Assembly Bill No. 338–Assemblyman Bache
CHAPTER..........
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
Sections. 1-3. (Deleted by amendment.)
Sec. 4. NRS 616B.527 is hereby amended to read as follows:
616B.527 1. A self-insured employer, an association of self-insured
public or private employers or a private carrier may:
[1.] (a) Enter into a contract or contracts with one or more
organizations for managed care to provide comprehensive medical and
health care services to employees for injuries and diseases that are
compensable pursuant to chapters 616A to 617, inclusive, of NRS.
[2.] (b) Enter into a contract or contracts with providers of health care,
including, without limitation, physicians who provide primary care,
specialists, pharmacies, physical therapists, radiologists, nurses, diagnostic
facilities, laboratories, hospitals and facilities that provide treatment to
outpatients, to provide medical and health care services to employees for
injuries and diseases that are compensable pursuant to chapters 616A to
617, inclusive, of NRS.
[3.] (c) Require employees to obtain medical and health care services
for their industrial injuries from those organizations and persons with
whom the self-insured employer, association or private carrier has
contracted pursuant to [subsections 1 and 2,] paragraphs (a) and (b), or as
the self-insured employer, association or private carrier otherwise
prescribes.
[4. Require]
(d) Except as otherwise provided in subsection 3 of NRS 616C.090,
require employees to obtain the approval of the self-insured employer,
association or private carrier before obtaining medical and health care
services for their industrial injuries from a provider of health care who has
not been previously approved by the self-insured employer, association or
private carrier.
[5.] 2. An organization for managed care with whom a self-insured
employer, association of self-insured public or private employers or a
private carrier has contracted pursuant to this section shall comply with the
provisions of NRS 616B.528, 616B.5285 and 616B.529.
Sec. 5. Chapter 616C of NRS is hereby amended by adding thereto a
new section to read as follows:
If:
1. An insurer, an organization for managed care, a third-party
administrator or an employer who provides accident benefits for injured
employees pursuant to NRS 616C.265 denies authorization or
responsibility for payment for treatment or other services provided by a
provider of health care that the injured employee alleges are related to
an industrial injury or occupational disease;
2. The injured employee pays in protest for the treatment or other
services; and
3. A hearing officer or appeals officer ultimately determines that the
treatment or other services should have been covered, or the insurer,
organization for managed care, third-party administrator or employer
who provides accident benefits subsequently accepts responsibility for
payment,
the hearing officer or appeals officer shall order the insurer,
organization for managed care, third-party administrator or employer
who provides accident benefits to pay to the provider of health care the
amount which is allowed for the treatment or other services set forth in
the schedule of fees and charges established pursuant to NRS 616C.260
or, if the insurer has contracted with an organization for managed care
or with providers of health care pursuant to NRS 616B.527, the amount
that is allowed for the treatment or other services under that contract.
Within 30 days after receiving the payment, the provider of health care
shall reimburse the injured employee for the amount paid in protest by
him.
Sec. 6. NRS 616C.050 is hereby amended to read as follows:
616C.050 1. An insurer shall provide to each claimant:
(a) Upon written request, one copy of any medical information
concerning his injury or illness.
(b) A statement which contains information concerning the claimant’s
right to:
(1) Receive the information and forms necessary to file a claim;
(2) Select a treating physician or chiropractor and an alternative
treating physician or chiropractor in accordance with the provisions of
NRS 616C.090;
(3) Request the appointment of the Nevada attorney for injured
workers to represent him before the appeals officer;
(4) File a complaint with the administrator;
(5) When applicable, receive compensation for:
(I) Permanent total disability;
(II) Temporary total disability;
(III) Permanent partial disability;
(IV) Temporary partial disability; or
(V) All medical costs related to his injury or disease;
(6) Receive services for rehabilitation if his injury prevents him from
returning to gainful employment;
(7) Review by a hearing officer of any determination or rejection of a
claim by the insurer within the time specified by statute; and
(8) Judicial review of any final decision within the time specified by
statute.
2. The insurer’s statement must include a copy of the form designed
by the administrator pursuant to subsection 7 of NRS 616C.090 that
notifies injured employees of their right to select an alternative treating
physician or chiropractor. The administrator shall adopt regulations for
the manner of compliance by an insurer with the other provisions of
subsection 1.
Sec. 7. NRS 616C.090 is hereby amended to read as follows:
616C.090 1. The administrator shall establish a panel of physicians
and chiropractors who have demonstrated special competence and interest
in industrial health to treat injured employees under chapters 616A to
616D, inclusive, or chapter 617 of NRS. Every employer whose insurer
has not entered into a contract with an organization for managed care or
with providers of health care services pursuant to NRS 616B.527 shall
maintain a list of those physicians and chiropractors on the panel who are
reasonably accessible to his employees.
2. An injured employee whose employer’s insurer has not entered into
a contract with an organization for managed care or with providers of
health care services pursuant to NRS 616B.527 may choose his treating
physician or chiropractor from the panel of physicians and chiropractors.
If the injured employee is not satisfied with the first physician or
chiropractor he so chooses, he may make an alternative choice of
physician or chiropractor from the panel if the choice is made within 90
days after his injury. The insurer shall notify the first physician or
chiropractor in writing. The notice must be postmarked within 3 working
days after the insurer receives knowledge of the change. The first
physician or chiropractor must be reimbursed only for the services he
rendered to the injured employee up to and including the date of
notification. [Any] Except as otherwise provided in this subsection, any
further change is subject to the approval of the insurer, which must be
granted or denied within 10 days after a written request for such a change
is received from the injured employee. If no action is taken on the request
within 10 days, the request shall be deemed granted. Any request for a
change of physician or chiropractor must include the name of the new
physician or chiropractor chosen by the injured employee. If the treating
physician or chiropractor refers the injured employee to a specialist for
treatment, the treating physician or chiropractor shall provide to the
injured employee a list that includes the name of each physician or
chiropractor with that specialization who is on the panel. After receiving
the list, the injured employee shall, at the time the referral is made,
select a physician or chiropractor from the list.
3. An injured employee whose employer’s insurer has entered into a
contract with an organization for managed care or with providers of health
care services pursuant to NRS 616B.527 must choose his treating
physician or chiropractor pursuant to the terms of that contract. If the
injured employee is not satisfied with the first physician or chiropractor he
so chooses, he may make an alternative choice of physician or
chiropractor pursuant to the terms of the contract if the choice is made
within 90 days after his injury. If the injured employee, after choosing his
treating
physician or chiropractor, moves to a county which is not served by the
organization for managed care or providers of health care services named
in the contract and the insurer determines that it is impractical for the
injured employee to continue treatment with the physician or chiropractor,
the injured employee must choose a treating physician or chiropractor who
has agreed to the terms of that contract unless the insurer authorizes the
injured employee to choose another physician or chiropractor. If the
treating physician or chiropractor refers the injured employee to a
specialist for treatment, the treating physician or chiropractor shall
provide to the injured employee a list that includes the name of each
physician or chiropractor with that specialization who is available
pursuant to the terms of the contract with the organization for managed
care or with providers of health care services pursuant to NRS
616B.527, as appropriate. After receiving the list, the injured employee
shall, at the time the referral is made, select a physician or chiropractor
from the list. If the employee fails to select a physician or chiropractor,
the insurer may select a physician or chiropractor with that
specialization. If a physician or chiropractor with that specialization is
not available pursuant to the terms of the contract, the organization for
managed care or the provider of health care services may select a
physician or chiropractor with that specialization.
4. Except when emergency medical care is required and except as
otherwise provided in NRS 616C.055, the insurer is not responsible for
any charges for medical treatment or other accident benefits furnished or
ordered by any physician, chiropractor or other person selected by the
injured employee in disregard of the provisions of this section or for any
compensation for any aggravation of the injured employee’s injury
attributable to improper treatments by such physician, chiropractor or
other person.
5. The administrator may order necessary changes in a panel of
physicians and chiropractors and shall suspend or remove any physician or
chiropractor from a panel for good cause shown.
6. An injured employee may receive treatment by more than one
physician or chiropractor if the insurer provides written authorization for
such treatment.
7. The administrator shall design a form that notifies injured
employees of their right pursuant to subsections 2 and 3 to select an
alternative treating physician or chiropractor and make the form
available to insurers for distribution pursuant to subsection 2 of NRS
616C.050.
Secs. 8 and 9. (Deleted by amendment.)
Sec. 10. NRS 616C.135 is hereby amended to read as follows:
616C.135 1. A provider of health care who accepts a patient as a
referral for the treatment of an industrial injury or an occupational disease
may not charge the patient for any treatment related to the industrial injury
or occupational disease, but must charge the insurer. The provider of
health care may charge the patient for any other unrelated services which
are requested in writing by the patient.
2. The insurer is liable for the charges for approved services if the
charges do not exceed:
(a) The fees established in accordance with NRS 616C.260 or the usual
fee charged by that person or institution, whichever is less; and
(b) The charges provided for by the contract between the provider of
health care and the insurer or the contract between the provider of health
care and the organization for managed care.
3. A provider of health care may accept payment from an injured
employee who is paying in protest pursuant to section 5 of this act for
treatment or other services that the injured employee alleges are related
to the industrial injury or occupational disease.
4. If a provider of health care, an organization for managed care, an
insurer or an employer violates the provisions of this section, the
administrator shall impose an administrative fine of not more than $250
for each violation.
Sec. 11. NRS 616C.330 is hereby amended to read as follows:
616C.330 1. The hearing officer shall:
(a) Within 5 days after receiving a request for a hearing, set the hearing
for a date and time within 30 days after his receipt of the request;
(b) Give notice by mail or by personal service to all interested parties to
the hearing at least 15 days before the date and time scheduled; and
(c) Conduct hearings expeditiously and informally.
2. The notice must include a statement that the injured employee may
be represented by a private attorney or seek assistance and advice from the
Nevada attorney for injured workers.
3. If necessary to resolve a medical question concerning an injured
employee’s condition or to determine the necessity of treatment for which
authorization for payment has been denied, the hearing officer may refer
the employee to a physician or chiropractor of his choice who has
demonstrated special competence to treat the particular medical condition
of the employee. If the medical question concerns the rating of a
permanent disability, the hearing officer may refer the employee to a
rating physician or chiropractor. The rating physician or chiropractor must
be selected in rotation from the list of qualified physicians and
chiropractors maintained by the administrator pursuant to subsection 2 of
NRS 616C.490, unless the insurer and injured employee otherwise agree
to a rating physician or chiropractor. The insurer shall pay the costs of any
medical examination requested by the hearing officer.
4. If an injured employee has requested payment for the cost of
obtaining a second determination of his percentage of disability pursuant
to NRS 616C.100, the hearing officer shall decide whether the
determination of the higher percentage of disability made pursuant to NRS
616C.100 is appropriate and, if so, may order the insurer to pay to the
employee an amount equal to the maximum allowable fee established by
the administrator pursuant to NRS 616C.260 for the type of service
performed, or the usual fee of that physician or chiropractor for such
service, whichever is less.
5. The hearing officer shall order an insurer, organization for
managed care or employer who provides accident benefits for injured
employees pursuant to NRS 616C.265 to pay the charges of a provider of
health care if the conditions of section 5 of this act are satisfied.
6. The hearing officer may allow or forbid the presence of a court
reporter and the use of a tape recorder in a hearing.
[6.] 7. The hearing officer shall render his decision within 15 days
after:
(a) The hearing; or
(b) He receives a copy of the report from the medical examination he
requested.
[7.] 8. The hearing officer shall render his decision in the most
efficient format developed by the chief of the hearings division of the
department of administration.
[8.] 9. The hearing officer shall give notice of his decision to each
party by mail. He shall include with the notice of his decision the
necessary forms for appealing from the decision.
[9.] 10. Except as otherwise provided in NRS 616C.380, the decision
of the hearing officer is not stayed if an appeal from that decision is taken
unless an application for a stay is submitted by a party. If such an
application is submitted, the decision is automatically stayed until a
determination is made on the application. A determination on the
application must be made within 30 days after the filing of the application.
If, after reviewing the application, a stay is not granted by the hearing
officer or an appeals officer, the decision must be complied with within 10
days after the refusal to grant a stay.
Sec. 12. NRS 616C.360 is hereby amended to read as follows:
616C.360 1. A stenographic or electronic record must be kept of the
hearing before the appeals officer and the rules of evidence applicable to
contested cases under chapter 233B of NRS apply to the hearing.
2. The appeals officer must hear any matter raised before him on its
merits, including new evidence bearing on the matter.
3. If necessary to resolve a medical question concerning an injured
employee’s condition or to determine the necessity of treatment for which
authorization for payment has been denied, the appeals officer may refer
the employee to a physician or chiropractor of his choice who has
demonstrated special competence to treat the particular medical condition
of the employee. If the medical question concerns the rating of a
permanent disability, the appeals officer may refer the employee to a
rating physician or chiropractor. The rating physician or chiropractor must
be selected in rotation from the list of qualified physicians or chiropractors
maintained by the administrator pursuant to subsection 2 of NRS
616C.490, unless the insurer and the injured employee otherwise agree to
a rating physician or chiropractor. The insurer shall pay the costs of any
examination requested by the appeals officer.
4. If an injured employee has requested payment for the cost of
obtaining a second determination of his percentage of disability pursuant
to NRS 616C.100, the appeals officer shall decide whether the
determination of the higher percentage of disability made pursuant to NRS
616C.100 is appropriate and, if so, may order the insurer to pay to the
employee an amount equal to the maximum allowable fee established by
the administrator pursuant to NRS 616C.260 for the type of service
performed, or the usual fee of that physician or chiropractor for such
service, whichever is less.
5. The appeals officer shall order an insurer, organization for
managed care or employer who provides accident benefits for injured
employees pursuant to NRS 616C.265 to pay the charges of a provider of
health care if the conditions of section 5 of this act are satisfied.
6. Any party to the appeal or the appeals officer may order a transcript
of the record of the hearing at any time before the seventh day after the
hearing. The transcript must be filed within 30 days after the date of the
order unless the appeals officer otherwise orders.
[6.] 7. The appeals officer shall render his decision:
(a) If a transcript is ordered within 7 days after the hearing, within 30
days after the transcript is filed; or
(b) If a transcript has not been ordered, within 30 days after the date of
the hearing.
[7.] 8. The appeals officer may affirm, modify or reverse any decision
made by the hearing officer and issue any necessary and proper order to
give effect to his decision.
Sec. 13. (Deleted by amendment.)
Sec. 14. NRS 616C.475 is hereby amended to read as follows:
616C.475 1. Except as otherwise provided in this section, NRS
616C.175 and 616C.390, every employee in the employ of an employer,
within the provisions of chapters 616A to 616D, inclusive, of NRS, who is
injured by accident arising out of and in the course of employment, or his
dependents, is entitled to receive for the period of temporary total
disability, 66 2/3 percent of the average monthly wage.
2. Except as otherwise provided in NRS 616B.028 and 616B.029, an
injured employee or his dependents are not entitled to accrue or be paid
any benefits for a temporary total disability during the time the injured
employee is incarcerated. The injured employee or his dependents are
entitled to receive such benefits when the injured employee is released
from incarceration if he is certified as temporarily totally disabled by a
physician or chiropractor.
3. If a claim for the period of temporary total disability is allowed, the
first payment pursuant to this section must be issued by the insurer within
14 working days after receipt of the initial certification of disability and
regularly thereafter.
4. Any increase in compensation and benefits effected by the
amendment of subsection 1 is not retroactive.
5. Payments for a temporary total disability must cease when:
(a) A physician or chiropractor determines that the employee is
physically capable of any gainful employment for which the employee is
suited, after giving consideration to the employee’s education, training and
experience;
(b) The employer offers the employee light-duty employment or
employment that is modified according to the limitations or restrictions
imposed by a physician or chiropractor pursuant to subsection 7; or
(c) Except as otherwise provided in NRS 616B.028 and 616B.029, the
employee is incarcerated.
6. Each insurer may, with each check that it issues to an injured
employee for a temporary total disability, include a form approved by the
division for the injured employee to request continued compensation for
the temporary total disability.
7. A certification of disability issued by a physician or chiropractor
must:
(a) Include the period of disability and a description of any physical
limitations or restrictions imposed upon the work of the employee;
(b) Specify whether the limitations or restrictions are permanent or
temporary; and
(c) Be signed by the treating physician or chiropractor authorized
pursuant to NRS 616B.527[.] or appropriately chosen pursuant to
subsection 3 of NRS 616C.090.
8. If the certification of disability specifies that the physical limitations
or restrictions are temporary, the employer of the employee at the time of
his accident is not required to comply with NRS 616C.545 to 616C.575,
inclusive, and 616C.590 or the regulations adopted by the division
governing vocational rehabilitation services if the employer offers the
employee temporary, light-duty employment. Any offer of temporary,
light-duty employment made by the employer must specify a position that:
(a) Is substantially similar to the employee’s position at the time of his
injury in relation to the location of the employment and the hours he is
required to work; and
(b) Provides a gross wage that is:
(1) If the position is in the same classification of employment, equal
to the gross wage the employee was earning at the time of his injury; or
(2) If the position is not in the same classification of employment,
substantially similar to the gross wage the employee was earning at the
time of his injury.
Sec. 15. NRS 616C.490 is hereby amended to read as follows:
616C.490 1. Except as otherwise provided in NRS 616C.175, every
employee, in the employ of an employer within the provisions of chapters
616A to 616D, inclusive, of NRS, who is injured by an accident arising
out of and in the course of employment is entitled to receive the
compensation provided for permanent partial disability. As used in this
section, “disability” and “impairment of the whole man” are equivalent
terms.
2. Within 30 days after receiving from a physician or chiropractor a
report indicating that the injured employee may have suffered a permanent
disability and is stable and ratable, the insurer shall schedule an
appointment with the rating physician or chiropractor selected pursuant to
this subsection to determine the extent of the employee’s disability. Unless
the insurer and the injured employee otherwise agree to a rating physician
or chiropractor:
(a) The insurer shall select the rating physician or chiropractor from the
list of qualified rating physicians and chiropractors designated by the
administrator, to determine the percentage of disability in accordance with
the American Medical Association’s Guides to the Evaluation of
Permanent Impairment as adopted and supplemented by the division
pursuant to NRS 616C.110.
(b) Rating physicians and chiropractors must be selected in rotation
from the list of qualified physicians and chiropractors designated by the
administrator, according to their area of specialization and the order in
which their names appear on the list[.] unless the next physician or
chiropractor is currently an employee of the insurer making the
selection, in which case the insurer must select the physician or
chiropractor who is next on the list and who is not currently an
employee of the insurer.
3. If an insurer contacts the treating physician or chiropractor to
determine whether an injured employee has suffered a permanent
disability, the insurer shall deliver to the treating physician or
chiropractor that portion or a summary of that portion of the American
Medical Association’s Guides to the Evaluation of Permanent
Impairment as adopted by the division pursuant to NRS 616C.110 that is
relevant to the type of injury incurred by the employee.
4. At the request of the insurer, the injured employee shall, before an
evaluation by a rating physician or chiropractor is performed, notify the
insurer of:
(a) Any previous evaluations performed to determine the extent of any
of the employee’s disabilities; and
(b) Any previous injury, disease or condition sustained by the employee
which is relevant to the evaluation performed pursuant to this
section.
The notice must be on a form approved by the administrator and provided
to the injured employee by the insurer at the time of the insurer’s request.
[4.] 5. Unless the regulations adopted pursuant to NRS 616C.110
provide otherwise, a rating evaluation must include an evaluation of the
loss of motion, sensation and strength of an injured employee if the injury
is of a type that might have caused such a loss. No factors other than the
degree of physical impairment of the whole man may be considered in
calculating the entitlement to compensation for a permanent partial
disability.
[5.] 6. The rating physician or chiropractor shall provide the insurer
with his evaluation of the injured employee. After receiving the
evaluation, the insurer shall, within 14 days, provide the employee with a
copy of the evaluation and notify the employee:
(a) Of the compensation to which he is entitled pursuant to this
section; or
(b) That he is not entitled to benefits for permanent partial disability.
[6.] 7. Each 1 percent of impairment of the whole man must be
compensated by a monthly payment:
(a) Of 0.5 percent of the claimant’s average monthly wage for injuries
sustained before July 1, 1981;
(b) Of 0.6 percent of the claimant’s average monthly wage for injuries
sustained on or after July 1, 1981, and before June 18, 1993;
(c) Of 0.54 percent of the claimant’s average monthly wage for injuries
sustained on or after June 18, 1993, and before January 1, 2000; and
(d) Of 0.6 percent of the claimant’s average monthly wage for injuries
sustained on or after January 1, 2000.
Compensation must commence on the date of the injury or the day
following the termination of temporary disability compensation, if any,
whichever is later, and must continue on a monthly basis for 5 years or
until the claimant is 70 years of age, whichever is later.
[7.] 8. Compensation benefits may be paid annually to claimants who
will be receiving less than $100 a month.
[8.] 9. Where there is a previous disability, as the loss of one eye, one
hand, one foot, or any other previous permanent disability, the percentage
of disability for a subsequent injury must be determined by computing the
percentage of the entire disability and deducting therefrom the percentage
of the previous disability as it existed at the time of the subsequent injury.
[9.] 10. The division may adopt schedules for rating permanent
disabilities resulting from injuries sustained before July 1, 1973, and
reasonable regulations to carry out the provisions of this section.
[10.] 11. The increase in compensation and benefits effected by the
amendment of this section is not retroactive for accidents which occurred
before July 1, 1973.
[11.] 12. This section does not entitle any person to double payments
for the death of an employee and a continuation of payments for a
permanent partial disability, or to a greater sum in the aggregate than if the
injury had been fatal.
Sec. 16. NRS 616C.495 is hereby amended to read as follows:
616C.495 1. Except as otherwise provided in NRS 616C.380, an
award for a permanent partial disability may be paid in a lump sum under
the following conditions:
(a) A claimant injured on or after July 1, 1973, and before July 1, 1981,
who incurs a disability that does not exceed 12 percent may elect to
receive his compensation in a lump sum. A claimant injured on or after
July 1, 1981, and before July 1, 1995, who incurs a disability that does not
exceed 25 percent may elect to receive his compensation in a lump sum.
(b) The spouse, or in the absence of a spouse, any dependent child of a
deceased claimant injured on or after July 1, 1973, who is not entitled to
compensation in accordance with NRS 616C.505, is entitled to a lump
sum equal to the present value of the deceased claimant’s undisbursed
award for a permanent partial disability.
(c) Any claimant injured on or after July 1, 1981, and before July 1,
1995, who incurs a disability that exceeds 25 percent may elect to receive
his compensation in a lump sum equal to the present value of an award for
a disability of 25 percent. If the claimant elects to receive compensation
pursuant to this paragraph, the insurer shall pay in installments to the
claimant that portion of the claimant’s disability in excess of 25 percent.
(d) Any claimant injured on or after July 1, 1995, may elect to receive
his compensation in a lump sum in accordance with regulations adopted
by the administrator and approved by the governor. The administrator
shall adopt regulations for determining the eligibility of such a claimant to
receive all or any portion of his compensation in a lump sum. Such
regulations may include the manner in which an award for a permanent
partial disability may be paid to such a claimant in installments.
Notwithstanding the provisions of NRS 233B.070, any regulation adopted
pursuant to this paragraph does not become effective unless it is first
approved by the governor.
2. If the claimant elects to receive his payment for a permanent partial
disability in a lump sum pursuant to subsection 1, all of his benefits for
compensation terminate. His acceptance of that payment constitutes a final
settlement of all factual and legal issues in the case. By so accepting he
waives all of his rights regarding the claim, including the right to appeal
from the closure of the case or the percentage of his disability, except:
(a) His right to reopen his claim according to the provisions of NRS
616C.390; and
(b) Any counseling, training or other rehabilitative services provided by
the insurer.
The claimant must be advised in writing of the provisions of this
subsection when he demands his payment in a lump sum, and has 20 days
after the mailing or personal delivery of this notice within which to retract
or reaffirm his demand, before payment may be made and his election
becomes final.
3. Any lump-sum payment which has been paid on a claim incurred on
or after July 1, 1973, must be supplemented if necessary to conform to the
provisions of this section.
4. Except as otherwise provided in this subsection, the total lump-sum
payment for disablement must not be less than one-half the product of the
average monthly wage multiplied by the percentage of disability. If the
claimant received compensation in installment payments for his permanent
partial disability before electing to receive his payment for that disability
in a lump sum, the lump-sum payment must be calculated for the
remaining payment of compensation.
5. The lump sum payable must be equal to the present value of the
compensation awarded, less any advance payment or lump sum previously
paid. The present value must be calculated using monthly payments in the
amounts prescribed in subsection [6] 7 of NRS 616C.490 and actuarial
annuity tables adopted by the division. The tables must be reviewed
annually by a consulting actuary.
6. If a claimant would receive more money by electing to receive
compensation in a lump sum than he would if he receives installment
payments, he may elect to receive the lump-sum payment.
Sec. 17. NRS 616C.555 is hereby amended to read as follows:
616C.555 1. A vocational rehabilitation counselor shall develop a
plan for a program of vocational rehabilitation for each injured employee
who is eligible for vocational rehabilitation services pursuant to NRS
616C.590. The counselor shall work with the insurer and the injured
employee to develop a program that is compatible with the injured
employee’s age, sex and physical condition.
2. If the counselor determined in the written assessment developed
pursuant to NRS 616C.550 that the injured employee has existing
marketable skills, the plan must consist of job placement assistance only.
When practicable, the goal of job placement assistance must be to aid the
employee in finding a position which pays a gross wage that is equal to or
greater than 80 percent of the gross wage that he was earning at the time of
his injury. An injured employee must not receive job placement assistance
for more than 6 months after the date on which he was notified that he is
eligible only for job placement assistance because:
(a) He was physically capable of returning to work; or
(b) It was determined that he had existing marketable skills.
3. If the counselor determined in the written assessment developed
pursuant to NRS 616C.550 that the injured employee does not have
existing marketable skills, the plan must consist of a program which trains
or educates the injured employee and provides job placement assistance.
Except as otherwise provided in NRS 616C.560, such a program must not
exceed:
(a) If the injured employee has incurred a permanent disability as a
result of which permanent restrictions on his ability to work have been
imposed but no permanent physical impairment rating has been issued,
or a permanent disability with a permanent physical impairment of 1
percent or more but less than 6 percent, 9 months.
(b) If the injured employee has incurred a permanent physical
impairment of 6 percent or more, but less than 11 percent, 1 year.
(c) If the injured employee has incurred a permanent physical
impairment of 11 percent or more, 18 months.
The percentage of the injured employee’s permanent physical impairment
must be determined pursuant to NRS 616C.490.
4. A plan for a program of vocational rehabilitation must comply with
the requirements set forth in NRS 616C.585.
5. A plan created pursuant to subsection 2 or 3 must assist the
employee in finding a job or train or educate the employee and assist
him in finding a job that is a part of an employer’s regular business
operations and from which the employee will gain skills that would
generally be transferable to a job with another employer.
6. A program of vocational rehabilitation must not commence before
the treating physician or chiropractor, or an examining physician or
chiropractor determines that the injured employee is capable of safely
participating in the program.
[6.] 7. If, based upon the opinion of a treating or an examining
physician or chiropractor, the counselor determines that an injured
employee is not eligible for vocational rehabilitation services, the
counselor shall provide a copy of the opinion to the injured employee, the
injured employee’s employer and the insurer.
[7.] 8. A plan for a program of vocational rehabilitation must be
signed by a certified vocational rehabilitation counselor.
[8.] 9. If an initial program of vocational rehabilitation pursuant to this
section is unsuccessful, an injured employee may submit a written request
for the development of a second program of vocational rehabilitation
which relates to the same injury. An insurer shall authorize a second
program for an injured employee upon good cause shown.
[9.] 10. If a second program of vocational rehabilitation pursuant to
subsection [8] 9 is unsuccessful, an injured employee may submit a
written request for the development of a third program of vocational
rehabilitation which relates to the same injury. The insurer, with the
approval of the employer who was the injured employee’s employer at the
time of his injury, may authorize a third program for the injured employee.
If such an employer has terminated operations, his approval is not required
for authorization of a third program. An insurer’s determination to
authorize or deny a third program of vocational rehabilitation may not be
appealed.
[10.] 11. The division shall adopt regulations to carry out the
provisions of this section. The regulations must specify the contents of a
plan for a program of vocational rehabilitation.
Sec. 18. NRS 616C.580 is hereby amended to read as follows:
616C.580 1. Except as otherwise provided in this section, vocational
rehabilitation services must not be provided outside of this state. An
injured employee who:
(a) Lives within 50 miles from any border of this state on the date of
injury; or
(b) Was injured while temporarily employed in this state by an
employer subject to the provisions of chapters 616A to 617, inclusive, of
NRS who can demonstrate that, on the date of injury, his permanent
residence was outside of this state,
may receive vocational rehabilitation services at a location within 50 miles
from his residence if such services are available at such location.
2. An injured employee, who:
(a) Is eligible for vocational rehabilitation services pursuant to NRS
616C.590; and
(b) Resides outside of this state but does not qualify to receive
vocational rehabilitation services outside of this state pursuant to
subsection 1,
may execute a written agreement with the insurer which provides for the
payment of compensation in a lump sum in lieu of the provision of
vocational rehabilitation services pursuant to NRS 616C.595. The amount
of the lump sum must not exceed [$15,000.] $20,000.
3. An injured employee who resides outside of this state but does not
qualify to receive vocational rehabilitation services outside of this state
pursuant to subsection 1 may receive the vocational rehabilitation services
to which he is entitled pursuant to NRS 616C.545 to 616C.575, inclusive,
and 616C.590 if he relocates to:
(a) This state; or
(b) A location within 50 miles from any border of this state,
at his own expense, if such services are available at such location.
Sec. 19. NRS 616C.590 is hereby amended to read as follows:
616C.590 1. Except as otherwise provided in this section, an injured
employee is not eligible for vocational rehabilitation services, unless:
(a) The treating physician or chiropractor approves the return of the
injured employee to work but imposes permanent restrictions that prevent
the injured employee from returning to the position that he held at the time
of his injury;
(b) The injured employee’s employer does not offer employment that
[the] :
(1) The employee is eligible for considering the restrictions imposed
pursuant to paragraph (a); and
(2) Provides a gross wage that is equal to or greater than 80 percent
of the gross wage that the employee was earning at the time of his
injury; and
(c) The injured employee is unable to return to gainful employment
with any other employer at a gross wage that is equal to or greater than 80
percent of the gross wage that [he] the employee was earning at the time
of his injury.
2. If the treating physician or chiropractor imposes permanent
restrictions on the injured employee for the purposes of paragraph (a) of
subsection 1, he shall specify in writing:
(a) The medically objective findings upon which his determination is
based; and
(b) A detailed description of the restrictions.
The treating physician or chiropractor shall deliver a copy of the findings
and the description of the restrictions to the insurer.
3. If there is a question as to whether the restrictions imposed upon the
injured employee are permanent, the employee may receive vocational
rehabilitation services until a final determination concerning the duration
of the restrictions is made.
4. Vocational rehabilitation services must cease as soon as the injured
employee is no longer eligible for the services pursuant to subsection 1.
5. An injured employee is not entitled to vocational rehabilitation
services solely because the position that he held at the time of his injury is
no longer available.
6. An injured employee or his dependents are not entitled to accrue or
be paid any money for vocational rehabilitation services during the time
the injured employee is incarcerated.
7. Any injured employee eligible for compensation other than accident
benefits may not be paid those benefits if he refuses counseling, training or
other vocational rehabilitation services offered by the insurer. Except as
otherwise provided in NRS 616B.028 and 616B.029, an injured employee
shall be deemed to have refused counseling, training and other vocational
rehabilitation services while he is incarcerated.
8. If an insurer cannot locate an injured employee for whom it has
ordered vocational rehabilitation services, the insurer may close his claim
21 days after the insurer determines that the employee cannot be located.
The insurer shall make a reasonable effort to locate the employee.
9. The reappearance of the injured employee after his claim has been
closed does not automatically reinstate his eligibility for vocational
rehabilitation benefits. If the employee wishes to reestablish his eligibility
for such benefits, he must file a written application with the insurer to
reinstate his claim. The insurer shall reinstate the employee’s claim if
good cause is shown for the employee’s absence.
Sec. 20. This act becomes effective on July 1, 2002.
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