injured employee proves that the insurer calculated his or her average monthly wage improperly or incorrectly, resulting in an underpayment of compensation:

      (a) The insurer shall:

             (1) Increase the injured employee’s future compensation based on the correct average monthly wage; and

             (2) Pay the injured employee a lump sum in an amount equal to the underpayment of compensation for the period during which the insurer was using the incorrect average monthly wage; and

      (b) The remedy provided in paragraph (a) is the sole remedy for the underpayment and the insurer is not subject to the imposition of any fine or benefit penalty therefor.

      4.  If the hearing officer determines that the calculation of the average monthly wage resulted in an overpayment of compensation, the insurer may require the injured employee to repay to the insurer an amount equal to the overpayment received by the injured employee during any one 30-day period.

      5.  The average monthly wage of an injured employee may not be challenged by the insurer, the employer or the injured employee after the date on which any portion of an award for permanent partial disability is paid or the claim closes, whichever occurs first.

      6.  The provisions of this section do not apply if the issue of the average monthly wage of the injured employee was previously adjudicated to a final decision in:

      (a) A hearing before a hearing officer or appeals officer pursuant to the provisions of NRS 616C.315 to 616C.385, inclusive; or

      (b) Any proceedings for judicial review.

      (Added to NRS by 2007, 3342)

Permanent Total Disability

      NRS 616C.435  Injuries deemed total and permanent.

      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)

      NRS 616C.440  Amount and duration of compensation; limitations; effect of previous award of compensation.

      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 or her 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 or her 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 or her dependents are entitled to receive those benefits when the injured employee is released from incarceration if the injured employee 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)

      NRS 616C.445  Recipient of compensation to report annual earnings; payments suspended if report not made.  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 the former employee’s 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)

      NRS 616C.447  Insurer required to make certain accountings to injured employee who is entitled to compensation for permanent total disability; additional accountings may be requested by injured employee.

      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)

      NRS 616C.450  Compensation to injured employee or dependents of injured employee for permanent total disability or death benefit if injury or occupational disease occurred before July 1, 1980.

      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 or her 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)

      NRS 616C.453  Additional annual payment to certain claimants and dependents of claimants who are entitled to receive compensation for permanent total disability; adoption of regulations to determine amount of payment.

      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. Except as otherwise provided in subsection 5, 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.  Except as otherwise provided in subsection 5, 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.

      5.  The Administrator may make a payment from the Account to a claimant or a dependent of a claimant that would have been payable in a prior year pursuant to subsection 3 if the Administrator determines that the claimant or dependent was entitled to the payment pursuant to subsection 1.

      (Added to NRS by 2005, 1316; A 2007, 3356)

      NRS 616C.455  Increase in benefits for permanent total disability incurred before April 9, 1971.

      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)

      NRS 616C.460  Additional increase in benefits for permanent total disability incurred before July 1, 1973.  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)

      NRS 616C.465  Increase in benefits for permanent total disability incurred on or after April 9, 1971, or for claimant or dependent not entitled to benefits for disability from federal social security system.

      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)

      NRS 616C.470  Increase in benefits for permanent total disability if claimant is entitled to benefits for disability from federal social security system.

      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 or her 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 the claimant 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)

      NRS 616C.473  Annual increase in benefits for permanent total disability incurred on or after January 1, 2004.

      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

      NRS 616C.475  Amount and duration of compensation; limitations; requirements for certification of disability; offer of light-duty employment.

      1.  Except as otherwise provided in this section, NRS 616C.175 and 616C.390, every employee in the employ of an employer, within the provisions of chapters 616A to 616D, inclusive, of NRS, who is injured by accident arising out of and in the course of employment, or his or her dependents, is entitled to receive for the period of temporary total disability, 66 2/3 percent of the average monthly wage.

      2.  Except as otherwise provided in NRS 616B.028 and 616B.029, an injured employee or his or her dependents are not entitled to accrue or be paid any benefits for a temporary total disability during the time the injured employee is incarcerated. The injured employee or his or her dependents are entitled to receive such benefits when the injured employee is released from incarceration if the injured employee is 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 or 4 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 the employee’s accident may offer temporary, light-duty employment to the employee. If the employer makes such an offer, the employer shall confirm the offer in writing within 10 days after making the offer. The making, acceptance or rejection of an offer of temporary, light-duty employment pursuant to this subsection does not affect the eligibility of the employee to receive vocational rehabilitation services, including compensation, and does not exempt the employer from complying with NRS 616C.545 to 616C.575, inclusive, and 616C.590 or the regulations adopted by the Division governing vocational rehabilitation services. Any offer of temporary, light-duty employment made by the employer must specify a position that:

      (a) Is substantially similar to the employee’s position at the time of his or her injury in relation to the location of the employment and the hours the employee is required to work;

      (b) Provides a gross wage that is:

             (1) If the position is in the same classification of employment, equal to the gross wage the employee was earning at the time of his or her injury; or

             (2) If the position is not in the same classification of employment, substantially similar to the gross wage the employee was earning at the time of his or her injury; and

      (c) Has the same employment benefits as the position of the employee at the time of his or her injury.

      [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; 2009, 1287)

      NRS 616C.477  Compensation for lost wages incurred by employee who receives medical treatment after returning to work; prohibition against employer requiring employee to use personal leave for such treatment.

      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 or her injury, qualified for benefits for a temporary total disability pursuant to NRS 616C.475 and who receives medical treatment for that injury after the injured employee returns to work is entitled to compensation pursuant to this subsection for each hour the injured employee is absent from the place of employment of the responsible employer to receive such medical treatment if the injured employee 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 or her regular hourly rate of pay by his or her employer for each hour the injured employee 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 the injured employee’s absence from the place of employment to receive medical treatment for the injury after the injured employee returns to work. The provisions of this subsection apply whether the injured employee is being paid compensation pursuant to subsection 1 or the injured employee’s 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)

      NRS 616C.480  Reduction of benefits for previous injury causing permanent partial disability prohibited.  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 or her 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

      NRS 616C.485  Permanent partial disability: Loss of or permanent damage to teeth.  The Administrator shall adopt, by regulation, a schedule which, in the judgment of the Administrator, 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)

      NRS 616C.490  Permanent partial disability: Compensation.

      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 person” 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. Except in the case of claims accepted pursuant to NRS 616C.180, no factors other than the degree of physical impairment of the whole person 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 or her 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 the employee is entitled pursuant to this section; or

      (b) That the employee is not entitled to benefits for permanent partial disability.

      7.  Each 1 percent of impairment of the whole person 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; 2009, 3036)

      NRS 616C.495  Permanent partial disability: Payments in lump sum.

      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 or her 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 or her 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 or her 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 or her 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 or her 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 or her payment for a permanent partial disability in a lump sum pursuant to subsection 1, all of the claimant’s benefits for compensation terminate. The claimant’s acceptance of that payment constitutes a final settlement of all factual and legal issues in the case. By so accepting the claimant waives all of his or her rights regarding the claim, including the right to appeal from the closure of the case or the percentage of his or her disability, except:

      (a) The right of the claimant to:

             (1) Reopen his or her claim in accordance with the provisions of NRS 616C.390; or

             (2) Have his or her claim considered by his or her insurer pursuant to NRS 616C.392;

      (b) Any counseling, training or other rehabilitative services provided by the insurer; and

      (c) The right of the claimant to receive a benefit penalty in accordance with NRS 616D.120.

Ê The claimant, when he or she demands payment in a lump sum, must be provided with a written notice which prominently displays a statement describing the effects of accepting payment in a lump sum of an entire permanent partial disability award, any portion of such an award or any uncontested portion of such an award, and that the claimant has 20 days after the mailing or personal delivery of the notice within which to retract or reaffirm the demand, before payment may be made and the claimant’s 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 or her permanent partial disability before electing to receive 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 the claimant would if he or she receives installment payments, the claimant 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; 2007, 3357)

      NRS 616C.500  Temporary partial disability: Compensation.

      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 or her 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 or her 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 the injured employee 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

      NRS 616C.505  Amount and duration of compensation.  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 $10,000, plus the cost of transporting the remains of the deceased employee. 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.  Except as otherwise provided in subsection 3, to the surviving spouse of the deceased employee, 66 2/3 percent of the average monthly wage is payable until the death of the surviving spouse.

      3.  If there is a surviving spouse and any surviving children of the deceased employee who are not the children of the surviving spouse, the compensation otherwise payable pursuant to subsection 2 must be paid as follows until the entitlement of all children of the deceased employee to receive compensation pursuant to this subsection ceases:

      (a) To the surviving spouse, 50 percent of the death benefit is payable until the death of the surviving spouse; and

      (b) To each child of the deceased employee, regardless of whether the child is the child of the surviving spouse, the child’s proportionate share of 50 percent of the death benefit and, except as otherwise provided in subsection 11, if the child has a guardian, the compensation the child is entitled to receive may be paid to the guardian.

      4.  In the event of the subsequent death of the surviving spouse:

      (a) Each surviving child of the deceased employee, in addition to any amount the child may be entitled to pursuant to subsection 3, 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.

      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 or her proportionate share of 66 2/3 percent of the average monthly wage for the support of the child.

      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 the death of the deceased employee, 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 the death of the deceased employee, 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 the death of the deceased employee, his or her 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 the earnings of the deceased employee for support at the time of the injury causing his or her 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 or her 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 the dependent, funeral expenses are payable in an amount not to exceed $10,000.

      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 or her proportionate share of compensation pursuant to this section ceases when the child dies, marries or reaches the age of 18 years. A child is entitled to continue to receive compensation pursuant to this section if the child is:

      (a) Over 18 years of age and incapable of supporting himself or herself, until such time as the child becomes capable of supporting himself or herself; or

      (b) Over 18 years of age and enrolled as a full-time student in an accredited vocational or educational institution, until the child 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; 2007, 679, 3358; 2009, 3037, 3073)

      NRS 616C.510  Increased death benefits if injury or disablement occurred before July 1, 1973.

      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)

      NRS 616C.515  Additional increase in death benefits if injury or disablement occurred before July 1, 1973.  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)

      NRS 616C.520  Increased death benefits if injury or disablement occurred on or after July 1, 1973.

      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

      NRS 616C.530  Priorities for returning injured employee to work.  An insurer shall adhere to the following priorities in returning an injured employee to work:

      1.  Return the injured employee to the job the injured employee had before his or her injury.

      2.  Return the injured employee to a job with the employer the injured employee worked for before his or her accident that accommodates any limitation imposed by the injury.

      3.  Return the injured employee to employment with another employer in a job that uses the injured employee’s existing skills.

      4.  Provide training for the injured employee while the injured employee 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)

      NRS 616C.540  Supervision, ratio and review of uncertified counselors; knowledge of labor market required.  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)

      NRS 616C.542  Prohibiting vocational rehabilitation counselor employed by entity administering injured employee’s case from providing services to injured employee without provision of certain written disclosures; right of injured employee to be assigned alternate counselor.

      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 or her 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)

      NRS 616C.543  Prohibited acts of vocational rehabilitation counselor.  A vocational rehabilitation counselor shall not:

      1.  Offer payment of compensation in a lump sum in lieu of the provision of vocational rehabilitation services to an injured employee:

      (a) Without providing written notice of the offer to the attorney for the injured employee; or

      (b) If the injured employee is not represented by an attorney, without providing a written notice to the employee which satisfies the requirements of the notice required by paragraph (c) of subsection 3 of NRS 616C.595;

      2.  Offer any monetary payment to an injured employee in an amount that is less than the amount authorized by the insurer;

      3.  Make any false statement or implication that an injured employee must make a decision regarding vocational rehabilitation within a certain period of time;

      4.  Advise an insured or claimant not to seek legal counsel; or

      5.  Provide legal advice to a claimant.

      (Added to NRS by 2007, 3343)

      NRS 616C.545  Duty of insurer to determine physical limitations on injured employee’s ability to work.  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 or her 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)

      NRS 616C.547  General duties of vocational rehabilitation counselor.

      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)

      NRS 616C.550  Written assessment of injured employee.

      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 the employee held at the time that he or she 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 the employee held at the time of his or her injury or to any other position. The treating physician or chiropractor shall determine whether an employee may return to the position that the employee held at the time of his or her 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 the insurer’s 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 or her 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)

      NRS 616C.555  Plan for program of vocational rehabilitation.

      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 the employee was earning at the time of his or her injury. An injured employee must not receive job placement assistance for more than 6 months after the date on which the injured employee was notified that he or she is eligible only for job placement assistance because:

      (a) The injured employee was physically capable of returning to work; or

      (b) It was determined that the injured employee 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 the ability of the injured employee 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 the employee 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 or her injury, may authorize a third program for the injured employee. If such an employer has terminated operations, the employer’s 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)

      NRS 616C.560  Extension of program for vocational rehabilitation.

      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 the insurer’s sole discretion; or

      (b) In accordance with this section if:

             (1) The injured employee makes a written request to extend the program not later than 30 days after the program has been completed; 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 the injured employee 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 the injured employee 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; 2007, 3360)

      NRS 616C.570  On-the-job training as component of plan for program of vocational rehabilitation.

      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 or her 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 or her successful completion of the training, obtains employment which requires the skills obtained by him or her 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)

      NRS 616C.575  Payment of vocational rehabilitation maintenance.

      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 the injured employee’s 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 the injured employee 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)

      NRS 616C.580  Provision of services outside of State; limited lump-sum payment in lieu of services.

      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 or her permanent residence was outside of this State,

Ê may receive vocational rehabilitation services at a location within 50 miles from his or her 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 the injured employee is entitled pursuant to NRS 616C.545 to 616C.575, inclusive, and 616C.590 if the injured employee relocates to:

      (a) This State; or

      (b) A location within 50 miles from any border of this State,

Ê at his or her 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 the residence of the injured employee 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.

      6.  An injured employee may receive vocational rehabilitation services in any state that borders this State if the injured employee demonstrates that the services are available in a more cost-effective manner than are available in this State. Any vocational rehabilitation services provided pursuant to this subsection must be monitored by a vocational rehabilitation counselor in this State.

      (Added to NRS by 1993, 668; A 1999, 1795; 2001, 1902; 2005, 209; 2007, 3361)

      NRS 616C.585  Limit on goods and services which may be provided; exceptions.

      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 or her employer during the course of his or her 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 the insurer of the injured employee 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)

      NRS 616C.590  Eligibility for services; effect of incarceration; effect of refusing services offered by insurer; effect of inability of insurer to locate injured employee.

      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 the employee held at the time of his or her 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 injury; and

             (3) Has the same employment benefits as the position of the employee at the time of his or her 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 or her 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 or she shall specify in writing:

      (a) The medically objective findings upon which his or her 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 the employee held at the time of his or her injury is no longer available.

      6.  An injured employee or the dependents of the injured employee 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 the injured employee 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 the injured employee is incarcerated.

      8.  If an insurer cannot locate an injured employee for whom it has ordered vocational rehabilitation services, the insurer may close his or her 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 or her claim has been closed does not automatically reinstate his or her eligibility for vocational rehabilitation benefits. If the employee wishes to re-establish his or her eligibility for those benefits, the injured employee must file a written application with the insurer to reinstate the 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)

      NRS 616C.595  Agreements for payment of compensation in lump sum in lieu of provision of vocational rehabilitation services.

      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 the right of the injured employee to receive vocational rehabilitation services under the injured employee’s claim. Except as otherwise required by federal law, an injured employee shall not receive vocational rehabilitation services from any state agency after the injured employee 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 the injured employee 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 the right of the injured employee to receive such services.

      4.  Except as otherwise provided in NRS 616C.580, any payment of compensation in a lump sum in lieu of the provision of vocational rehabilitation services must not be less than 40 percent of the maximum amount of vocational rehabilitation maintenance due to the injured employee pursuant to NRS 616C.555.

      5.  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; 2007, 3362)

      NRS 616C.597  Response to request for payment of compensation in lump sum in lieu of provision of vocational rehabilitation services.

      1.  Except as otherwise provided in subsection 2, an insurer shall, within 30 days after receiving a written request from an injured employee for payment of compensation in a lump sum in lieu of the provision of vocational rehabilitation services, respond in writing to the request and, if the insurer agrees to the request, include in the response:

      (a) The amount of the lump sum that the insurer is offering to pay;

      (b) A statement that the injured employee has 30 days after the date of the written response to accept or reject the lump-sum offer; and

      (c) A statement indicating that, if the injured employee rejects the lump-sum offer, the injured employee must continue working with his or her vocational rehabilitation counselor in accordance with the provisions of this chapter and the regulations adopted pursuant thereto.

      2.  An insurer need only respond to a written request from an injured employee for payment of compensation in a lump sum in lieu of the provision of vocational rehabilitation services if the injured employee is eligible for vocational rehabilitation services.

      (Added to NRS by 2007, 3344)

      NRS 616C.600  Orders for self-employment or payment of compensation in lump sum for vocational rehabilitation prohibited; agreements concerning self-employment authorized.

      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)

CATASTROPHIC INJURIES

      NRS 616C.700  Duties of insurer who accepts a claim for catastrophic injury; life care plan.

      1.  Notwithstanding any other provision of this chapter, if an insurer accepts a claim for a catastrophic injury, the insurer shall:

      (a) As soon as reasonably practicable after the date of acceptance of the claim, assign the claim to a qualified adjuster, nurse and vocational rehabilitation counselor;

      (b) Within 120 days after the date on which the treating physician determines that the condition of the injured employee has stabilized and that the injured employee requires a life care plan, develop a life care plan in consultation with the adjuster, nurse and vocational rehabilitation counselor assigned to the claim pursuant to paragraph (a); and

      (c) Pay benefits and provide the proper medical services to the injured employee during the entire period of the development and implementation of the life care plan.

      2.  A life care plan which is developed pursuant to subsection 1 must ensure the prompt, efficient and proper provision of medical services to the injured employee.

      3.  In developing a life care plan for an injured employee, the insurer, in consultation with the adjuster, nurse and vocational rehabilitation counselor assigned to the claim pursuant to paragraph (a) of subsection 1, shall assess the following:

      (a) The number of home or hospital visits determined to be necessary or appropriate by the registered nurse and vocational rehabilitation counselor;

      (b) The life expectancy of the injured employee;

      (c) The medical needs of the injured employee, including, without limitation:

             (1) Surgery;

             (2) Prescription medication;

             (3) Physical therapy; and

             (4) Maintenance therapy;

      (d) The effect, if any, of any preexisting medical condition; and

      (e) The potential of the injured employee for rehabilitation, taking into account:

             (1) The injured employee’s medical condition, age, educational level, work experience and motivation; and

             (2) Any other relevant factors.

      4.  A life care plan developed pursuant to paragraph (b) of subsection 1 must include, without limitation, a schedule for the adjuster, nurse and vocational rehabilitation counselor assigned to the claim pursuant to paragraph (a) of subsection 1 to meet or communicate with the injured employee, if practicable, and the treating physician to determine the need for, without limitation:

      (a) Special medical attention or treatment;

      (b) Psychological counseling or testing; and

      (c) Any medical device, including, without limitation:

             (1) A wheelchair;

             (2) A prosthesis; and

             (3) A specially equipped or designed motor vehicle.

      5.  A life care plan developed pursuant to paragraph (b) of subsection 1 must include a plan of action for treatment or vocational rehabilitation of the injured employee or consideration of the possible permanent total disability of the injured employee.

      6.  In addition to any claim determination affecting the rights of an injured employee under his or her claim, or responses to requests on behalf of the injured employee for specific action or information on the claim or any other contact that may occur, an insurer shall:

      (a) Schedule a personal meeting concerning the status of the claim to take place at least once per calendar month between the adjuster assigned to the claim pursuant to paragraph (a) of subsection 1 and the injured employee or a family member or designated representative of the injured employee; or

      (b) If a personal meeting described in paragraph (a) is not practicable, provide a written report concerning the status of the claim and soliciting requests and information at least once per calendar month to the injured employee or a family member or designated representative of the injured employee. The report must be mailed to the injured employee or a family member or designated representative of the injured employee by first-class mail.

      7.  Except as otherwise provided in this subsection, a life care plan developed pursuant to paragraph (b) of subsection 1 must be based on the condition of the injured employee at the time the life care plan is established. If there is a substantial or significant change in the condition or prognosis of the injured employee, the insurer shall amend the life care plan to reflect the change in the condition or prognosis of the injured employee.

      (Added to NRS by 2009, 2779; A 2011, 718)

      NRS 616C.703  Injured employee may request insurer to administer claim as for catastrophic injury; insurer to issue determination.

      1.  An injured employee may submit to an insurer a written request for a determination that his or her injury should be administered as a claim for a catastrophic injury.

      2.  If an employee submits a written request to an insurer pursuant to subsection 1, the insurer shall issue a written determination concerning the request not later than 30 days after receipt of the request.

      (Added to NRS by 2011, 718)

      NRS 616C.707  Insurer to designate claim as for catastrophic injury if injury later satisfies requirements for catastrophic injury.  An insurer that did not originally accept a claim as a claim for a catastrophic injury shall designate the claim as a claim for a catastrophic injury if at any time after the claim is accepted the injury satisfies the requirements for a catastrophic injury.

      (Added to NRS by 2011, 718)

      NRS 616C.710  Rescission or revision of determination of catastrophic injury.  An insurer that has accepted a claim for a catastrophic injury may thereafter rescind or revise its original determination that the injury is a catastrophic injury if:

      1.  Medical evidence supports the rescission or revision;

      2.  The injured employee is stable and ratable; or

      3.  Other circumstances warrant such a rescission or revision.

      (Added to NRS by 2009, 2779)

      NRS 616C.720  Requirements for adjuster who administers claim for catastrophic injury.  An adjuster who administers a claim for a catastrophic injury must:

      1.  Have at least 4 years of experience in adjusting workers’ compensation claims for lost time; or

      2.  Have at least 2 years of experience in adjusting workers’ compensation claims for lost time and work under the direct supervision of an adjuster who has at least 4 years of experience in adjusting such claims.

      (Added to NRS by 2009, 2779; A 2011, 720)