Senate Bill No. 417–Senator O’Connell
March 15, 1999
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Referred to Committee on Commerce and Labor
SUMMARY—Creates appeals panel for industrial insurance to hear certain grievances of employers. (BDR 53-1080)
FISCAL NOTE: Effect on Local Government: No.
Effect on the State or on Industrial Insurance: Yes.
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EXPLANATION – Matter in
bolded italics is new; matter between brackets
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1-1
Section 1. Chapter 616A of NRS is hereby amended by adding thereto1-2
a new section to read as follows:1-3
"Appeals panel" means the appeals panel for industrial insurance that1-4
hears grievances of employers, other than self-insured employers,1-5
pursuant to the provisions of sections 5 to 17, inclusive, of this act.1-6
Sec. 2. NRS 616A.025 is hereby amended to read as follows: 616A.025 As used in chapters 616A to 616D, inclusive, of NRS,1-8
unless the context otherwise requires, the words and terms defined in NRS1-9
616A.030 to 616A.360, inclusive, and section 1 of this act, have the1-10
meanings ascribed to them in those sections.1-11
Sec. 3. (Deleted by amendment.)1-12
Sec. 4. Chapter 616B of NRS is hereby amended by adding thereto the1-13
provisions set forth as sections 5 to 17, inclusive, of this act.1-14
Sec. 5. 1. The appeals panel for industrial insurance is hereby1-15
created. The appeals panel consists of seven members who are appointed1-16
by the governor, in consultation with the commissioner. From the1-17
appropriate list of persons, if any, provided by the advisory organization2-1
pursuant to subsection 2, the governor, in consultation with the2-2
commissioner, shall appoint:2-3
(a) An employee of the division of insurance of the department of2-4
business and industry;2-5
(b) An agent who is:2-6
(1) Licensed pursuant to chapter 683A of NRS and qualified2-7
pursuant to regulations adopted by the commissioner to take an2-8
application for, procure or place on behalf of others, industrial2-9
insurance; and2-10
(2) A member of a nationally recognized association for the2-11
profession of insurance agents;2-12
(c) Two representatives of the general public:2-13
(1) One of which must be employed by, or the proprietor of, a2-14
business which is a member of:2-15
(I) A local chamber of commerce; or2-16
(II) Another organization representing the general business2-17
interests of a group of businesses located in this state.2-18
(2) Neither of which may be an independent contractor to, or an2-19
employee or representative of, an insurance company, insurance broker,2-20
insurance agent or insurance solicitor, a law firm, actuary or a2-21
representative of a trade association that represents or supports the2-22
interests specific to the trade of any such persons.2-23
(3) Both of which must be knowledgeable in the field and business2-24
of industrial insurance in this state;2-25
(d) Two representatives of private carriers; and2-26
(e) A representative of the advisory organization who administers2-27
appeals panels for grievances of employers in other states.2-28
2. On or before June 1 of a year in which the governor is to appoint2-29
a member to the appeals panel, the advisory organization shall compile2-30
lists of nominees for appointment pursuant to subsection 1 and provide2-31
such lists to the governor and the commissioner. The advisory2-32
organization shall compile three lists, each containing the names of at2-33
least five persons who, in the opinion of the advisory organization, would2-34
be appropriate members of the appeals panel as:2-35
(a) The agent appointed pursuant to paragraph (b) of subsection 1;2-36
(b) The two representatives of the general public appointed pursuant2-37
to paragraph (c) of subsection 1; and2-38
(c) The two representatives of private carriers appointed pursuant to2-39
paragraph (d) of subsection 1.2-40
3. Within 30 days after such appointments have been made, the2-41
governor shall notify the advisory organization of the names of each new2-42
member.3-1
4. After the initial terms, members shall serve terms of 2 years,3-2
except when appointed to fill unexpired terms.3-3
5. A vacancy in the membership of the appeals panel must be filled3-4
by the governor, in consultation with the commissioner, in accordance3-5
with the provisions of subsections 1 and 2 for the remainder of the3-6
unexpired term. The newly appointed member must have the same3-7
qualifications as the vacating member, as specified in paragraph (a), (b),3-8
(c), (d) or (e) of subsection 1, as appropriate.3-9
Sec. 6. 1. At its first meeting of each year, the appeals panel shall3-10
elect a chairman from among its members.3-11
2. The chairman shall hold office for 1 year.3-12
3. If a vacancy occurs in the chairmanship, the members of the3-13
panel shall elect a chairman from among its members for the remainder3-14
of the unexpired term of the chairman.3-15
4. Unless the members agree unanimously to a different date, the3-16
first meeting of each year must be as soon as practicable after July 1.3-17
Sec. 7. 1. The chairman of the appeals panel shall:3-18
(a) Schedule the time and place of the meetings and hearings of the3-19
appeals panel;3-20
(b) Establish the agenda for each meeting and hearing of the appeals3-21
panel; and3-22
(c) Ensure that the meetings of the appeals panel are conducted in an3-23
efficient manner.3-24
2. The chairman of the appeals panel may appoint from the3-25
membership of the appeals panel a secretary to whom he may delegate3-26
his administrative functions.3-27
Sec. 8. 1. The appeals panel shall meet at the times and places3-28
specified by a call of the chairman.3-29
2. Four members of the appeals panel constitute a quorum to3-30
transact all business, and a majority of those present must concur on any3-31
decision.3-32
Sec. 9. 1. Each member of the appeals panel is entitled to receive,3-33
for his attendance at the meetings of the appeals panel, the per diem3-34
allowance and travel expenses provided for state officers and employees3-35
generally.3-36
2. Expenses of the members of the appeals panel must be paid from3-37
assessments payable by each insurer pursuant to the formula filed with3-38
and approved by the commissioner pursuant to section 20.2 of this act.3-39
3. As used in this section, "insurer" has the meaning ascribed to it in3-40
NRS 686B.1759.3-41
Sec. 10. 1. An employer, other than a self-insured employer, who3-42
determines that circumstances specific to his case require a review of the:4-1
(a) Establishment of the employer’s modification of premium based4-2
on experience;4-3
(b) Classification of risk assigned for the employer’s business; or4-4
(c) Application of the supplementary rate information to the employer,4-5
may file a written grievance with the appeals panel.4-6
2. The insurer of that employer and the advisory organization may4-7
participate in a hearing on the grievance by appearing and providing4-8
testimony or other evidence. If an insurer or the advisory organization4-9
participates in the hearing, the insurer or the advisory organization is a4-10
party to the hearing and may appeal, pursuant to the provisions of4-11
section 16 of this act, the decision made by the appeals panel.4-12
3. As used in this section "supplementary rate information" has the4-13
meaning ascribed to it in NRS 686B.020.4-14
Sec. 11. 1. The appeals panel shall hear a grievance of an4-15
employer filed pursuant to section 10 of this act.4-16
2. The appeals panel shall not hear:4-17
(a) Complaints concerning the effect of the classifications of risks or4-18
rules that are applied by all insurers to all similarly classified businesses4-19
within this state.4-20
(b) Grievances concerning contested cases for compensation pursuant4-21
to the provisions of chapters 616A to 616D, inclusive, or 617 of NRS.4-22
Sec. 12. 1. Within 30 days after receipt of a written grievance from4-23
an employer pursuant to section 10 of this act and not less than 10 days4-24
before the hearing on such grievance, the appeals panel shall provide4-25
written notice to the employer, his insurer and the advisory organization4-26
of the date and place of the hearing.4-27
2. A decision on a grievance must be issued pursuant to section 15 of4-28
this act within 30 days after the hearing.4-29
Sec. 13. A hearing held pursuant to section 11 of this act must be4-30
open to the public, unless the appeals panel will be considering4-31
proprietary information of the employer or the insurer. As used in this4-32
section, the term "proprietary information" means any information4-33
which, if disclosed to the general public, may result in a competitive4-34
disadvantage to an insurer or employer, including, without limitation:4-35
1. Rules, criteria and standards for underwriting policies that are4-36
applied by an insurer.4-37
2. Plans or other documents concerning the marketing or strategic4-38
planning of an insurer or employer.4-39
3. Data, studies and reports concerning the development of new4-40
products or services.4-41
4. Data that identify the share of the market of an insurer within4-42
each class of risk.5-1
Sec. 14. 1. If a member of the appeals panel determines that he5-2
has a personal interest or a conflict of interest, directly or indirectly, with5-3
a party to a hearing or the subject matter of the hearing, the chairman of5-4
the appeals panel shall appoint a substitute member for that hearing who5-5
has the same qualifications, as specified in paragraph (a), (b), (c), (d) or5-6
(e) of subsection 1 of section 5 of this act as the member who has the5-7
conflict of interest. If the chairman is the member with the conflict of5-8
interest, another member of the appeals panel shall appoint the5-9
substitute.5-10
2. A conflict of interest may be waived if, after full written disclosure5-11
of the facts raising such a conflict, all parties to the appeal agree in5-12
writing to the hearing of the appeal by the member. Such waiver must be5-13
filed with the chairman of the appeals panel before the hearing. If the5-14
chairman is the member with the conflict of interest, the waiver must be5-15
filed with the commissioner.5-16
3. The member of the appeals panel who represents the advisory5-17
organization shall be deemed not to have a conflict of interest with5-18
respect to the advisory organization if it is a party to a hearing.5-19
Sec. 15. 1. Within 30 days after each hearing, the chairman or a5-20
member of the appeals panel designated by the chairman shall prepare5-21
and deliver personally or by mail to each party to the hearing and to the5-22
commissioner a written memorandum stating:5-23
(a) The reasons for the decision of the appeals panel concerning those5-24
parties; and5-25
(b) The rights of any party to the hearing to appeal pursuant to5-26
section 16 of this act and a brief description of the procedure for making5-27
such an appeal.5-28
The votes of each member of the appeals panel must not be recorded on5-29
this memorandum.5-30
2. Each month, copies of all decisions made by the appeals panel5-31
during the prior month must be delivered personally or by mail to the5-32
advisory organization.5-33
Sec. 16. 1. A party to the hearing who wishes to appeal a decision5-34
of the appeals panel must do so pursuant to the provisions of NRS5-35
679B.310. Such a hearing must be conducted by the commissioner5-36
pursuant to the provisions of NRS 679B.310 to 679B.370, inclusive, and5-37
the regulations adopted pursuant thereto.5-38
2. The commissioner shall not hold a hearing on the request of an5-39
employer concerning the establishment of the employer’s modification of5-40
premium based on experience, the classification of risk assigned for the5-41
employer’s business, or application of the insurer’s supplementary rate5-42
information to the employer unless the employer has:6-1
(a) Filed a written grievance with the appeals panel pursuant to6-2
section 10 of this act; and6-3
(b) Received a written decision from the appeals panel.6-4
Sec. 17. The commissioner may adopt regulations to carry out the6-5
provisions of sections 5 to 17, inclusive, of this act.6-6
Sec. 18. NRS 616C.315 is hereby amended to read as follows: 616C.315 1. Any person who is subject to the jurisdiction of the6-8
hearing officers pursuant to chapters 616A to 616D, inclusive, or chapter6-9
617 of NRS may request a hearing before a hearing officer of any matter6-10
within the hearing officer’s authority. The insurer shall provide, without6-11
cost, the forms necessary to request a hearing to any person who requests6-12
them.6-13
2. Except as otherwise provided in NRS 616C.305, and sections 10, 116-14
and 16 of this act, a person who is aggrieved by:6-15
(a) A written determination of an insurer; or6-16
(b) The failure of an insurer to respond within 30 days to a written6-17
request mailed to the insurer by the person who is aggrieved,6-18
may appeal from the determination or failure to respond by filing a request6-19
for a hearing before a hearing officer. Such a request must be filed within6-20
70 days after the date on which the notice of the insurer’s determination6-21
was mailed by the insurer or the unanswered written request was mailed to6-22
the insurer, as applicable. The failure of an insurer to respond to a written6-23
request for a determination within 30 days after receipt of such a request6-24
shall be deemed by the hearing officer to be a denial of the request.6-25
3. Failure to file a request for a hearing within the period specified in6-26
subsection 2 may be excused if the person aggrieved shows by a6-27
preponderance of the evidence that he did not receive the notice of the6-28
determination and the forms necessary to request a hearing. The claimant or6-29
employer shall notify the insurer of a change of address.6-30
4. The hearing before the hearing officer must be conducted as6-31
expeditiously and informally as is practicable.6-32
5. The parties to a contested claim may, if the claimant is represented6-33
by legal counsel, agree to forego a hearing before a hearing officer and6-34
submit the contested claim directly to an appeals officer.6-35
Sec. 19. (Deleted by amendment.)6-36
Sec. 20. NRS 679B.370 is hereby amended to read as follows: 679B.370 1. Except as to matters arising under chapter 686B of NRS6-38
6-39
employers that must be appealed to the appeals panel for industrial6-40
insurance, an appeal from the commissioner must be taken only from an6-41
order on hearing, or as to a matter on which the commissioner has refused6-42
or failed to hold a hearing after application therefor under NRS 679B.310,7-1
or as to a matter concerning which the commissioner has refused or failed7-2
to make his order on hearing as required by NRS 679B.360.7-3
2. Any person who was a party to a hearing or whose pecuniary7-4
interests are directly and immediately affected by any such refusal or7-5
failure, and who is aggrieved by the order, refusal or failure, may petition7-6
for judicial review in the manner provided by chapter 233B of NRS.7-7
Sec. 20.2. Chapter 686B of NRS is hereby amended by adding thereto7-8
a new section to read as follows:7-9
1. The advisory organization shall, at least 60 days before imposing7-10
an assessment pursuant to this section, file with the commissioner a7-11
formula for an assessment on all insurers, which results in an equitable7-12
distribution among all insurers, of:7-13
(a) The costs of paying the expenses of the members of the appeals7-14
panel for industrial insurance pursuant to the provisions of section 9 of7-15
this act; and7-16
(b) Any costs incurred by the advisory organization to administer the7-17
appeals panel for industrial insurance pursuant to the provisions of7-18
sections 5 to 17, inclusive, of this act.7-19
2. The formula for the assessment filed pursuant to subsection 17-20
shall be deemed approved unless it is disapproved by the commissioner7-21
within 60 days after it is filed.7-22
Sec. 20.4. NRS 686B.1751 is hereby amended to read as follows: 686B.1751 As used in NRS 686B.1751 to 686B.1799, inclusive, and7-24
section 20.2 of this act, unless the context otherwise requires, the words7-25
and terms defined in NRS 686B.1752 to 686B.1762, inclusive, have the7-26
meanings ascribed to them in those sections.7-27
Sec. 21. NRS 686B.1785 is hereby amended to read as follows: 686B.1785 Any person aggrieved by any decision, action or omission7-29
of the advisory organization or an insurer regarding rates or other7-30
information filed with the commissioner may request in writing that the7-31
organization or insurer reconsider the decision, action or omission.7-32
Except as otherwise provided in sections 10, 11 and 16 of this act, if the7-33
request for reconsideration is rejected or is not acted upon within 30 days7-34
by the organization or insurer, the person requesting reconsideration may,7-35
within 30 days thereafter, appeal from the decision, action or omission to7-36
the commissioner by filing a written complaint and request for a hearing7-37
specifying the grounds relied upon.7-38
Sec. 22. As soon as practicable after the effective date of this act, the7-39
governor, in consultation with the commissioner of insurance shall appoint:7-40
1. One of the members described in paragraph (c) of subsection 1 of7-41
section 5 of this act and one of the members described in paragraph (d) of7-42
subsection 1 of section 5 of this act to terms that expire on June 30, 2000.8-1
2. One of the members described in paragraph (c) of subsection 1 of8-2
section 5 of this act and one of the members described in paragraph (d) of8-3
subsection 1 of section 5 of this act and the members described in8-4
paragraphs (a), (b) and (e) of subsection 1 of section 5 of this act to terms8-5
that expire on June 30, 2001.8-6
Sec. 23. 1. This section and sections 1 to 18, inclusive, 20 and 22 of8-7
this act become effective upon passage and approval and expire by8-8
limitation on July 1, 2001.8-9
2. Sections 20.2, 20.4 and 21 of this act become effective at 12:01 a.m.8-10
on July 1, 1999, and expire by limitation on July 1, 2001.~