AB168_R2

Assembly Bill No. 168–Assemblymen Giunchigliani, Anderson, Parks, Goldwater, Gibbons, Arberry, Atkinson, Buckley, Claborn, Collins, Conklin, Horne, Leslie, Manendo and Williams

Joint Sponsor: Senator Carlton

CHAPTER..........

AN ACT relating to industrial insurance; prohibiting a self-insured employer, an association of self-insured public or private employers or a private carrier from entering into a contract with an organization for managed care under certain circumstances; increasing the period during which the Administrator of the Division of Industrial Relations of the Department of Business and Industry must cause an audit of certain insurers to be conducted; revising the requirements for determining the percentage of disability for certain injuries and occupational diseases; requiring an employer who offers temporary, light-duty employment to an injured employee to confirm the offer within a certain period under certain circumstances; providing that such an offer must specify a position that has the same employment benefits as the position of the employee at the time of his injury; requiring a person who wishes to contest a decision of the Administrator to impose an administrative fine to file a notice of appeal with an appeals officer; authorizing a person who is aggrieved by a written determination of the Administrator or the failure of the Administrator to respond to a written request to appeal the determination or failure to respond to an appeals officer under certain circumstances; and providing other matters properly relating thereto.

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. NRS 616A.070 is hereby amended to read as

follows:

616A.070 “Benefit penalty” means an additional amount of

money that is payable to a claimant if the Administrator has

determined that a violation of any of the provisions of paragraphs

(a) to [(d),] (e), inclusive, of subsection 1 of NRS 616D.120 has

occurred.

Sec. 2. Chapter 616B of NRS is hereby amended by adding

thereto the provisions set forth as sections 3 and 4 of this act.

Sec. 3. (Deleted by amendment.)

Sec. 4. 1. A self-insured employer, an association of self-

insured public or private employers or a private carrier shall not

enter into a contract with an organization for managed care

unless the organization’s proposed plan for providing medical and

health care services:

(a) Will provide all medical and health care services that may

be required for industrial injuries and occupational diseases that

are compensable under chapters 616A to 617, inclusive, of NRS in

a manner that ensures the availability and accessibility of

adequate treatment to injured employees;

(b) Provides to injured employees an adequate choice of

providers of health care who have contracted with the

organization to participate in the proposed plan; and

medical and health care services without affecting the quality of

any care provided to an injured employee.

2. The Division may adopt regulations to ensure the adequacy

of an insurer’s panel of providers of health care established

pursuant to subsection 1.

Sec. 5. NRS 616B.003 is hereby amended to read as follows:

616B.003 1. The Administrator shall cause to be conducted

at least every [3] 5 years an audit of all insurers who provide

benefits to injured employees pursuant to chapters 616A to 616D,

inclusive, or chapter 617 of NRS. The Administrator shall cause to

be conducted each year on a random basis additional partial audits

of any insurer who has a history of violations of the provisions of

chapters 616A to 616D, inclusive, or chapter 617 of NRS, or the

regulations adopted pursuant thereto, as determined by the

Administrator.

2. The Administrator shall require the use of standard auditing

procedures and shall establish a manual to describe the standard

auditing procedures. The manual must include:

(a) Specific audit objectives;

(b) Standards for documentation;

(d) Policies for the training of auditors;

(e) The format for the audit report; and

(f) Procedures for the presentation, distribution and retention of

the audit report.

3. The Commissioner and the Administrator shall establish a

procedure for sharing information between the Division of

Insurance of the Department of Business and Industry and the

Division concerning the qualifications of employers as self-insured

employers pursuant to NRS 616B.300 or as an association of self-

insured public or private employers pursuant to NRS 616B.353.

4. On or before March 1 of each year, the Administrator shall

make a report of each audit to the Legislature, if it is in session, or to

the Interim Finance Committee if the Legislature is not in session.

Sec. 6. NRS 616B.527 is hereby amended to read as follows:

616B.527 1. A self-insured employer, an association of self-

insured public or private employers or a private carrier may:

(a) [Enter] Except as otherwise provided in section 4 of this act,

enter into a contract or contracts with one or more organizations for

managed care to provide comprehensive medical and health care

services to employees for injuries and diseases that are compensable

pursuant to chapters 616A to 617, inclusive, of NRS.

(b) Enter into a contract or contracts with providers of health

care, including, without limitation, physicians who provide primary

care, specialists, pharmacies, physical therapists, radiologists,

nurses, diagnostic facilities, laboratories, hospitals and facilities that

provide treatment to outpatients, to provide medical and health care

services to employees for injuries and diseases that are compensable

pursuant to chapters 616A to 617, inclusive, of NRS.

services for their industrial injuries from those organizations and

persons with whom the self-insured employer, association or private

carrier has contracted pursuant to paragraphs (a) and (b), or as the

self-insured employer, association or private carrier otherwise

prescribes.

(d) Except as otherwise provided in subsection 3 of NRS

616C.090, require employees to obtain the approval of the self-

insured employer, association or private carrier before obtaining

medical and health care services for their industrial injuries from a

provider of health care who has not been previously approved by the

self-insured employer, association or private carrier.

2. An organization for managed care with whom a self-insured

employer, association of self-insured public or private employers or

a private carrier has contracted pursuant to this section shall comply

with the provisions of NRS 616B.528, 616B.5285 and 616B.529.

Sec. 7. NRS 616C.110 is hereby amended to read as follows:

616C.110 1. For the purposes of NRS 616B.557, 616B.578,

616B.587, 616C.490 and 617.459 [,] :

(a) Not later than August 1, 2003, the Division shall adopt

regulations incorporating the American Medical Association’s

Guides to the Evaluation of Permanent Impairment , 5th edition, by

reference . [and may amend those regulations from time to time as it

deems necessary. In adopting the] The regulations:

(1) Must become effective on October 1, 2003; and

(2) Must be applied to all examinations for a permanent

partial disability that are conducted on or after October 1, 2003,

regardless of the date of the injury, until regulations incorporating

the 6th edition by reference have become effective pursuant to

paragraph (b).

(b) Beginning with the 6th edition and continuing for each

edition thereafter, the Division shall adopt regulations

incorporating the most recent edition of the American Medical

Association’s Guides to the Evaluation of Permanent Impairment [,

the Division shall consider] by reference. The regulations:

(1) Must become effective not later than 18 months after

the most recent edition [most recently] is published by the

American Medical Association [.] ; and

(2) Must be applied to all examinations for a permanent

partial disability that are conducted on or after the effective date

of the regulations, regardless of the date of injury, until

regulations incorporating the next edition by reference have

become effective pursuant to this paragraph.

2. After adopting the regulations required pursuant to

subsection 1, the Division may amend those regulations as it

deems necessary, except that the amendments to those regulations:

(a) Must be consistent with the edition of the American

Medical Association’s Guides to the Evaluation of Permanent

Impairment most recently adopted by the Division;

(b) Must not incorporate any contradictory matter from any

other edition of the American Medical Association’s Guides to the

Evaluation of Permanent Impairment; and

physical impairment of the whole man in calculating the

entitlement to compensation.

3. If the edition of the American Medical Association’s

Guides to the Evaluation of Permanent Impairment most recently

adopted by the Division [contain] 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.

Sec. 8. NRS 616C.340 is hereby amended to read as follows:

616C.340 1. The Governor shall appoint one or more appeals

officers to conduct hearings [in contested claims for compensation

pursuant to NRS 616C.360.] and appeals as required pursuant to

chapters 616A to 617, inclusive, of NRS. Each appeals officer shall

hold office for 2 years [from] after the date of his appointment and

until his successor is appointed and has qualified. Each appeals

officer is entitled to receive an annual salary in an amount provided

by law and is in the unclassified service of the State.

2. Each appeals officer must be an attorney who has been

licensed to practice law before all the courts of this state for at least

2 years. Except as otherwise provided in NRS 7.065, an appeals

officer shall not engage in the private practice of law.

3. If an appeals officer determines that he has a personal

interest or a conflict of interest, directly or indirectly, in any case

which is before him, he shall disqualify himself from hearing the

case.

4. The Governor may appoint one or more special appeals

officers to conduct hearings [in contested claims for compensation

pursuant to NRS 616C.360.] and appeals as required pursuant to

chapters 616A to 617, inclusive, of NRS. The Governor shall not

appoint an attorney who represents persons in actions related to

claims for compensation to serve as a special appeals officer.

5. A special appeals officer appointed pursuant to subsection 4

is vested with the same powers as a regular appeals officer. A

special appeals officer may hear any case in which a regular appeals

officer has a conflict, or any case assigned to him by the Senior

Appeals Officer to assist with a backlog of cases. A special appeals

officer is entitled to be paid at an hourly rate, as determined by the

Department of Administration.

6. The decision of an appeals officer is the final and binding

administrative determination of a claim for compensation under

chapters 616A to 616D, inclusive, or chapter 617 of NRS, and the

whole record consists of all evidence taken at the hearing before the

appeals officer and any findings of fact and conclusions of law

based thereon.

Sec. 9. NRS 616C.345 is hereby amended to read as follows:

616C.345 1. Any party aggrieved by a decision of the

hearing officer relating to a claim for compensation may appeal

from the decision by filing a notice of appeal with an appeals officer

within 30 days after the date of the decision.

2. 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,

any party to the dispute may file a notice of appeal within 70 days

after the date on which the final determination was mailed to the

employee, or his dependent, or the unanswered request for

resolution was submitted. Failure to render a written determination

within 30 days after receipt of such a request shall be deemed by the

appeals officer to be a denial of the request.

3. 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.

4. Except as otherwise provided in this subsection, [the appeals

officer shall,] within 10 days after receiving a notice of appeal

pursuant to this section or NRS 616D.140, or within 10 days after

receiving a notice of a contested claim pursuant to subsection 5 of

NRS 616C.315, the appeals officer shall schedule a hearing on the

merits of the appeal or contested claim for a date and time within 90

days after his receipt of the notice and 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. 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,

may be submitted to the appeals officer only if all parties to the

appeal or contested claim agree to the request.

5. An appeal or contested claim may be continued upon written

stipulation of all parties, or upon good cause shown.

6. Failure to file a notice of appeal within the period specified

in subsection 1 or 2 may be excused if the party aggrieved shows by

a preponderance of the evidence that he did not receive the notice of

the determination and the forms necessary to appeal the

determination. The claimant, employer or insurer shall notify the

hearing officer of a change of address.

Sec. 10. NRS 616C.475 is hereby amended to read as follows:

616C.475 1. Except as otherwise provided in this section,

NRS 616C.175 and 616C.390, every employee in the employ of an

employer, within the provisions of chapters 616A to 616D,

inclusive, of NRS, who is injured by accident arising out of and in

the course of employment, or his dependents, is entitled to receive

for the period of temporary total disability, 66 2/3 percent of the

average monthly wage.

2. Except as otherwise provided in NRS 616B.028 and

616B.029, an injured employee or his dependents are not entitled to

accrue or be paid any benefits for a temporary total disability during

the time the injured employee is incarcerated. The injured employee

or his dependents are entitled to receive such benefits when the

injured employee is released from incarceration if he is certified as

temporarily totally disabled by a physician or chiropractor.

3. If a claim for the period of temporary total disability is

allowed, the first payment pursuant to this section must be issued by

the insurer within 14 working days after receipt of the initial

certification of disability and regularly thereafter.

4. Any increase in compensation and benefits effected by the

amendment of subsection 1 is not retroactive.

5. Payments for a temporary total disability must cease when:

(a) A physician or chiropractor determines that the employee is

physically capable of any gainful employment for which the

employee is suited, after giving consideration to the employee’s

education, training and experience;

(b) The employer offers the employee light-duty employment or

employment that is modified according to the limitations or

restrictions imposed by a physician or chiropractor pursuant to

subsection 7; or

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

authorized pursuant to NRS 616B.527 or appropriately chosen

pursuant to subsection 3 of NRS 616C.090.

8. If the certification of disability specifies that the physical

limitations or restrictions are temporary, the employer of the

employee at the time of his accident [is not required to comply] 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 . [if the employer offers

the employee temporary, light -duty employment.] Any offer of

temporary, light-duty employment made by the employer must

specify a position that:

(a) Is substantially similar to the employee’s position at the time

of his injury in relation to the location of the employment and the

hours he is required to work; [and]

(b) Provides a gross wage that is:

(1) If the position is in the same classification of

employment, equal to the gross wage the employee was earning at

the time of his injury; or

(2) If the position is not in the same classification of

employment, substantially similar to the gross wage the employee

was earning at the time of his injury[.] ; and

employee at the time of his injury.

Sec. 11. NRS 616C.495 is hereby amended to read as follows:

616C.495 1. Except as otherwise provided in NRS 616C.380,

an award for a permanent partial disability may be paid in a lump

sum under the following conditions:

(a) A claimant injured on or after July 1, 1973, and before

July 1, 1981, who incurs a disability that does not exceed 12 percent

may elect to receive his compensation in a lump sum. A claimant

injured on or after July 1, 1981, and before July 1, 1995, who incurs

a disability that does not exceed 25 percent may elect to receive his

compensation in a lump sum.

(b) The spouse, or in the absence of a spouse, any dependent

child of a deceased claimant injured on or after July 1, 1973, who is

not entitled to compensation in accordance with NRS 616C.505, is

entitled to a lump sum equal to the present value of the deceased

claimant’s undisbursed award for a permanent partial disability.

July 1, 1995, who incurs a disability that exceeds 25 percent may

elect to receive his compensation in a lump sum equal to the present

value of an award for a disability of 25 percent. If the claimant

elects to receive compensation pursuant to this paragraph, the

insurer shall pay in installments to the claimant that portion of the

claimant’s disability in excess of 25 percent.

(d) Any claimant injured on or after July 1, 1995, may elect to

receive his compensation in a lump sum in accordance with

regulations adopted by the Administrator and approved by the

Governor. The Administrator shall adopt regulations for

determining the eligibility of such a claimant to receive all or any

portion of his compensation in a lump sum. Such regulations may

include the manner in which an award for a permanent partial

disability may be paid to such a claimant in installments.

Notwithstanding the provisions of NRS 233B.070, any regulation

adopted pursuant to this paragraph does not become effective unless

it is first approved by the Governor.

2. If the claimant elects to receive his payment for a permanent

partial disability in a lump sum pursuant to subsection 1, all of his

benefits for compensation terminate. His acceptance of that payment

constitutes a final settlement of all factual and legal issues in the

case. By so accepting , he waives all of his rights regarding the

claim, including the right to appeal from the closure of the case or

the percentage of his disability, except:

(a) His right to reopen his claim according to the provisions of

NRS 616C.390; [and]

(b) Any counseling, training or other rehabilitative services

provided by the insurer [.] ; and

NRS 616D.120.

The claimant must be advised in writing of the provisions of this

subsection when he demands his payment in a lump sum, and has 20

days after the mailing or personal delivery of [this] the notice within

which to retract or reaffirm his demand, before payment may be

made and his election becomes final.

3. Any lump-sum payment which has been paid on a claim

incurred on or after July 1, 1973, must be supplemented if necessary

to conform to the provisions of this section.

4. Except as otherwise provided in this subsection, the total

lump-sum payment for disablement must not be less than one-half

the product of the average monthly wage multiplied by the

percentage of disability. If the claimant received compensation in

installment payments for his permanent partial disability before

electing to receive his payment for that disability in a lump sum, the

lump-sum payment must be calculated for the remaining payment of

compensation.

5. The lump sum payable must be equal to the present value of

the compensation awarded, less any advance payment or lump sum

previously paid. The present value must be calculated using monthly

payments in the amounts prescribed in subsection 7 of NRS

616C.490 and actuarial annuity tables adopted by the Division. The

tables must be reviewed annually by a consulting actuary.

6. If a claimant would receive more money by electing to

receive compensation in a lump sum than he would if he receives

installment payments, he may elect to receive the lump-sum

payment.

Sec. 12. NRS 616C.590 is hereby amended to read as follows:

616C.590 1. Except as otherwise provided in this section, an

injured employee is not eligible for vocational rehabilitation

services, unless:

(a) The treating physician or chiropractor approves the return of

the injured employee to work but imposes permanent restrictions

that prevent the injured employee from returning to the position that

he held at the time of his injury;

(b) The injured employee’s employer does not offer

employment that:

(1) The employee is eligible for considering the restrictions

imposed pursuant to paragraph (a); [and]

(2) Provides a gross wage that is equal to or greater than 80

percent of the gross wage that the employee was earning at the time

of his injury; and

(3) Has the same employment benefits as the position of the

employee at the time of his injury; and

employment with any other employer at a gross wage that is equal

to or greater than 80 percent of the gross wage that the employee

was earning at the time of his injury.

2. If the treating physician or chiropractor imposes permanent

restrictions on the injured employee for the purposes of paragraph

(a) of subsection 1, he shall specify in writing:

(a) The medically objective findings upon which his

determination is based; and

(b) A detailed description of the restrictions.

The treating physician or chiropractor shall deliver a copy of the

findings and the description of the restrictions to the insurer.

3. If there is a question as to whether the restrictions imposed

upon the injured employee are permanent, the employee may

receive vocational rehabilitation services until a final determination

concerning the duration of the restrictions is made.

4. Vocational rehabilitation services must cease as soon as the

injured employee is no longer eligible for the services pursuant to

subsection 1.

5. An injured employee is not entitled to vocational

rehabilitation services solely because the position that he held at the

time of his injury is no longer available.

6. An injured employee or his dependents are not entitled to

accrue or be paid any money for vocational rehabilitation services

during the time the injured employee is incarcerated.

7. Any injured employee eligible for compensation other than

accident benefits may not be paid those benefits if he refuses

counseling, training or other vocational rehabilitation services

offered by the insurer. Except as otherwise provided in NRS

616B.028 and 616B.029, an injured employee shall be deemed to

have refused counseling, training and other vocational rehabilitation

services while he is incarcerated.

8. If an insurer cannot locate an injured employee for whom it

has ordered vocational rehabilitation services, the insurer may close

his claim 21 days after the insurer determines that the employee

cannot be located. The insurer shall make a reasonable effort to

locate the employee.

9. The reappearance of the injured employee after his claim has

been closed does not automatically reinstate his eligibility for

vocational rehabilitation benefits. If the employee wishes to

reestablish his eligibility for [such] those benefits, he must file a

written application with the insurer to reinstate his claim. The

insurer shall reinstate the employee’s claim if good cause is shown

for the employee’s absence.

Sec. 13. Chapter 616D is hereby amended by adding thereto

a new section to read as follows:

1. If a person wishes to contest a decision of the

Administrator to impose an administrative fine pursuant to this

chapter or chapter 616A, 616B, 616C or 617 of NRS, he must file

a notice of appeal with an appeals officer in accordance with this

section. The notice of appeal must set forth the reasons the

proposed administrative fine should not be imposed.

2. A person who is aggrieved by a written determination of

the Administrator may appeal from the determination by filing a

request for a hearing before an appeals officer. The request must

be filed within 30 days after the date on which the notice of the

Administrator’s determination was mailed by the Administrator.

3. If a notice of appeal is not filed as required by this section,

the imposition of the administrative fine shall be deemed a final

order and is not subject to review by any court or agency.

4. An administrative fine imposed pursuant to this chapter or

chapter 616A, 616B, 616C or 617 of NRS must be paid to the

Division. If the violation for which the fine is levied was

committed by a person while acting within the course and scope of

his agency or employment, the fine must be paid by his principal

or employer. The fine may be recovered in a civil action brought

in the name of the Division in a court of competent jurisdiction in

the county in which the violation occurred or in which the person

against whom the fine is levied has his principal place of business.

Sec. 14. NRS 616D.120 is hereby amended to read as follows:

616D.120 1. Except as otherwise provided in this section, if

the Administrator determines that an insurer, organization for

managed care, health care provider, third-party administrator or

employer has:

(a) [Through fraud, coercion, duress or undue influence:

(1)] Induced a claimant to fail to report an accidental injury

or occupational disease;

[(2) Persuaded]

(b) Without justification, persuaded a claimant to [settle] :

(1) Settle for an amount which is less than reasonable;

[(3) Persuaded a claimant to settle]

(2) Settle for an amount which is less than reasonable while a

hearing or an appeal is pending; or

[(4) Persuaded a claimant to accept]

(3) Accept less than the compensation found to be due him

by a hearing officer, appeals officer, court of competent jurisdiction,

written settlement agreement, written stipulation or the Division

when carrying out its duties pursuant to chapters 616A to 617,

inclusive, of NRS;

[(b)] (c) Refused to pay or unreasonably delayed payment to a

claimant of compensation or other relief found to be due him by a

hearing officer, appeals officer, court of competent jurisdiction,

written settlement agreement, written stipulation or the Division

when carrying out its duties pursuant to chapters 616A to 616D,

inclusive, or chapter 617 of NRS, if the refusal or delay occurs:

(1) Later than 10 days after the date of the settlement

agreement or stipulation;

(2) Later than 30 days after the date of the decision of a

court, hearing officer, appeals officer or the Division, unless a stay

has been granted; or

(3) Later than 10 days after a stay of the decision of a court,

hearing officer, appeals officer or the Division has been lifted;

[(c)] (d) Refused to process a claim for compensation pursuant

to chapters 616A to 616D, inclusive, or chapter 617 of NRS;

[(d)] (e) Made it necessary for a claimant to initiate proceedings

pursuant to chapters 616A to 616D, inclusive, or chapter 617 of

NRS for compensation or other relief found to be due him by a

hearing officer, appeals officer, court of competent jurisdiction,

written settlement agreement, written stipulation or the Division

when carrying out its duties pursuant to chapters 616A to 616D,

inclusive, or chapter 617 of NRS;

[(e)] (f) Failed to comply with the Division’s regulations

covering the payment of an assessment relating to the funding of

costs of administration of chapters 616A to 617, inclusive, of NRS;

[(f)] (g) Failed to provide or unreasonably delayed payment to

an injured employee or reimbursement to an insurer pursuant to

NRS 616C.165; or

[(g)] (h) Intentionally failed to comply with any provision of, or

regulation adopted pursuant to, this chapter or chapter 616A, 616B,

616C or 617 of NRS,

the Administrator shall impose an administrative fine of $1,000 for

each initial violation, or a fine of $10,000 for a second or

subsequent violation.

2. Except as otherwise provided in chapters 616A to 616D,

inclusive, or chapter 617 of NRS, if the Administrator determines

that an insurer, organization for managed care, health care provider,

third-party administrator or employer has failed to comply with any

provision of this chapter or chapter 616A, 616B, 616C or 617 of

NRS, or any regulation adopted pursuant thereto, the Administrator

may take any of the following actions:

(a) Issue a notice of correction for:

(1) A minor violation, as defined by regulations adopted by

the Division; or

(2) A violation involving the payment of compensation in an

amount which is greater than that required by any provision of this

chapter or chapter 616A, 616B, 616C or 617 of NRS, or any

regulation adopted pursuant thereto.

The notice of correction must set forth with particularity the

violation committed and the manner in which the violation may be

corrected. The provisions of this section do not authorize the

Administrator to modify or negate in any manner a determination or

any portion of a determination made by a hearing officer, appeals

officer or court of competent jurisdiction or a provision contained in

a written settlement agreement or written stipulation.

(b) Impose an administrative fine for:

(1) A second or subsequent violation for which a notice of

correction has been issued pursuant to paragraph (a); or

(2) Any other violation of this chapter or chapter 616A,

616B, 616C or 617 of NRS, or any regulation adopted pursuant

thereto, for which a notice of correction may not be issued pursuant

to paragraph (a).

The fine imposed [may] must not be greater than $250 for an initial

violation, or more than $1,000 for any second or subsequent

violation.

Administrator within 30 days after the date of the order.

3. If the Administrator determines that a violation of any of the

provisions of paragraphs (a) to [(d),] (e), inclusive, of subsection 1

has occurred, the Administrator shall order the insurer, organization

for managed care, health care provider, third-party administrator or

employer to pay to the claimant a benefit penalty in an amount that

is not less than $5,000 and not greater than $25,000. To determine

the amount of the benefit penalty, the Administrator shall consider

the degree of physical harm suffered by the injured employee or his

dependents as a result of the violation of paragraph (a), (b), (c) , [or]

(d) or (e) of subsection 1, the amount of compensation found to be

due the claimant , and the number of fines and benefit penalties

previously imposed against the insurer, organization for managed

care, health care provider, third-party administrator or employer

pursuant to this section. If this is the third violation within 5 years

for which a benefit penalty has been imposed against the insurer,

organization for managed care, health care provider, third-party

administrator or employer, the Administrator shall also consider the

degree of economic harm suffered by the injured employee or his

dependents as a result of the violation of paragraph (a), (b), (c) , [or]

(d) or (e) of subsection 1. Except as otherwise provided in this

section, the benefit penalty is for the benefit of the claimant and

must be paid directly to him within 10 days after the date of the

Administrator’s determination. If the claimant is the injured

employee and he dies before the benefit penalty is paid to him, the

benefit penalty must be paid to his estate. Proof of the payment of

the benefit penalty must be submitted to the Administrator within 10

days after the date of his determination unless an appeal is filed

pursuant to NRS 616D.140. Any compensation to which the

claimant may otherwise be entitled pursuant to chapters 616A to

616D, inclusive, or chapter 617 of NRS must not be reduced by the

amount of any benefit penalty received pursuant to this subsection.

4. In addition to any fine or benefit penalty imposed pursuant

to this section, the Administrator may assess against an insurer who

violates any regulation concerning the reporting of claims

expenditures or premiums received that are used to calculate an

assessment, an administrative penalty of up to twice the amount of

any underpaid assessment.

5. If:

(a) The Administrator determines that a person has violated any

of the provisions of NRS 616D.200, 616D.220, 616D.240,

616D.300, 616D.310 or 616D.350 to 616D.440, inclusive; and

(b) The Fraud Control Unit for Industrial Insurance of the Office

of the Attorney General established pursuant to NRS 228.420

notifies the Administrator that the unit will not prosecute the person

for that violation,

the Administrator shall impose an administrative fine of not more

than $10,000.

6. Two or more fines of $1,000 or more imposed in 1 year for

acts enumerated in subsection 1 must be considered by the

Commissioner as evidence for the withdrawal of:

(a) A certificate to act as a self-insured employer.

(b) A certificate to act as an association of self-insured public or

private employers.

7. The Commissioner may, without complying with the

provisions of NRS 616B.327 or 616B.431, withdraw the

certification of a self-insured employer, association of self-insured

public or private employers or third-party administrator if, after a

hearing, it is shown that the self-insured employer, association of

self-insured public or private employers or third-party administrator

violated any provision of subsection 1.

Sec. 15. NRS 616D.130 is hereby amended to read as follows:

616D.130 1. Upon receipt of a complaint for a violation of

subsection 1 of NRS 616D.120, or if the Administrator has reason to

believe that such a violation has occurred, the Administrator shall

cause to be conducted an investigation of the alleged violation.

Except as otherwise provided in subsection 2, the Administrator

shall, within 30 days after initiating the investigation:

(a) Render a determination. The determination must include his

findings of fact and, if he determines that a violation has occurred,

one or more of the following:

(1) The amount of any fine required to be paid pursuant to

NRS 616D.120.

(2) The amount of any benefit penalty required to be paid to

a claimant pursuant to NRS 616D.120.

(3) A plan of corrective action to be taken by the insurer,

organization for managed care, health care provider, third-party

administrator or employer, including the manner and time within

which the violation must be corrected.

(4) A requirement that notice of the violation be given to the

appropriate agency that regulates the activities of the violator.

(b) Notify the Commissioner if he determines that a violation

was committed by a self-insured employer, association of self-

insured public or private employers or third-party administrator.

2. Upon receipt of a complaint for any violation of paragraph

(a) [or] , (b), (c) or (d) of subsection 1 of NRS 616D.120, or if the

Administrator has reason to believe that such a violation has

occurred, the Administrator shall complete the investigation

required by subsection 1 within [120] 60 days and, within 30 days

after the completion of the investigation, render a determination and

notify the Commissioner if he determines that a violation was

committed by a self-insured employer, association of self-insured

public or private employers or third-party administrator.

3. If, based upon the Administrator’s findings of fact, he

determines that a violation has not occurred, he shall issue a

determination to that effect.

Sec. 16. NRS 616D.140 is hereby amended to read as follows:

616D.140 1. If a person wishes to contest a decision of the

Administrator to impose [an administrative fine] or refuse to impose

a benefit penalty pursuant to [this chapter or chapter 616A, 616B,

616C or 617 of NRS,] NRS 616D.120, he must file a notice of

appeal with [the Division within 10 days after receipt of the

Administrator’s decision, showing why] an appeals officer in

accordance with this section. The notice of appeal must set forth

the reasons the proposed [fine or] benefit penalty should or should

not be imposed.

2. [If a notice of appeal is filed as required by subsection 1, the

Administrator shall, in accordance with the provisions of NRS

233B.121, issue a notice of hearing that must include a date for a

hearing on the matter, which must be no sooner than 30 days after

the notice of appeal is filed. The Administrator may grant a

continuance of the hearing upon a showing of good cause.] A

person who is aggrieved by:

(a) A written determination of the Administrator; or

(b) The failure of the Administrator to respond within 90 days

to a written request mailed to the Administrator by the person who

is aggrieved,

may appeal from the determination or failure to respond by filing

a request for a hearing before an appeals officer. The request

must be filed within 30 days after the date on which the notice of

the Administrator’s determination was mailed by the

Administrator or within 100 days after the date on which the

unanswered written request was mailed to the Administrator, as

applicable. The failure of the Administrator to respond to a written

request for a determination within 90 days after receipt of

the request shall be deemed by the appeals officer to be a denial of

the request.

3. If a notice of appeal is not filed as required by this section,

the imposition of or refusal to impose the [fine or] benefit penalty

shall be deemed a final order and is not subject to review by any

court or agency.

4. [Except as otherwise provided in NRS 616A.467, a] A

hearing held pursuant to this section must be conducted by the

[Administrator or a person designated by him. A record of the

hearing must be kept but it need not be transcribed unless it is

requested by the person against whom the order or notice of

violation has been issued and that person pays the cost of

transcription. The Administrator] appeals officer as a hearing de

novo. The appeals officer shall render a written decision on the

appeal. Except as otherwise provided in this section, the provisions

of NRS 616C.345 to 616C.385, inclusive, apply to an appeal filed

pursuant to this section.

5. [An administrative fine imposed pursuant to this chapter or

chapter 616A, 616B, 616C or 617 of NRS must be paid to the

Division. If the violation for which the fine is levied was committed

by a person while acting within the course and scope of his agency

or employment, the fine must be paid by his principal or employer.

The fine may be recovered in a civil action brought in the name of

the Division in a court of competent jurisdiction in the county in

which the violation occurred or in which the person against whom

the fine is levied has his principal place of business.

6.] A benefit penalty imposed pursuant to NRS 616D.120 must

be paid to the claimant on whose behalf it is imposed. If such a

payment is not made within the period required by NRS 616D.120,

the benefit penalty may be recovered in a civil action brought by the

Administrator on behalf of the claimant in a court of competent

jurisdiction in the county in which the claimant resides, in which the

violation occurred or in which the person who is required to pay the

benefit penalty has his principal place of business.

[7.] 6. Any party aggrieved by a decision [of the Administrator

rendered] issued pursuant to this section by an appeals officer may

appeal the decision directly to the district court.

Sec. 17. NRS 616D.280 is hereby repealed.

Sec. 18. 1. This section becomes effective upon passage and

approval.

2. Section 7 of this act becomes effective upon passage and

approval for the purpose of adopting regulations and on October 1,

2003, for all other purposes.

3. Sections 1 to 6, inclusive, and 8 to 17, inclusive, of this act

become effective on October 1, 2003.

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