Assembly Bill No. 338–Assemblyman Bache

 

March 13, 2001

____________

 

Referred to Committee on Commerce and Labor

 

SUMMARY—Makes various changes concerning workers’ compensation. (BDR 53‑711)

 

FISCAL NOTE:            Effect on Local Government: Yes.

                                    Effect on the State: No.

 

~

 

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

 

AN ACT relating to workers’ compensation; requiring an insurer to provide copies of documents in a claimant’s file within a certain time; requiring an insurer to reimburse an injured employee for medical expenses paid by the employee under certain circumstances; requiring insurers to provide certain types of notifications concerning an injured employee’s right to choose physicians or chiropractors; requiring the administrator of the division of industrial relations of the department of business and industry to design a form notifying injured employees of their right to choose an alternate physician or chiropractor; allowing injured employees to choose under certain circumstances physicians or chiropractors who are not under contract with the managed care organization of the insurer; allowing an injured employee to choose any qualified physician or chiropractor to render a second determination of his percentage of disability; revising certain provisions governing eligibility for compensation for reopening a claim; revising the provisions governing offers of temporary, light-duty employment; revising the provisions governing the determination of a permanent partial disability; revising provisions governing eligibility for and length, goals and amounts of vocational rehabilitation services; authorizing a claimant to bring and maintain a certain cause of action against an insurer or a third-party administrator if the claimant does not accept a benefit penalty; and providing other matters properly relating thereto.

 

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN

SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

 

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

1-2    616A.070  “Benefit penalty” means an additional amount of money

1-3  that , except as otherwise provided in NRS 616D.120 and section 20 of

1-4  this act, is payable to a claimant if the administrator has determined that a

1-5  violation of any of the provisions of paragraphs (a) to (d), inclusive, of

1-6  subsection 1 of NRS 616D.120 has occurred.

 

 

2-1    Sec. 2.  NRS 616A.465 is hereby amended to read as follows:

2-2    616A.465  1.  Except as otherwise provided in this section, the

2-3  division shall:

2-4    (a) Regulate insurers pursuant to chapters 616A to 617, inclusive, of

2-5  NRS;

2-6    (b) Investigate insurers regarding compliance with statutes and the

2-7  division’s regulations;

2-8    (c) Determine whether an employee leasing company is entitled to a

2-9  certificate of registration pursuant to NRS 616B.673; and

2-10    (d) Regulate employee leasing companies pursuant to the provisions of

2-11  NRS 616B.670 to 616B.697, inclusive.

2-12    2.  The commissioner is responsible for reviewing rates, investigating

2-13  the solvency of insurers, authorizing private carriers pursuant to chapter

2-14  680A of NRS and certifying:

2-15    (a) Self-insured employers pursuant to NRS 616B.300 to 616B.330,

2-16  inclusive, and 616B.336;

2-17    (b) Associations of self-insured public or private employers pursuant to

2-18  NRS 616B.350 to 616B.446, inclusive; and

2-19    (c) Third-party administrators pursuant to chapter 683A of NRS.

2-20    3.  The department of administration is responsible for contested claims

2-21  relating to industrial insurance pursuant to NRS 616C.310 to 616C.385,

2-22  inclusive. The administrator is responsible for administrative appeals

2-23  pursuant to NRS 616B.215.

2-24    4.  The Nevada attorney for injured workers is responsible for legal

2-25  representation of claimants pursuant to NRS 616A.435 to 616A.460,

2-26  inclusive, and 616D.120.

2-27    5.  The division is responsible for the investigation of complaints. [If]

2-28  Except as otherwise provided in subsection 3 of section 20 of this act, if a

2-29  complaint is filed with the division, the administrator shall cause to be

2-30  conducted an investigation which includes a review of relevant records and

2-31  interviews of affected persons. If the administrator determines that a

2-32  violation may have occurred, the administrator shall proceed in accordance

2-33  with the provisions of NRS 616D.120 and 616D.130.

2-34    6.  As used in this section, “employee leasing company” has the

2-35  meaning ascribed to it in NRS 616B.670.

2-36    Sec. 3.  NRS 616B.021 is hereby amended to read as follows:

2-37    616B.021  1.  An insurer shall provide access to the files of claims in

2-38  its offices.

2-39    2.  A file [is] must be available for inspection during regular business

2-40  hours by the [employee] claimant or his designated agent, the employer or

2-41  his designated agent and the administrator or his designated agent.

2-42    3.  Upon request, the insurer shall make copies of anything in the file

2-43  and may charge a reasonable fee for this service. Copies of materials in the

2-44  file which are requested by the administrator or his designated agent, or the

2-45  Nevada attorney for injured workers or his designated agent must be

2-46  provided free of charge. Any copies requested by a claimant or his

2-47  designated agent must be produced within 21 days after the request is

2-48  made. The failure of an insurer to provide copies to a claimant or his

2-49  designated agent in a timely manner pursuant to this subsection shall be

3-1  deemed to be a minor violation for purposes of the administrative fines

3-2  imposed by the administrator pursuant to subsection 2 of NRS 616D.120.

3-3    4.  If a claim has been closed for at least 1 year, the insurer may

3-4  microphotograph or film any of its records relating to that claim. The

3-5  microphotographs or films must be placed in convenient and accessible

3-6  files.

3-7    5.  The administrator shall adopt regulations concerning the:

3-8    (a) Maintenance of records in a file on current or closed claims;

3-9    (b) Preservation, examination and use of records which have been

3-10  microphotographed or filmed by an insurer; and

3-11    (c) Location of a file on a closed claim.

3-12    6.  This section does not require an insurer to allow inspection or

3-13  reproduction of material regarding which a legal privilege against

3-14  disclosure has been conferred.

3-15    Sec. 4.  NRS 616B.527 is hereby amended to read as follows:

3-16    616B.527  1.  A self-insured employer, an association of self-insured

3-17  public or private employers or a private carrier may:

3-18    [1.] (a) Enter into a contract or contracts with one or more

3-19  organizations for managed care to provide comprehensive medical and

3-20  health care services to employees for injuries and diseases that are

3-21  compensable pursuant to chapters 616A to 617, inclusive, of NRS.

3-22    [2.] (b) Enter into a contract or contracts with providers of health care,

3-23  including, without limitation, physicians who provide primary care,

3-24  specialists, pharmacies, physical therapists, radiologists, nurses, diagnostic

3-25  facilities, laboratories, hospitals and facilities that provide treatment to

3-26  outpatients, to provide medical and health care services to employees for

3-27  injuries and diseases that are compensable pursuant to chapters 616A to

3-28  617, inclusive, of NRS.

3-29    [3.] (c) Require employees to obtain medical and health care services

3-30  for their industrial injuries from those organizations and persons with

3-31  whom the self-insured employer, association or private carrier has

3-32  contracted pursuant to [subsections 1 and 2,] paragraphs (a) and (b), or as

3-33  the self-insured employer, association or private carrier otherwise

3-34  prescribes.

3-35    [4.  Require]

3-36    (d) Except as otherwise provided in subsection 3 of NRS 616C.090,

3-37  require employees to obtain the approval of the self-insured employer,

3-38  association or private carrier before obtaining medical and health care

3-39  services for their industrial injuries from a provider of health care who has

3-40  not been previously approved by the self-insured employer, association or

3-41  private carrier.

3-42    [5.] 2.  An organization for managed care with whom a self-insured

3-43  employer, association of self-insured public or private employers or a

3-44  private carrier has contracted pursuant to this section shall comply with the

3-45  provisions of NRS 616B.528, 616B.5285 and 616B.529.

 

 

 

4-1    Sec. 5.  Chapter 616C of NRS is hereby amended by adding thereto a

4-2  new section to read as follows:

4-3    If:

4-4    1.  An insurer, an organization for managed care, a third-party

4-5  administrator or an employer who provides accident benefits for injured

4-6  employees pursuant to NRS 616C.265 denies authorization or

4-7  responsibility for payment for treatment or other services provided by a

4-8  provider of health care that the injured employee alleges are related to an

4-9  industrial injury or occupational disease;

4-10    2.  The injured employee pays in protest for the treatment or other

4-11  services; and

4-12    3.  A hearing officer or appeals officer ultimately determines that the

4-13  treatment or other services should have been covered, or the insurer,

4-14  organization for managed care, third-party administrator or employer

4-15  who provides accident benefits subsequently accepts responsibility for

4-16  payment,

4-17  the hearing officer or appeals officer shall order the insurer,

4-18  organization for managed care, third-party administrator or employer

4-19  who provides accident benefits to reimburse the injured employee for the

4-20  amount paid by the injured employee, or the insurer, organization for

4-21  managed care, third-party administrator or employer who provides

4-22  accident benefits shall, as a part of any settlement with the injured

4-23  employee, reimburse the injured employee for the amount paid by the

4-24  injured employee.

4-25    Sec. 6.  NRS 616C.050 is hereby amended to read as follows:

4-26    616C.050  1.  An insurer shall provide to each claimant:

4-27    (a) Upon written request, one copy of any medical information

4-28  concerning his injury or illness.

4-29    (b) A statement which contains information concerning the claimant’s

4-30  right to:

4-31      (1) Receive the information and forms necessary to file a claim;

4-32      (2) Select a treating physician or chiropractor and an alternate

4-33  treating physician or chiropractor in accordance with the provisions of

4-34  NRS 616C.090;

4-35      (3) Request the appointment of the Nevada attorney for injured

4-36  workers to represent him before the appeals officer;

4-37      (4) File a complaint with the administrator;

4-38      (5) When applicable, receive compensation for:

4-39        (I) Permanent total disability;

4-40        (II) Temporary total disability;

4-41        (III) Permanent partial disability;

4-42        (IV) Temporary partial disability; or

4-43        (V) All medical costs related to his injury or disease;

4-44      (6) Receive services for rehabilitation if his injury prevents him from

4-45  returning to gainful employment;

4-46      (7) Review by a hearing officer of any determination or rejection of a

4-47  claim by the insurer within the time specified by statute; and

4-48      (8) Judicial review of any final decision within the time specified by

4-49  statute.

5-1    2.  The insurer’s statement must include a copy of the form designed

5-2  by the administrator pursuant to subsection 7 of NRS 616C.090 that

5-3  notifies injured employees of their right to select an alternate treating

5-4  physician or chiropractor. The administrator shall adopt regulations for

5-5  the manner of compliance by an insurer with the other provisions of

5-6  subsection 1.

5-7    Sec. 7.  NRS 616C.090 is hereby amended to read as follows:

5-8    616C.090  1.  The administrator shall establish a panel of physicians

5-9  and chiropractors who have demonstrated special competence and interest

5-10  in industrial health to treat injured employees under chapters 616A to

5-11  616D, inclusive, or chapter 617 of NRS. Every employer whose insurer has

5-12  not entered into a contract with an organization for managed care or with

5-13  providers of health care services pursuant to NRS 616B.527 shall maintain

5-14  a list of those physicians and chiropractors on the panel who are reasonably

5-15  accessible to his employees.

5-16    2.  An injured employee whose employer’s insurer has not entered into

5-17  a contract with an organization for managed care or with providers of

5-18  health care services pursuant to NRS 616B.527 may choose his treating

5-19  physician or chiropractor from the panel of physicians and chiropractors. If

5-20  the injured employee is not satisfied with the first physician or chiropractor

5-21  he so chooses, he may make an alternative choice of physician or

5-22  chiropractor from the panel if the choice is made within 90 days after his

5-23  injury. The insurer shall notify the first physician or chiropractor in

5-24  writing. The notice must be postmarked within 3 working days after the

5-25  insurer receives knowledge of the change. The first physician or

5-26  chiropractor must be reimbursed only for the services he rendered to the

5-27  injured employee up to and including the date of notification. [Any] Except

5-28  as otherwise provided in this subsection, any further change is subject to

5-29  the approval of the insurer, which must be granted or denied within 10 days

5-30  after a written request for such a change is received from the injured

5-31  employee. If no action is taken on the request within 10 days, the request

5-32  shall be deemed granted. Any request for a change of physician or

5-33  chiropractor must include the name of the new physician or chiropractor

5-34  chosen by the injured employee. If the treating physician or chiropractor

5-35  refers the injured employee to a specialist, the insurer shall, in writing,

5-36  notify the employee whether the name of more than one physician or

5-37  chiropractor with that specialization is on the panel and, if so, inform the

5-38  employee that he has a right to choose any one of those specialists.

5-39    3.  An injured employee whose employer’s insurer has entered into a

5-40  contract with an organization for managed care or with providers of health

5-41  care services pursuant to NRS 616B.527 must choose his treating physician

5-42  or chiropractor pursuant to the terms of that contract. If the injured

5-43  employee is not satisfied with the first physician or chiropractor he so

5-44  chooses, he may make an alternative choice of physician or chiropractor

5-45  pursuant to the terms of the contract if the choice is made within 90 days

5-46  after his injury. If the injured employee, after choosing his treating

5-47  physician or chiropractor, moves to a county which is not served by the

5-48  organization for managed care or providers of health care services named

5-49  in the contract and the insurer determines that it is impractical for the

6-1  injured employee to continue treatment with the physician or chiropractor,

6-2  the injured employee must choose a treating physician or chiropractor who

6-3  has agreed to the terms of that contract unless the insurer authorizes the

6-4  injured employee to choose another physician or chiropractor. If the

6-5  treating physician or chiropractor refers the injured employee to a

6-6  specialist, the insurer shall, in writing, notify the employee whether the

6-7  name of more than one physician or chiropractor with that specialization

6-8  is available pursuant to the terms of the contract with the organization

6-9  for managed care or with providers of health care services pursuant to

6-10  NRS 616B.527, as appropriate, and, if so, inform the employee that he

6-11  has a right to choose any one of those specialists. If a choice of

6-12  physicians or chiropractors within that specialization is not available

6-13  pursuant to the terms of the contract, the injured employee may, without

6-14  obtaining prior approval from the insurer, select any physician or

6-15  chiropractor practicing within that area of specialization who agrees to

6-16  accept the terms of the contract with the organization for managed care

6-17  or with providers of health care pursuant to NRS 616B.527, as

6-18  appropriate.

6-19    4.  Except when emergency medical care is required and except as

6-20  otherwise provided in NRS 616C.055, the insurer is not responsible for any

6-21  charges for medical treatment or other accident benefits furnished or

6-22  ordered by any physician, chiropractor or other person selected by the

6-23  injured employee in disregard of the provisions of this section or for any

6-24  compensation for any aggravation of the injured employee’s injury

6-25  attributable to improper treatments by such physician, chiropractor or other

6-26  person.

6-27    5.  The administrator may order necessary changes in a panel of

6-28  physicians and chiropractors and shall suspend or remove any physician or

6-29  chiropractor from a panel for good cause shown.

6-30    6.  An injured employee may receive treatment by more than one

6-31  physician or chiropractor if the insurer provides written authorization for

6-32  such treatment.

6-33    7.  The administrator shall design a form that notifies injured

6-34  employees of their right pursuant to subsections 2 and 3 to select an

6-35  alternate treating physician or chiropractor and make the form available

6-36  to insurers for distribution pursuant to subsection 2 of NRS 616C.050.

6-37    Sec. 8.  NRS 616C.100 is hereby amended to read as follows:

6-38    616C.100  1.  If an injured employee disagrees with the percentage of

6-39  disability determined by a physician or chiropractor, the injured employee

6-40  may obtain a second determination of the percentage of disability[. If the

6-41  employee wishes to obtain such a determination, he must select the next

6-42  physician or chiropractor in rotation from the list of qualified physicians or

6-43  chiropractors maintained by the administrator pursuant to subsection 2 of

6-44  NRS 616C.490.] from any qualified physician or chiropractor. If a second

6-45  determination is obtained, the injured employee shall pay for the

6-46  determination. If the physician or chiropractor selected to make the second

6-47  determination finds a higher percentage of disability than the first

6-48  physician or chiropractor, the injured employee may request a hearing

7-1  officer or appeals officer to order the insurer to reimburse the employee

7-2  pursuant to the provisions of NRS 616C.330 or 616C.360.

7-3    2.  The results of a second determination made pursuant to subsection 1

7-4  may be offered at any hearing or settlement conference.

7-5    Sec. 9.  NRS 616C.110 is hereby amended to read as follows:

7-6    616C.110  1.  For the purposes of NRS 616B.557, 616C.490 and

7-7  617.459, the division shall adopt regulations incorporating the American

7-8  Medical Association’s Guides to the Evaluation of Permanent Impairment

7-9  by reference and may amend those regulations from time to time as it

7-10  deems necessary. In adopting the Guides to the Evaluation of Permanent

7-11  Impairment, the division shall consider the edition most recently published

7-12  by the American Medical Association.

7-13    2.  [If] Except as otherwise provided in subsection 6 of NRS

7-14  616C.490, if the Guides to the Evaluation of Permanent Impairment

7-15  adopted by the division contain more than one method of determining the

7-16  rating of an impairment, the administrator shall designate by regulation the

7-17  method which must be used to rate an impairment pursuant to NRS

7-18  616C.490.

7-19    Sec. 10.  NRS 616C.135 is hereby amended to read as follows:

7-20    616C.135  1.  A provider of health care who accepts a patient as a

7-21  referral for the treatment of an industrial injury or an occupational disease

7-22  may not charge the patient for any treatment related to the industrial injury

7-23  or occupational disease, but must charge the insurer. The provider of health

7-24  care may charge the patient for any other unrelated services which are

7-25  requested in writing by the patient.

7-26    2.  The insurer is liable for the charges for approved services if the

7-27  charges do not exceed:

7-28    (a) The fees established in accordance with NRS 616C.260 or the usual

7-29  fee charged by that person or institution, whichever is less; and

7-30    (b) The charges provided for by the contract between the provider of

7-31  health care and the insurer or the contract between the provider of health

7-32  care and the organization for managed care.

7-33    3.  A provider of health care may accept payment from an injured

7-34  employee who is paying in protest pursuant to section 5 of this act for

7-35  treatment or other services that the injured employee alleges are related

7-36  to the industrial injury or occupational disease.

7-37    4.  If a provider of health care, an organization for managed care, an

7-38  insurer or an employer violates the provisions of this section, the

7-39  administrator shall impose an administrative fine of not more than $250 for

7-40  each violation.

7-41    Sec. 11.  NRS 616C.330 is hereby amended to read as follows:

7-42    616C.330  1.  The hearing officer shall:

7-43    (a) Within 5 days after receiving a request for a hearing, set the hearing

7-44  for a date and time within 30 days after his receipt of the request;

7-45    (b) Give notice by mail or by personal service to all interested parties to

7-46  the hearing at least 15 days before the date and time scheduled; and

7-47    (c) Conduct hearings expeditiously and informally.

8-1    2.  The notice must include a statement that the injured employee may

8-2  be represented by a private attorney or seek assistance and advice from the

8-3  Nevada attorney for injured workers.

8-4    3.  If necessary to resolve a medical question concerning an injured

8-5  employee’s condition or to determine the necessity of treatment for which

8-6  authorization for payment has been denied, the hearing officer may refer

8-7  the employee to a physician or chiropractor of his choice who has

8-8  demonstrated special competence to treat the particular medical condition

8-9  of the employee. If the medical question concerns the rating of a permanent

8-10  disability, the hearing officer may refer the employee to a rating physician

8-11  or chiropractor. The rating physician or chiropractor must be selected in

8-12  rotation from the list of qualified physicians and chiropractors maintained

8-13  by the administrator pursuant to subsection 2 of NRS 616C.490, unless the

8-14  insurer and injured employee otherwise agree to a rating physician or

8-15  chiropractor. The insurer shall pay the costs of any medical examination

8-16  requested by the hearing officer.

8-17    4.  If an injured employee has requested payment for the cost of

8-18  obtaining a second determination of his percentage of disability pursuant to

8-19  NRS 616C.100, the hearing officer shall decide whether the determination

8-20  of the higher percentage of disability made pursuant to NRS 616C.100 is

8-21  appropriate and, if so, may order the insurer to pay to the employee an

8-22  amount equal to the maximum allowable fee established by the

8-23  administrator pursuant to NRS 616C.260 for the type of service performed,

8-24  or the usual fee of that physician or chiropractor for such service,

8-25  whichever is less.

8-26    5.  The hearing officer shall order an insurer, organization for

8-27  managed care or employer who provides accident benefits for injured

8-28  employees pursuant to NRS 616C.265 to reimburse an injured employee

8-29  for the payment of charges of a provider of health care if the conditions

8-30  of section 5 of this act are satisfied.

8-31    6.  The hearing officer may allow or forbid the presence of a court

8-32  reporter and the use of a tape recorder in a hearing.

8-33    [6.] 7.  The hearing officer shall render his decision within 15 days

8-34  after:

8-35    (a) The hearing; or

8-36    (b) He receives a copy of the report from the medical examination he

8-37  requested.

8-38    [7.] 8.  The hearing officer shall render his decision in the most

8-39  efficient format developed by the chief of the hearings division of the

8-40  department of administration.

8-41    [8.] 9.  The hearing officer shall give notice of his decision to each

8-42  party by mail. He shall include with the notice of his decision the necessary

8-43  forms for appealing from the decision.

8-44    [9.] 10.  Except as otherwise provided in NRS 616C.380, the decision

8-45  of the hearing officer is not stayed if an appeal from that decision is taken

8-46  unless an application for a stay is submitted by a party. If such an

8-47  application is submitted, the decision is automatically stayed until a

8-48  determination is made on the application. A determination on the

8-49  application must be made within 30 days after the filing of the application.

9-1  If, after reviewing the application, a stay is not granted by the hearing

9-2  officer or an appeals officer, the decision must be complied with within 10

9-3  days after the refusal to grant a stay.

9-4    Sec. 12.  NRS 616C.360 is hereby amended to read as follows:

9-5    616C.360  1.  A stenographic or electronic record must be kept of the

9-6  hearing before the appeals officer and the rules of evidence applicable to

9-7  contested cases under chapter 233B of NRS apply to the hearing.

9-8    2.  The appeals officer must hear any matter raised before him on its

9-9  merits, including new evidence bearing on the matter.

9-10    3.  If necessary to resolve a medical question concerning an injured

9-11  employee’s condition or to determine the necessity of treatment for which

9-12  authorization for payment has been denied, the appeals officer may refer

9-13  the employee to a physician or chiropractor of his choice who has

9-14  demonstrated special competence to treat the particular medical condition

9-15  of the employee. If the medical question concerns the rating of a permanent

9-16  disability, the appeals officer may refer the employee to a rating physician

9-17  or chiropractor. The rating physician or chiropractor must be selected in

9-18  rotation from the list of qualified physicians or chiropractors maintained by

9-19  the administrator pursuant to subsection 2 of NRS 616C.490, unless the

9-20  insurer and the injured employee otherwise agree to a rating physician or

9-21  chiropractor. The insurer shall pay the costs of any examination requested

9-22  by the appeals officer.

9-23    4.  If an injured employee has requested payment for the cost of

9-24  obtaining a second determination of his percentage of disability pursuant to

9-25  NRS 616C.100, the appeals officer shall decide whether the determination

9-26  of the higher percentage of disability made pursuant to NRS 616C.100 is

9-27  appropriate and, if so, may order the insurer to pay to the employee an

9-28  amount equal to the maximum allowable fee established by the

9-29  administrator pursuant to NRS 616C.260 for the type of service performed,

9-30  or the usual fee of that physician or chiropractor for such service,

9-31  whichever is less.

9-32    5.  The appeals officer shall order an insurer, organization for

9-33  managed care or employer who provides accident benefits for injured

9-34  employees pursuant to NRS 616C.265 to reimburse an injured employee

9-35  for the payment of charges of a provider of health care if the conditions

9-36  of section 5 of this act are satisfied.

9-37    6.  Any party to the appeal or the appeals officer may order a transcript

9-38  of the record of the hearing at any time before the seventh day after the

9-39  hearing. The transcript must be filed within 30 days after the date of the

9-40  order unless the appeals officer otherwise orders.

9-41    [6.] 7.  The appeals officer shall render his decision:

9-42    (a) If a transcript is ordered within 7 days after the hearing, within 30

9-43  days after the transcript is filed; or

9-44    (b) If a transcript has not been ordered, within 30 days after the date of

9-45  the hearing.

9-46    [7.] 8.  The appeals officer may affirm, modify or reverse any decision

9-47  made by the hearing officer and issue any necessary and proper order to

9-48  give effect to his decision.

 

10-1    Sec. 13.  NRS 616C.390 is hereby amended to read as follows:

10-2    616C.390  1.  If an application to reopen a claim to increase or

10-3  rearrange compensation is made in writing more than 1 year after the date

10-4  on which the claim was closed, the insurer shall reopen the claim if:

10-5    (a) A change of circumstances warrants an increase or rearrangement of

10-6  compensation during the life of the claimant;

10-7    (b) [The primary] A substantial contributing cause of the change of

10-8  circumstances is the injury or disease for which the claim was originally

10-9  made; and

10-10  (c) The application is accompanied by the certificate of a physician or a

10-11  chiropractor showing a change of circumstances which would warrant an

10-12  increase or rearrangement of compensation.

10-13  2.  After a claim has been closed, the insurer, upon receiving an

10-14  application and for good cause shown, may authorize the reopening of the

10-15  claim for medical investigation only. The application must be accompanied

10-16  by a written request for treatment from the physician or chiropractor

10-17  treating the claimant, certifying that the treatment is indicated by a change

10-18  in circumstances and is related to the industrial injury sustained or

10-19  occupational disease contracted by the claimant.

10-20  3.  If a claimant applies for a claim to be reopened pursuant to

10-21  subsection 1 or 2 and a final determination denying the reopening is issued,

10-22  the claimant [shall] may not reapply to reopen the claim until at least 1 year

10-23  after the date on which the final determination is issued.

10-24  4.  Except as otherwise provided in subsection 5, if an application to

10-25  reopen a claim is made in writing within 1 year after the date on which the

10-26  claim was closed, the insurer shall reopen the claim only if:

10-27  (a) The application is supported by medical evidence demonstrating an

10-28  objective change in the medical condition of the claimant; and

10-29  (b) There is clear and convincing evidence that [the primary] a

10-30  substantial contributing cause of the change of circumstances is the injury

10-31  or disease for which the claim was originally made.

10-32  5.  An application to reopen a claim must be made in writing within 1

10-33  year after the date on which the claim was closed if:

10-34  (a) The claimant was not off work as a result of the injury[;] or disease;

10-35  and

10-36  (b) The claimant did not receive benefits for a permanent partial

10-37  disability.

10-38  If an application to reopen a claim to increase or rearrange compensation is

10-39  made pursuant to this subsection, the insurer shall reopen the claim if the

10-40  requirements set forth in paragraphs (a), (b) and (c) of subsection 1 are

10-41  met.

10-42  6.  If an employee’s claim is reopened pursuant to this section, he is not

10-43  entitled to vocational rehabilitation services or benefits for a temporary

10-44  total disability if, before his claim was reopened, he:

10-45  (a) Retired; or

10-46  (b) Otherwise voluntarily removed himself from the work force,

10-47  for reasons unrelated to the injury or disease for which the claim was

10-48  originally made.

11-1    7.  One year after the date on which the claim was closed, an insurer

11-2  may dispose of the file of a claim authorized to be reopened pursuant to

11-3  subsection 5, unless an application to reopen the claim has been filed

11-4  pursuant to that subsection.

11-5    8.  An increase or rearrangement of compensation is not effective

11-6  before an application for reopening a claim is made unless good cause is

11-7  shown. The insurer shall, upon good cause shown, allow the cost of

11-8  emergency treatment the necessity for which has been certified by a

11-9  physician or a chiropractor.

11-10  9.  A claim that closes pursuant to subsection 2 of NRS 616C.235 and

11-11  is not appealed or is unsuccessfully appealed pursuant to the provisions of

11-12  NRS 616C.305 and 616C.315 to 616C.385, inclusive, may not be reopened

11-13  pursuant to this section.

11-14  10.  The provisions of this section apply to any claim for which an

11-15  application to reopen the claim or to increase or rearrange compensation is

11-16  made pursuant to this section, regardless of the date of the injury or

11-17  accident or the date of disablement to the claimant. If a claim is reopened

11-18  pursuant to this section, the amount of any compensation or benefits

11-19  provided must be determined in accordance with the provisions of NRS

11-20  616C.425[.] or 617.445, as appropriate.

11-21  Sec. 14.  NRS 616C.475 is hereby amended to read as follows:

11-22  616C.475  1.  Except as otherwise provided in this section, NRS

11-23  616C.175 and 616C.390, every employee in the employ of an employer,

11-24  within the provisions of chapters 616A to 616D, inclusive, of NRS, who is

11-25  injured by accident arising out of and in the course of employment, or his

11-26  dependents, is entitled to receive for the period of temporary total

11-27  disability, 66 2/3 percent of the average monthly wage.

11-28  2.  Except as otherwise provided in NRS 616B.028 and 616B.029, an

11-29  injured employee or his dependents are not entitled to accrue or be paid

11-30  any benefits for a temporary total disability during the time the injured

11-31  employee is incarcerated. The injured employee or his dependents are

11-32  entitled to receive such benefits when the injured employee is released

11-33  from incarceration if he is certified as temporarily totally disabled by a

11-34  physician or chiropractor.

11-35  3.  If a claim for the period of temporary total disability is allowed, the

11-36  first payment pursuant to this section must be issued by the insurer within

11-37  14 working days after receipt of the initial certification of disability and

11-38  regularly thereafter.

11-39  4.  Any increase in compensation and benefits effected by the

11-40  amendment of subsection 1 is not retroactive.

11-41  5.  Payments for a temporary total disability must cease when:

11-42  (a) A physician or chiropractor determines that the employee is

11-43  physically capable of any gainful employment for which the employee is

11-44  suited, after giving consideration to the employee’s education, training and

11-45  experience;

11-46  (b) The employer offers the employee light-duty employment or

11-47  employment that is modified according to the limitations or restrictions

11-48  imposed by a physician or chiropractor pursuant to subsection 7; or

12-1    (c) Except as otherwise provided in NRS 616B.028 and 616B.029, the

12-2  employee is incarcerated.

12-3    6.  Each insurer may, with each check that it issues to an injured

12-4  employee for a temporary total disability, include a form approved by the

12-5  division for the injured employee to request continued compensation for

12-6  the temporary total disability.

12-7    7.  A certification of disability issued by a physician or chiropractor

12-8  must:

12-9    (a) Include the period of disability and a description of any physical

12-10  limitations or restrictions imposed upon the work of the employee;

12-11  (b) Specify whether the limitations or restrictions are permanent or

12-12  temporary; and

12-13  (c) Be signed by the treating physician or chiropractor authorized

12-14  pursuant to NRS 616B.527[.] or appropriately chosen pursuant to

12-15  subsection 3 of NRS 616C.090.

12-16  8.  If the certification of disability specifies that the physical limitations

12-17  or restrictions are temporary, the employer of the employee at the time of

12-18  his accident [is not required to comply with NRS 616C.545 to 616C.575,

12-19  inclusive, and 616C.590 or the regulations adopted by the division

12-20  governing vocational rehabilitation services if the employer offers] may

12-21  offer the employee temporary, light-duty employment. Any offer of

12-22  temporary, light-duty employment made by the employer must:

12-23  (a) Specify a position that:

12-24  [(a)] (1) Is substantially similar to the employee’s position at the time

12-25  of his injury in relation to the location of the employment and the hours he

12-26  is required to work; and

12-27  [(b)] (2) Provides a gross wage that is:

12-28     [(1)] (I) If the position is in the same classification of employment,

12-29  equal to the gross wage the employee was earning at the time of his injury;

12-30  or

12-31     [(2)] (II) If the position is not in the same classification of

12-32  employment, substantially similar to the gross wage the employee was

12-33  earning at the time of his injury.

12-34  (b) Be accompanied by a written statement of whether the employer

12-35  has a policy of terminating an employee who:

12-36     (1) Is absent from work without having obtained prior approval

12-37  from the employer; and

12-38     (2) Cannot demonstrate a medical reason for his absence.

12-39  9.  If an employer fails to provide the statement required by

12-40  paragraph (b) of subsection 8 and terminates the employment of such an

12-41  employee, the insurer of that employer or the self-insured employer

12-42  cannot refuse to reinstate the payments for temporary total disability that

12-43  the employee was receiving before accepting the temporary, light-duty

12-44  employment until after the employer has given such notice and the

12-45  employee is absent from work a subsequent time without having obtained

12-46  prior approval from the employer and without being able to demonstrate

12-47  a medical reason for his absence.

 

 

13-1    Sec. 15.  NRS 616C.490 is hereby amended to read as follows:

13-2    616C.490  1.  Except as otherwise provided in NRS 616C.175, every

13-3  employee, in the employ of an employer within the provisions of chapters

13-4  616A to 616D, inclusive, of NRS, who is injured by an accident arising out

13-5  of and in the course of employment is entitled to receive the compensation

13-6  provided for permanent partial disability. As used in this section,

13-7  “disability” and “impairment of the whole man” are equivalent terms.

13-8    2.  Within 30 days after receiving from a physician or chiropractor a

13-9  report indicating that the injured employee may have suffered a permanent

13-10  disability and is stable and ratable, the insurer shall schedule an

13-11  appointment with the rating physician or chiropractor selected pursuant to

13-12  this subsection to determine the extent of the employee’s disability. Unless

13-13  the insurer and the injured employee otherwise agree to a rating physician

13-14  or chiropractor:

13-15  (a) The insurer shall select the rating physician or chiropractor from the

13-16  list of qualified rating physicians and chiropractors designated by the

13-17  administrator, to determine the percentage of disability in accordance with

13-18  the American Medical Association’s Guides to the Evaluation of

13-19  Permanent Impairment as adopted and supplemented by the division

13-20  pursuant to NRS 616C.110.

13-21  (b) Rating physicians and chiropractors must be selected in rotation

13-22  from the list of qualified physicians and chiropractors designated by the

13-23  administrator, according to their area of specialization and the order in

13-24  which their names appear on the list[.] unless the next physician or

13-25  chiropractor is currently an employee of the insurer making the

13-26  selection, in which case the insurer must select the physician or

13-27  chiropractor who is next on the list and who is not currently an employee

13-28  of the insurer.

13-29  3.  When an insurer contacts the physician or chiropractor to

13-30  determine whether an injured employee has suffered a permanent

13-31  disability and, thus, whether a rating is necessary, the insurer shall

13-32  deliver to the physician or chiropractor that portion of the American

13-33  Medical Association’s Guides to the Evaluation of Permanent

13-34  Impairment as adopted by the division pursuant to NRS 616C.110 that is

13-35  relevant to the type of injury incurred by the employee.

13-36  4.  At the request of the insurer, the injured employee shall, before an

13-37  evaluation by a rating physician or chiropractor is performed, notify the

13-38  insurer of:

13-39  (a) Any previous evaluations performed to determine the extent of any

13-40  of the employee’s disabilities; and

13-41  (b) Any previous injury, disease or condition sustained by the employee

13-42  which is relevant to the evaluation performed pursuant to this section.

13-43  The notice must be on a form approved by the administrator and provided

13-44  to the injured employee by the insurer at the time of the insurer’s request.

13-45  [4.] 5.  Unless the regulations adopted pursuant to NRS 616C.110

13-46  provide otherwise, a rating evaluation must include an evaluation of the

13-47  loss of motion, sensation and strength of an injured employee if the injury

13-48  is of a type that might have caused such a loss. [No factors other than the

13-49  degree of physical impairment of the whole man may be considered in

14-1  calculating the entitlement to compensation for a permanent partial

14-2  disability.

14-3    5.] A rating evaluation may include a percentage of disability for a

14-4  psychological impairment that results from the industrial injury.

14-5    6.  A rating evaluation of the spinal region must determine the

14-6  percentage of disability as it existed before any surgical procedures were

14-7  performed on the spinal region, unless the physician or chiropractor

14-8  determines that the injured employee experienced major complications

14-9  from the surgical procedure. If the physician or chiropractor determines

14-10  that an injured employee experienced major complications from a

14-11  surgical procedure performed on the spinal region, the physician or

14-12  chiropractor shall include the effect of the complications when

14-13  determining the percentage of disability of that injured employee. A

14-14  physician or chiropractor may use any method for rating the spinal

14-15  region authorized by the edition of the American Medical Association’s

14-16  Guides to the Evaluation of Permanent Impairment that has been most

14-17  recently adopted by the division pursuant to NRS 616C.110.

14-18  7.  The rating physician or chiropractor shall provide the insurer with

14-19  his evaluation of the injured employee. After receiving the evaluation, the

14-20  insurer shall, within 14 days, provide the employee with a copy of the

14-21  evaluation and notify the employee:

14-22  (a) Of the compensation to which he is entitled pursuant to this section;

14-23  or

14-24  (b) That he is not entitled to benefits for permanent partial disability.

14-25  [6.] 8.  Each 1 percent of impairment of the whole man must be

14-26  compensated by a monthly payment:

14-27  (a) Of 0.5 percent of the claimant’s average monthly wage for injuries

14-28  sustained before July 1, 1981;

14-29  (b) Of 0.6 percent of the claimant’s average monthly wage for injuries

14-30  sustained on or after July 1, 1981, and before June 18, 1993;

14-31  (c) Of 0.54 percent of the claimant’s average monthly wage for injuries

14-32  sustained on or after June 18, 1993, and before January 1, 2000; and

14-33  (d) Of 0.6 percent of the claimant’s average monthly wage for injuries

14-34  sustained on or after January 1, 2000.

14-35  Compensation must commence on the date of the injury or the day

14-36  following the termination of temporary disability compensation, if any,

14-37  whichever is later, and must continue on a monthly basis for 5 years or

14-38  until the claimant is 70 years of age, whichever is later.

14-39  [7.] 9.  Compensation benefits may be paid annually to claimants who

14-40  will be receiving less than $100 a month.

14-41  [8.] 10.  Where there is a previous disability, as the loss of one eye,

14-42  one hand, one foot, or any other previous permanent disability, the

14-43  percentage of disability for a subsequent injury must be determined by

14-44  computing the percentage of the entire disability and deducting therefrom

14-45  the percentage of the previous disability as it existed at the time of the

14-46  subsequent injury.

14-47  [9.] 11.  The division may adopt schedules for rating permanent

14-48  disabilities resulting from injuries sustained before July 1, 1973, and

14-49  reasonable regulations to carry out the provisions of this section.

15-1    [10.] 12.  The increase in compensation and benefits effected by the

15-2  amendment of this section is not retroactive for accidents which occurred

15-3  before July 1, 1973.

15-4    [11.] 13.  This section does not entitle any person to double payments

15-5  for the death of an employee and a continuation of payments for a

15-6  permanent partial disability, or to a greater sum in the aggregate than if the

15-7  injury had been fatal.

15-8    Sec. 16.  NRS 616C.495 is hereby amended to read as follows:

15-9    616C.495  1.  Except as otherwise provided in NRS 616C.380, an

15-10  award for a permanent partial disability may be paid in a lump sum under

15-11  the following conditions:

15-12  (a) A claimant injured on or after July 1, 1973, and before July 1, 1981,

15-13  who incurs a disability that does not exceed 12 percent may elect to receive

15-14  his compensation in a lump sum. A claimant injured on or after July 1,

15-15  1981, and before July 1, 1995, who incurs a disability that does not exceed

15-16  25 percent may elect to receive his compensation in a lump sum.

15-17  (b) The spouse, or in the absence of a spouse, any dependent child of a

15-18  deceased claimant injured on or after July 1, 1973, who is not entitled to

15-19  compensation in accordance with NRS 616C.505, is entitled to a lump sum

15-20  equal to the present value of the deceased claimant’s undisbursed award for

15-21  a permanent partial disability.

15-22  (c) Any claimant injured on or after July 1, 1981, and before July 1,

15-23  1995, who incurs a disability that exceeds 25 percent may elect to receive

15-24  his compensation in a lump sum equal to the present value of an award for

15-25  a disability of 25 percent. If the claimant elects to receive compensation

15-26  pursuant to this paragraph, the insurer shall pay in installments to the

15-27  claimant that portion of the claimant’s disability in excess of 25 percent.

15-28  (d) Any claimant injured on or after July 1, 1995, may elect to receive

15-29  his compensation in a lump sum in accordance with regulations adopted by

15-30  the administrator and approved by the governor. The administrator shall

15-31  adopt regulations for determining the eligibility of such a claimant to

15-32  receive all or any portion of his compensation in a lump sum. Such

15-33  regulations may include the manner in which an award for a permanent

15-34  partial disability may be paid to such a claimant in installments.

15-35  Notwithstanding the provisions of NRS 233B.070, any regulation adopted

15-36  pursuant to this paragraph does not become effective unless it is first

15-37  approved by the governor.

15-38  2.  If the claimant elects to receive his payment for a permanent partial

15-39  disability in a lump sum pursuant to subsection 1, all of his benefits for

15-40  compensation terminate. His acceptance of that payment constitutes a final

15-41  settlement of all factual and legal issues in the case. By so accepting he

15-42  waives all of his rights regarding the claim, including the right to appeal

15-43  from the closure of the case or the percentage of his disability, except:

15-44  (a) His right to reopen his claim according to the provisions of NRS

15-45  616C.390; and

15-46  (b) Any counseling, training or other rehabilitative services provided by

15-47  the insurer.

15-48  The claimant must be advised in writing of the provisions of this

15-49  subsection when he demands his payment in a lump sum, and has 20 days

16-1  after the mailing or personal delivery of this notice within which to retract

16-2  or reaffirm his demand, before payment may be made and his election

16-3  becomes final.

16-4    3.  Any lump-sum payment which has been paid on a claim incurred on

16-5  or after July 1, 1973, must be supplemented if necessary to conform to the

16-6  provisions of this section.

16-7    4.  Except as otherwise provided in this subsection, the total lump-sum

16-8  payment for disablement must not be less than one-half the product of the

16-9  average monthly wage multiplied by the percentage of disability. If the

16-10  claimant received compensation in installment payments for his permanent

16-11  partial disability before electing to receive his payment for that disability in

16-12  a lump sum, the lump-sum payment must be calculated for the remaining

16-13  payment of compensation.

16-14  5.  The lump sum payable must be equal to the present value of the

16-15  compensation awarded, less any advance payment or lump sum previously

16-16  paid. The present value must be calculated using monthly payments in the

16-17  amounts prescribed in subsection [6] 8 of NRS 616C.490 and actuarial

16-18  annuity tables adopted by the division. The tables must be reviewed

16-19  annually by a consulting actuary.

16-20  6.  If a claimant would receive more money by electing to receive

16-21  compensation in a lump sum than he would if he receives installment

16-22  payments, he may elect to receive the lump-sum payment.

16-23  Sec. 17.  NRS 616C.555 is hereby amended to read as follows:

16-24  616C.555  1.  A vocational rehabilitation counselor shall develop a

16-25  plan for a program of vocational rehabilitation for each injured employee

16-26  who is eligible for vocational rehabilitation services pursuant to NRS

16-27  616C.590. The counselor shall work with the insurer and the injured

16-28  employee to develop a program that is compatible with the injured

16-29  employee’s age, sex and physical condition.

16-30  2.  If the counselor determined in the written assessment developed

16-31  pursuant to NRS 616C.550 that the injured employee has existing

16-32  marketable skills, the plan must consist of job placement assistance only.

16-33  When practicable, the goal of job placement assistance must be to aid the

16-34  employee in finding a position which pays a gross wage that is equal to or

16-35  greater than 80 percent of the gross wage that he was earning at the time of

16-36  his injury. An injured employee must not receive job placement assistance

16-37  for more than 6 months after the date on which he was notified that he is

16-38  eligible only for job placement assistance because:

16-39  (a) He was physically capable of returning to work; or

16-40  (b) It was determined that he had existing marketable skills.

16-41  3.  If the counselor determined in the written assessment developed

16-42  pursuant to NRS 616C.550 that the injured employee does not have

16-43  existing marketable skills, the plan must consist of a program which trains

16-44  or educates the injured employee and provides job placement assistance.

16-45  Except as otherwise provided in NRS 616C.560, such a program must not

16-46  exceed:

16-47  (a) If the injured employee has incurred a permanent disability as a

16-48  result of which permanent restrictions on his ability to work have been

16-49  imposed but no permanent physical impairment rating has been issued,

17-1  or a permanent disability with a permanent physical impairment of 1

17-2  percent or more but less than 6 percent, 9 months.

17-3    (b) If the injured employee has incurred a permanent physical

17-4  impairment of 6 percent or more, but less than 11 percent, 1 year.

17-5    (c) If the injured employee has incurred a permanent physical

17-6  impairment of 11 percent or more, 18 months.

17-7  The percentage of the injured employee’s permanent physical impairment

17-8  must be determined pursuant to NRS 616C.490.

17-9    4.  A plan for a program of vocational rehabilitation must comply with

17-10  the requirements set forth in NRS 616C.585.

17-11  5.  A plan created pursuant to subsection 2 or 3 must assist the

17-12  employee in finding a job or train or educate the employee and assist him

17-13  in finding a job that is a part of an employer’s regular business

17-14  operations and from which the employee will gain skills that would

17-15  generally be transferable to a job with another employer.

17-16  6.  A program of vocational rehabilitation must not commence before

17-17  the treating physician or chiropractor, or an examining physician or

17-18  chiropractor determines that the injured employee is capable of safely

17-19  participating in the program.

17-20  [6.] 7.  If, based upon the opinion of a treating or an examining

17-21  physician or chiropractor, the counselor determines that an injured

17-22  employee is not eligible for vocational rehabilitation services, the

17-23  counselor shall provide a copy of the opinion to the injured employee, the

17-24  injured employee’s employer and the insurer.

17-25  [7.] 8.  A plan for a program of vocational rehabilitation must be

17-26  signed by a certified vocational rehabilitation counselor.

17-27  [8.] 9.  If an initial program of vocational rehabilitation pursuant to this

17-28  section is unsuccessful, an injured employee may submit a written request

17-29  for the development of a second program of vocational rehabilitation which

17-30  relates to the same injury. An insurer shall authorize a second program for

17-31  an injured employee upon good cause shown.

17-32  [9.] 10.  If a second program of vocational rehabilitation pursuant to

17-33  subsection [8] 9 is unsuccessful, an injured employee may submit a written

17-34  request for the development of a third program of vocational rehabilitation

17-35  which relates to the same injury. The insurer, with the approval of the

17-36  employer who was the injured employee’s employer at the time of his

17-37  injury, may authorize a third program for the injured employee. If such an

17-38  employer has terminated operations, his approval is not required for

17-39  authorization of a third program. An insurer’s determination to authorize or

17-40  deny a third program of vocational rehabilitation may not be appealed.

17-41  [10.] 11.  The division shall adopt regulations to carry out the

17-42  provisions of this section. The regulations must specify the contents of a

17-43  plan for a program of vocational rehabilitation.

17-44  Sec. 18.  NRS 616C.580 is hereby amended to read as follows:

17-45  616C.580  1.  Except as otherwise provided in this section, vocational

17-46  rehabilitation services must not be provided outside of this state. An

17-47  injured employee who:

17-48  (a) Lives within 50 miles from any border of this state on the date of

17-49  injury; or

18-1    (b) Was injured while temporarily employed in this state by an

18-2  employer subject to the provisions of chapters 616A to 617, inclusive, of

18-3  NRS who can demonstrate that, on the date of injury, his permanent

18-4  residence was outside of this state,

18-5  may receive vocational rehabilitation services at a location within 50 miles

18-6  from his residence if such services are available at such location.

18-7    2.  An injured employee, who:

18-8    (a) Is eligible for vocational rehabilitation services pursuant to NRS

18-9  616C.590; and

18-10  (b) Resides outside of this state but does not qualify to receive

18-11  vocational rehabilitation services outside of this state pursuant to

18-12  subsection 1,

18-13  may execute a written agreement with the insurer which provides for the

18-14  payment of compensation in a lump sum in lieu of the provision of

18-15  vocational rehabilitation services pursuant to NRS 616C.595. The amount

18-16  of the lump sum must not exceed [$15,000.] $25,000.

18-17  3.  An injured employee who resides outside of this state but does not

18-18  qualify to receive vocational rehabilitation services outside of this state

18-19  pursuant to subsection 1 may receive the vocational rehabilitation services

18-20  to which he is entitled pursuant to NRS 616C.545 to 616C.575, inclusive,

18-21  and 616C.590 if he relocates to:

18-22  (a) This state; or

18-23  (b) A location within 50 miles from any border of this state,

18-24  at his own expense, if such services are available at such location.

18-25  Sec. 19.  NRS 616C.590 is hereby amended to read as follows:

18-26  616C.590  1.  Except as otherwise provided in this section, an injured

18-27  employee is not eligible for vocational rehabilitation services, unless:

18-28  (a) The treating physician or chiropractor approves the return of the

18-29  injured employee to work but imposes permanent restrictions that prevent

18-30  the injured employee from returning to the position that he held at the time

18-31  of his injury;

18-32  (b) The injured employee’s employer does not offer employment that

18-33  [the] :

18-34     (1) The employee is eligible for considering the restrictions imposed

18-35  pursuant to paragraph (a); and

18-36     (2) Provides a gross wage that is equal to or greater than 80 percent

18-37  of the gross wage that the employee was earning at the time of his injury;

18-38  and

18-39  (c) The injured employee is unable to return to gainful employment

18-40  with any other employer at a gross wage that is equal to or greater than 80

18-41  percent of the gross wage that [he] the employee was earning at the time of

18-42  his injury.

18-43  2.  If the treating physician or chiropractor imposes permanent

18-44  restrictions on the injured employee for the purposes of paragraph (a) of

18-45  subsection 1, he shall specify in writing:

18-46  (a) The medically objective findings upon which his determination is

18-47  based; and

 

 

19-1    (b) A detailed description of the restrictions.

19-2  The treating physician or chiropractor shall deliver a copy of the findings

19-3  and the description of the restrictions to the insurer.

19-4    3.  If there is a question as to whether the restrictions imposed upon the

19-5  injured employee are permanent, the employee may receive vocational

19-6  rehabilitation services until a final determination concerning the duration

19-7  of the restrictions is made.

19-8    4.  Vocational rehabilitation services must cease as soon as the injured

19-9  employee is no longer eligible for the services pursuant to subsection 1.

19-10  5.  An injured employee is not entitled to vocational rehabilitation

19-11  services solely because the position that he held at the time of his injury is

19-12  no longer available.

19-13  6.  An injured employee or his dependents are not entitled to accrue or

19-14  be paid any money for vocational rehabilitation services during the time

19-15  the injured employee is incarcerated.

19-16  7.  Any injured employee eligible for compensation other than accident

19-17  benefits may not be paid those benefits if he refuses counseling, training or

19-18  other vocational rehabilitation services offered by the insurer. Except as

19-19  otherwise provided in NRS 616B.028 and 616B.029, an injured employee

19-20  shall be deemed to have refused counseling, training and other vocational

19-21  rehabilitation services while he is incarcerated.

19-22  8.  If an insurer cannot locate an injured employee for whom it has

19-23  ordered vocational rehabilitation services, the insurer may close his claim

19-24  21 days after the insurer determines that the employee cannot be located.

19-25  The insurer shall make a reasonable effort to locate the employee.

19-26  9.  The reappearance of the injured employee after his claim has been

19-27  closed does not automatically reinstate his eligibility for vocational

19-28  rehabilitation benefits. If the employee wishes to reestablish his eligibility

19-29  for such benefits, he must file a written application with the insurer to

19-30  reinstate his claim. The insurer shall reinstate the employee’s claim if good

19-31  cause is shown for the employee’s absence.

19-32  Sec. 20.  Chapter 616D of NRS is hereby amended by adding thereto a

19-33  new section to read as follows:

19-34  1.  A cause of action may be brought and maintained against an

19-35  insurer or a third-party administrator, by a claimant who has not

19-36  accepted a benefit penalty pursuant to NRS 616D.120, which alleges that

19-37  the insurer or third-party administrator has, with knowledge of or

19-38  reckless disregard for his lack of a justification, denied or unreasonably

19-39  delayed payment of compensation to that claimant.

19-40  2.  A claimant may pursue a cause of action against an insurer or

19-41  third-party administrator pursuant to subsection 1 and file a complaint

19-42  with the administrator alleging a violation of any of the provisions of

19-43  paragraphs (a) to (d), inclusive, of subsection 1 of NRS 616D.120, but

19-44  may not accept a benefit penalty from that insurer or third-party

19-45  administrator unless he first waives, in writing, all rights to:

19-46  (a) Proceed in the previously instituted action; and

19-47  (b) Bring any future action against the insurer or third-party

19-48  administrator pursuant to subsection 1.

20-1  Such a claimant must deliver to the insurer or third-party administrator

20-2  the written waiver within 5 days after the insurer or third-party

20-3  administrator attempts to deliver the benefit penalty to the claimant.

20-4    3.  If a claimant who has brought a cause of action against an

20-5  insurer or third-party administrator pursuant to subsection 1 does not

20-6  wish to participate in an investigation conducted by the administrator

20-7  pursuant to NRS 616D.130 against that insurer or third-party

20-8  administrator, the claimant may notify the administrator that he is

20-9  pursuing a cause of action against that insurer or third-party

20-10  administrator pursuant to subsection 1 and is waiving his right to receive

20-11  a benefit penalty from that insurer or third-party administrator. If a

20-12  claimant notifies the administrator that he is pursuing a cause of action

20-13  against an insurer or third-party administrator pursuant to subsection 1,

20-14  the administrator shall not require the claimant to participate in the

20-15  investigation concerning that insurer or third-party administrator and

20-16  shall not impose a benefit penalty on that insurer or third-party

20-17  administrator.

20-18  4.  A claimant who:

20-19  (a) Wishes to preserve his right to bring or maintain a cause of action

20-20  against an insurer or third-party administrator pursuant to subsection 1;

20-21  and

20-22  (b) Is offered a benefit penalty by that insurer or third-party

20-23  administrator pursuant to an order of the administrator issued pursuant

20-24  to subsection 3 of NRS 616D.120,

20-25  must refuse to accept the benefit penalty and must deliver to the insurer

20-26  or third-party administrator a written refusal to accept the benefit penalty

20-27  within 5 days after the insurer or third-party administrator attempts to

20-28  deliver the benefit penalty.

20-29  Sec. 21.  NRS 616D.010 is hereby amended to read as follows:

20-30  616D.010  Except as otherwise provided in NRS 616A.020, 616B.600

20-31  and 616C.190, and section 20 of this act, no penalty or remedy provided in

20-32  this chapter or chapter 616A, 616B or 616C of NRS is exclusive of any

20-33  other penalty or remedy, but is cumulative and in addition to every other

20-34  penalty or remedy and may be exercised without exhausting and without

20-35  regard to any other penalty or remedy provided by those chapters or any

20-36  other statute.

20-37  Sec. 22.  NRS 616D.030 is hereby amended to read as follows:

20-38  616D.030  1.  [No] Except as otherwise provided in section 20 of this

20-39  act, no cause of action may be brought or maintained against an insurer or

20-40  a third-party administrator who violates any provision of this chapter or

20-41  chapter 616A, 616B, 616C or 617 of NRS.

20-42  2.  [The] Except as otherwise provided in section 20 of this act, the

20-43  administrative fines provided for in NRS 616B.318 and 616D.120 are the

20-44  exclusive remedies for any violation of this chapter or chapter 616A, 616B,

20-45  616C or 617 of NRS committed by an insurer or a third-party

20-46  administrator.

 

21-1    Sec. 23.  NRS 616D.050 is hereby amended to read as follows:

21-2    616D.050  1.  Appeals officers, the administrator, and the

21-3  administrator’s designee, in conducting hearings or other proceedings

21-4  pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter

21-5  617 of NRS or regulations adopted pursuant to those chapters may:

21-6    (a) [Issue] Except as otherwise provided in subsection 3 of section 20

21-7  of this act, issue subpoenas requiring the attendance of any witness or the

21-8  production of books, accounts, papers, records and documents.

21-9    (b) Administer oaths.

21-10  (c) Certify to official acts.

21-11  (d) [Call] Except as otherwise provided in subsection 3 of section 20 of

21-12  this act, call and examine under oath any witness or party to a claim.

21-13  (e) Maintain order.

21-14  (f) Rule upon all questions arising during the course of a hearing or

21-15  proceeding.

21-16  (g) Permit discovery by deposition or interrogatories.

21-17  (h) Initiate and hold conferences for the settlement or simplification of

21-18  issues.

21-19  (i) Dispose of procedural requests or similar matters.

21-20  (j) Generally regulate and guide the course of a pending hearing or

21-21  proceeding.

21-22  2.  Hearing officers, in conducting hearings or other proceedings

21-23  pursuant to the provisions of chapters 616A to 616D, inclusive, or chapter

21-24  617 of NRS or regulations adopted pursuant to those chapters, may:

21-25  (a) Issue subpoenas requiring the attendance of any witness or the

21-26  production of books, accounts, papers, records and documents that are

21-27  relevant to the dispute for which the hearing or other proceeding is being

21-28  held.

21-29  (b) Maintain order.

21-30  (c) Permit discovery by deposition or interrogatories.

21-31  (d) Initiate and hold conferences for the settlement or simplification of

21-32  issues.

21-33  (e) Dispose of procedural requests or similar matters.

21-34  (f) Generally regulate and guide the course of a pending hearing or

21-35  proceeding.

21-36  Sec. 24.  NRS 616D.120 is hereby amended to read as follows:

21-37  616D.120  1.  Except as otherwise provided in this section, if the

21-38  administrator determines that an insurer, organization for managed care,

21-39  health care provider, third-party administrator or employer has:

21-40  (a) Through fraud, coercion, duress or undue influence:

21-41     (1) Induced a claimant to fail to report an accidental injury or

21-42  occupational disease;

21-43     (2) Persuaded a claimant to settle for an amount which is less than

21-44  reasonable;

21-45     (3) Persuaded a claimant to settle for an amount which is less than

21-46  reasonable while a hearing or an appeal is pending; or

21-47     (4) Persuaded a claimant to accept less than the compensation found

21-48  to be due him by a hearing officer, appeals officer, court of competent

21-49  jurisdiction, written settlement agreement, written stipulation or the

22-1  division when carrying out its duties pursuant to chapters 616A to 617,

22-2  inclusive, of NRS;

22-3    (b) Refused to pay or unreasonably delayed payment to a claimant of

22-4  compensation found to be due him by a hearing officer, appeals officer,

22-5  court of competent jurisdiction, written settlement agreement, written

22-6  stipulation or the division when carrying out its duties pursuant to chapters

22-7  616A to 616D, inclusive, or chapter 617 of NRS, if the refusal or delay

22-8  occurs:

22-9      (1) Later than 10 days after the date of the settlement agreement or

22-10  stipulation;

22-11     (2) Later than 30 days after the date of the decision of a court,

22-12  hearing officer, appeals officer or division, unless a stay has been granted;

22-13  or

22-14     (3) Later than 10 days after a stay of the decision of a court, hearing

22-15  officer, appeals officer or division has been lifted;

22-16  (c) Refused to process a claim for compensation pursuant to chapters

22-17  616A to 616D, inclusive, or chapter 617 of NRS;

22-18  (d) Made it necessary for a claimant to initiate proceedings pursuant to

22-19  chapters 616A to 616D, inclusive, or chapter 617 of NRS for compensation

22-20  found to be due him by a hearing officer, appeals officer, court of

22-21  competent jurisdiction, written settlement agreement, written stipulation or

22-22  the division when carrying out its duties pursuant to chapters 616A to

22-23  616D, inclusive, or chapter 617 of NRS;

22-24  (e) Failed to comply with the division’s regulations covering the

22-25  payment of an assessment relating to the funding of costs of administration

22-26  of chapters 616A to 617, inclusive, of NRS;

22-27  (f) Failed to provide or unreasonably delayed payment to an injured

22-28  employee or reimbursement to an insurer pursuant to NRS 616C.165; or

22-29  (g) Intentionally failed to comply with any provision of, or regulation

22-30  adopted pursuant to, this chapter or chapter 616A, 616B, 616C or 617 of

22-31  NRS,

22-32  the administrator shall impose an administrative fine of $1,000 for each

22-33  initial violation, or a fine of $10,000 for a second or subsequent violation.

22-34  2.  Except as otherwise provided in chapters 616A to 616D, inclusive,

22-35  or chapter 617 of NRS, if the administrator determines that an insurer,

22-36  organization for managed care, health care provider, third-party

22-37  administrator or employer has failed to comply with any provision of this

22-38  chapter or chapter 616A, 616B, 616C or 617 of NRS, or any regulation

22-39  adopted pursuant thereto, the administrator may take any of the following

22-40  actions:

22-41  (a) Issue a notice of correction for:

22-42     (1) A minor violation, as defined by regulations adopted by the

22-43  division; or

22-44     (2) A violation involving the payment of compensation in an amount

22-45  which is greater than that required by any provision of this chapter or

22-46  chapter 616A, 616B, 616C or 617 of NRS, or any regulation adopted

22-47  pursuant thereto.

22-48  The notice of correction must set forth with particularity the violation

22-49  committed and the manner in which the violation may be corrected. The

23-1  provisions of this section do not authorize the administrator to modify or

23-2  negate in any manner a determination or any portion of a determination

23-3  made by a hearing officer, appeals officer or court of competent

23-4  jurisdiction or a provision contained in a written settlement agreement or

23-5  written stipulation.

23-6    (b) Impose an administrative fine for:

23-7      (1) A second or subsequent violation for which a notice of correction

23-8  has been issued pursuant to paragraph (a); or

23-9      (2) Any other violation of this chapter or chapter 616A, 616B, 616C

23-10  or 617 of NRS, or any regulation adopted pursuant thereto, for which a

23-11  notice of correction may not be issued pursuant to paragraph (a).

23-12  The fine imposed may not be greater than $250 for an initial violation, or

23-13  more than $1,000 for any second or subsequent violation.

23-14  (c) Order a plan of corrective action to be submitted to the administrator

23-15  within 30 days after the date of the order.

23-16  3.  [If] Unless a claimant has notified the administrator that,

23-17  pursuant to subsection 3 of section 20 of this act, the claimant is

23-18  pursuing a cause of action against an insurer or third-party

23-19  administrator and waiving his right to receive a benefit penalty, if the

23-20  administrator determines that a violation of any of the provisions of

23-21  paragraphs (a) to (d), inclusive, of subsection 1 has occurred, the

23-22  administrator shall order the insurer, organization for managed care, health

23-23  care provider, third-party administrator or employer to pay to the claimant

23-24  a benefit penalty in an amount that is not less than $5,000 and not greater

23-25  than $25,000. To determine the amount of the benefit penalty, the

23-26  administrator shall consider the degree of physical harm suffered by the

23-27  injured employee or his dependents as a result of the violation of paragraph

23-28  (a), (b), (c) or (d) of subsection 1, the amount of compensation found to be

23-29  due the claimant and the number of fines and benefit penalties previously

23-30  imposed against the insurer, organization for managed care, health care

23-31  provider, third-party administrator or employer pursuant to this section. If

23-32  this is the third violation within 5 years for which a benefit penalty has

23-33  been imposed against the insurer, organization for managed care, health

23-34  care provider, third-party administrator or employer, the administrator shall

23-35  also consider the degree of economic harm suffered by the injured

23-36  employee or his dependents as a result of the violation of paragraph (a),

23-37  (b), (c) or (d) of subsection 1. Except as otherwise provided in this section,

23-38  the benefit penalty is for the benefit of the claimant and must be paid

23-39  directly to him within 10 days after the date of the administrator’s

23-40  determination. If the claimant is the injured employee and he dies before

23-41  the benefit penalty is paid to him, the benefit penalty must be paid to his

23-42  estate. If the claimant has, pursuant to section 20 of this act, brought an

23-43  action against an insurer or third-party administrator who is subject to

23-44  an order of the administrator pursuant to this section, the insurer or

23-45  third-party administrator is not required to pay the penalty to the

23-46  claimant if the claimant:

 

 

24-1    (a) Refuses to deliver a written waiver pursuant to subsection 2 of

24-2  section 20 of this act; or

24-3    (b) Delivers to the insurer or third-party administrator a written

24-4  refusal to accept the benefit penalty pursuant to subsection 4 of section

24-5  20 of this act.

24-6  Proof of the payment of the benefit penalty , the claimant’s refusal to

24-7  deliver a written waiver or the claimant’s refusal to accept the benefit

24-8  penalty must be submitted to the administrator within 10 days after the date

24-9  of his determination unless an appeal is filed pursuant to NRS 616D.140.

24-10  Any compensation to which the claimant may otherwise be entitled

24-11  pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS must

24-12  not be reduced by the amount of any benefit penalty received pursuant to

24-13  this subsection.

24-14  4.  In addition to any fine or benefit penalty imposed pursuant to this

24-15  section, the administrator may assess against an insurer who violates any

24-16  regulation concerning the reporting of claims expenditures used to

24-17  calculate an assessment an administrative penalty of up to twice the

24-18  amount of any underpaid assessment.

24-19  5.  If:

24-20  (a) The administrator determines that a person has violated any of the

24-21  provisions of NRS 616D.200, 616D.220, 616D.240, 616D.300, 616D.310

24-22  or 616D.350 to 616D.440, inclusive; and

24-23  (b) The fraud control unit for industrial insurance established pursuant

24-24  to NRS 228.420 notifies the administrator that the unit will not prosecute

24-25  the person for that violation,

24-26  the administrator shall impose an administrative fine of not more than

24-27  $10,000.

24-28  6.  Two or more fines of $1,000 or more imposed in 1 year for acts

24-29  enumerated in subsection 1 must be considered by the commissioner as

24-30  evidence for the withdrawal of:

24-31  (a) A certificate to act as a self-insured employer.

24-32  (b) A certificate to act as an association of self-insured public or private

24-33  employers.

24-34  (c) A certificate of registration as a third-party administrator.

24-35  7.  The commissioner may, without complying with the provisions of

24-36  NRS 616B.327 or 616B.431, withdraw the certification of a self-insured

24-37  employer, association of self-insured public or private employers or third-

24-38  party administrator if, after a hearing, it is shown that the self-insured

24-39  employer, association of self-insured public or private employers or third-

24-40  party administrator violated any provision of subsection 1.

24-41  Sec. 25.  NRS 616D.140 is hereby amended to read as follows:

24-42  616D.140  1.  If a person wishes to contest a decision of the

24-43  administrator to impose an administrative fine or benefit penalty pursuant

24-44  to this chapter or chapter 616A, 616B, 616C or 617 of NRS, he must file a

24-45  notice of appeal with the division within 10 days after receipt of the

24-46  administrator’s decision, showing why the proposed fine or benefit penalty

24-47  should not be imposed.

 

25-1    2.  If a notice of appeal is filed as required by subsection 1, the

25-2  administrator shall, in accordance with the provisions of NRS 233B.121,

25-3  issue a notice of hearing that must include a date for a hearing on the

25-4  matter, which must be no sooner than 30 days after the notice of appeal is

25-5  filed. The administrator may grant a continuance of the hearing upon a

25-6  showing of good cause.

25-7    3.  [If] Except as otherwise provided in this subsection, if a notice of

25-8  appeal is not filed as required by this section, the imposition of the fine or

25-9  benefit penalty shall be deemed a final order and is not subject to review by

25-10  any court or agency. If the claimant on whose behalf a benefit penalty is

25-11  imposed:

25-12  (a) Refused to deliver to an insurer or third-party administrator a

25-13  written waiver pursuant to subsection 2 of section 20 of this act; or

25-14  (b) Delivered a written refusal to accept the benefit penalty pursuant

25-15  to subsection 4 of section 20 of this act,

25-16  the imposition of a benefit penalty against the insurer or third-party

25-17  administrator shall not be deemed a final order pursuant to this

25-18  subsection.

25-19  4.  Except as otherwise provided in NRS 616A.467, a hearing held

25-20  pursuant to this section must be conducted by the administrator or a person

25-21  designated by him. A record of the hearing must be kept but it need not be

25-22  transcribed unless it is requested by the person against whom the order or

25-23  notice of violation has been issued and that person pays the cost of

25-24  transcription. The administrator shall render a written decision on the

25-25  appeal.

25-26  5.  An administrative fine imposed pursuant to this chapter or chapter

25-27  616A, 616B, 616C or 617 of NRS must be paid to the division. If the

25-28  violation for which the fine is levied was committed by a person while

25-29  acting within the course and scope of his agency or employment, the fine

25-30  must be paid by his principal or employer. The fine may be recovered in a

25-31  civil action brought in the name of the division in a court of competent

25-32  jurisdiction in the county in which the violation occurred or in which the

25-33  person against whom the fine is levied has his principal place of business.

25-34  6.  [A] Except as otherwise provided in subsection 3 of NRS

25-35  616D.120, a benefit penalty imposed pursuant to NRS 616D.120 must be

25-36  paid to the claimant on whose behalf it is imposed. If such payment is not

25-37  made within the period required by NRS 616D.120[,] and the insurer or

25-38  third-party administrator cannot demonstrate that the claimant refused

25-39  to deliver a written waiver or delivered a written refusal to accept the

25-40  benefit penalty pursuant to subsection 2 or 4 of section 20 of this act, the

25-41  benefit penalty may be recovered in a civil action brought by the

25-42  administrator on behalf of the claimant in a court of competent jurisdiction

25-43  in the county in which the claimant resides, in which the violation occurred

25-44  or in which the person who is required to pay the benefit penalty has his

25-45  principal place of business.

25-46  7.  Any party aggrieved by a decision of the administrator rendered

25-47  pursuant to this section may appeal the decision directly to the district

25-48  court.

 

26-1    Sec. 26.  NRS 617.510 is hereby amended to read as follows:

26-2    617.510  Except as otherwise provided in NRS 617.017, and section 20

26-3  of this act, no penalty or remedy provided in this chapter is exclusive of

26-4  any other penalty or remedy, but is cumulative and in addition to every

26-5  other penalty or remedy and may be exercised without exhausting and

26-6  without regard to any other penalty or remedy provided by this chapter or

26-7  any other statute.

 

26-8  H