(REPRINTED WITH ADOPTED AMENDMENTS)

 

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 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 alternative 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; 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    Secs. 1-3.  (Deleted by amendment.)

1-2    Sec. 4.  NRS 616B.527 is hereby amended to read as follows:

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

1-4  public or private employers or a private carrier may:

1-5    [1.] (a) Enter into a contract or contracts with one or more

1-6  organizations for managed care to provide comprehensive medical and

1-7  health care services to employees for injuries and diseases that are

1-8  compensable pursuant to chapters 616A to 617, inclusive, of NRS.

1-9    [2.] (b) Enter into a contract or contracts with providers of health care,

1-10  including, without limitation, physicians who provide primary care,

1-11  specialists, pharmacies, physical therapists, radiologists, nurses, diagnostic

2-1  facilities, laboratories, hospitals and facilities that provide treatment to

2-2  outpatients, to provide medical and health care services to employees for

2-3  injuries and diseases that are compensable pursuant to chapters 616A to

2-4  617, inclusive, of NRS.

2-5    [3.] (c) Require employees to obtain medical and health care services

2-6  for their industrial injuries from those organizations and persons with

2-7  whom the self-insured employer, association or private carrier has

2-8  contracted pursuant to [subsections 1 and 2,] paragraphs (a) and (b), or as

2-9  the self-insured employer, association or private carrier otherwise

2-10  prescribes.

2-11    [4.  Require]

2-12    (d) Except as otherwise provided in subsection 3 of NRS 616C.090,

2-13  require employees to obtain the approval of the self-insured employer,

2-14  association or private carrier before obtaining medical and health care

2-15  services for their industrial injuries from a provider of health care who has

2-16  not been previously approved by the self-insured employer, association or

2-17  private carrier.

2-18    [5.] 2.  An organization for managed care with whom a self-insured

2-19  employer, association of self-insured public or private employers or a

2-20  private carrier has contracted pursuant to this section shall comply with the

2-21  provisions of NRS 616B.528, 616B.5285 and 616B.529.

2-22    Sec. 5.  Chapter 616C of NRS is hereby amended by adding thereto a

2-23  new section to read as follows:

2-24    If:

2-25    1.  An insurer, an organization for managed care, a third-party

2-26  administrator or an employer who provides accident benefits for injured

2-27  employees pursuant to NRS 616C.265 denies authorization or

2-28  responsibility for payment for treatment or other services provided by a

2-29  provider of health care that the injured employee alleges are related to an

2-30  industrial injury or occupational disease;

2-31    2.  The injured employee pays in protest for the treatment or other

2-32  services; and

2-33    3.  A hearing officer or appeals officer ultimately determines that the

2-34  treatment or other services should have been covered, or the insurer,

2-35  organization for managed care, third-party administrator or employer

2-36  who provides accident benefits subsequently accepts responsibility for

2-37  payment,

2-38  the hearing officer or appeals officer shall order the insurer,

2-39  organization for managed care, third-party administrator or employer

2-40  who provides accident benefits to reimburse the injured employee for the

2-41  amount paid by the injured employee, or the insurer, organization for

2-42  managed care, third-party administrator or employer who provides

2-43  accident benefits shall, as a part of any settlement with the injured

2-44  employee, reimburse the injured employee for the amount paid by the

2-45  injured employee.

2-46    Sec. 6.  NRS 616C.050 is hereby amended to read as follows:

2-47    616C.050  1.  An insurer shall provide to each claimant:

2-48    (a) Upon written request, one copy of any medical information

2-49  concerning his injury or illness.

3-1    (b) A statement which contains information concerning the claimant’s

3-2  right to:

3-3       (1) Receive the information and forms necessary to file a claim;

3-4       (2) Select a treating physician or chiropractor and an alternative

3-5  treating physician or chiropractor in accordance with the provisions of

3-6  NRS 616C.090;

3-7       (3) Request the appointment of the Nevada attorney for injured

3-8  workers to represent him before the appeals officer;

3-9       (4) File a complaint with the administrator;

3-10      (5) When applicable, receive compensation for:

3-11        (I) Permanent total disability;

3-12        (II) Temporary total disability;

3-13        (III) Permanent partial disability;

3-14        (IV) Temporary partial disability; or

3-15        (V) All medical costs related to his injury or disease;

3-16      (6) Receive services for rehabilitation if his injury prevents him from

3-17  returning to gainful employment;

3-18      (7) Review by a hearing officer of any determination or rejection of a

3-19  claim by the insurer within the time specified by statute; and

3-20      (8) Judicial review of any final decision within the time specified by

3-21  statute.

3-22    2.  The insurer’s statement must include a copy of the form designed

3-23  by the administrator pursuant to subsection 7 of NRS 616C.090 that

3-24  notifies injured employees of their right to select an alternative treating

3-25  physician or chiropractor. The administrator shall adopt regulations for

3-26  the manner of compliance by an insurer with the other provisions of

3-27  subsection 1.

3-28    Sec. 7.  NRS 616C.090 is hereby amended to read as follows:

3-29    616C.090  1.  The administrator shall establish a panel of physicians

3-30  and chiropractors who have demonstrated special competence and interest

3-31  in industrial health to treat injured employees under chapters 616A to

3-32  616D, inclusive, or chapter 617 of NRS. Every employer whose insurer has

3-33  not entered into a contract with an organization for managed care or with

3-34  providers of health care services pursuant to NRS 616B.527 shall maintain

3-35  a list of those physicians and chiropractors on the panel who are reasonably

3-36  accessible to his employees.

3-37    2.  An injured employee whose employer’s insurer has not entered into

3-38  a contract with an organization for managed care or with providers of

3-39  health care services pursuant to NRS 616B.527 may choose his treating

3-40  physician or chiropractor from the panel of physicians and chiropractors. If

3-41  the injured employee is not satisfied with the first physician or chiropractor

3-42  he so chooses, he may make an alternative choice of physician or

3-43  chiropractor from the panel if the choice is made within 90 days after his

3-44  injury. The insurer shall notify the first physician or chiropractor in

3-45  writing. The notice must be postmarked within 3 working days after the

3-46  insurer receives knowledge of the change. The first physician or

3-47  chiropractor must be reimbursed only for the services he rendered to the

3-48  injured employee up to and including the date of notification. [Any] Except

3-49  as otherwise provided in this subsection, any further change is subject to

4-1  the approval of the insurer, which must be granted or denied within 10 days

4-2  after a written request for such a change is received from the injured

4-3  employee. If no action is taken on the request within 10 days, the request

4-4  shall be deemed granted. Any request for a change of physician or

4-5  chiropractor must include the name of the new physician or chiropractor

4-6  chosen by the injured employee. If the treating physician or chiropractor

4-7  refers the injured employee to a specialist for treatment, the insurer shall,

4-8  in writing, notify the employee whether the name of more than one

4-9  physician or chiropractor with that specialization is on the panel and, if

4-10  so, inform the employee that he has a right to choose any one of those

4-11  specialists.

4-12    3.  An injured employee whose employer’s insurer has entered into a

4-13  contract with an organization for managed care or with providers of health

4-14  care services pursuant to NRS 616B.527 must choose his treating physician

4-15  or chiropractor pursuant to the terms of that contract. If the injured

4-16  employee is not satisfied with the first physician or chiropractor he so

4-17  chooses, he may make an alternative choice of physician or chiropractor

4-18  pursuant to the terms of the contract if the choice is made within 90 days

4-19  after his injury. If the injured employee, after choosing his treating

4-20  physician or chiropractor, moves to a county which is not served by the

4-21  organization for managed care or providers of health care services named

4-22  in the contract and the insurer determines that it is impractical for the

4-23  injured employee to continue treatment with the physician or chiropractor,

4-24  the injured employee must choose a treating physician or chiropractor who

4-25  has agreed to the terms of that contract unless the insurer authorizes the

4-26  injured employee to choose another physician or chiropractor. If the

4-27  treating physician or chiropractor refers the injured employee to a

4-28  specialist for treatment, the insurer shall, in writing, notify the employee

4-29  whether the name of more than one physician or chiropractor with that

4-30  specialization is available pursuant to the terms of the contract with the

4-31  organization for managed care or with providers of health care services

4-32  pursuant to NRS 616B.527, as appropriate, and, if so, inform the

4-33  employee that he has a right to choose any one of those specialists. If a

4-34  choice of physicians or chiropractors within that specialization is not

4-35  available pursuant to the terms of the contract, the injured employee may

4-36  select any physician or chiropractor practicing within that area of

4-37  specialization who agrees to accept the terms of the contract with the

4-38  organization for managed care or with providers of health care pursuant

4-39  to NRS 616B.527, as appropriate.

4-40    4.  Except when emergency medical care is required and except as

4-41  otherwise provided in NRS 616C.055, the insurer is not responsible for any

4-42  charges for medical treatment or other accident benefits furnished or

4-43  ordered by any physician, chiropractor or other person selected by the

4-44  injured employee in disregard of the provisions of this section or for any

4-45  compensation for any aggravation of the injured employee’s injury

4-46  attributable to improper treatments by such physician, chiropractor or other

4-47  person.

5-1    5.  The administrator may order necessary changes in a panel of

5-2  physicians and chiropractors and shall suspend or remove any physician or

5-3  chiropractor from a panel for good cause shown.

5-4    6.  An injured employee may receive treatment by more than one

5-5  physician or chiropractor if the insurer provides written authorization for

5-6  such treatment.

5-7    7.  The administrator shall design a form that notifies injured

5-8  employees of their right pursuant to subsections 2 and 3 to select an

5-9  alternative treating physician or chiropractor and make the form

5-10  available to insurers for distribution pursuant to subsection 2 of NRS

5-11  616C.050.

5-12    Sec. 8.  NRS 616C.100 is hereby amended to read as follows:

5-13    616C.100  1.  If an injured employee disagrees with the percentage of

5-14  disability determined by a physician or chiropractor, the injured employee

5-15  may obtain a second determination of the percentage of disability[. If the

5-16  employee wishes to obtain such a determination, he must select the next

5-17  physician or chiropractor in rotation from the list of qualified physicians or

5-18  chiropractors maintained by the administrator pursuant to subsection 2 of

5-19  NRS 616C.490.] from any qualified physician or chiropractor. If a second

5-20  determination is obtained, the injured employee shall pay for the

5-21  determination. If the physician or chiropractor selected to make the second

5-22  determination finds a higher percentage of disability than the first

5-23  physician or chiropractor, the injured employee may request a hearing

5-24  officer or appeals officer to order the insurer to reimburse the employee

5-25  pursuant to the provisions of NRS 616C.330 or 616C.360.

5-26    2.  The results of a second determination made pursuant to subsection 1

5-27  may be offered at any hearing or settlement conference.

5-28    Sec. 9.  NRS 616C.110 is hereby amended to read as follows:

5-29    616C.110  1.  For the purposes of NRS 616B.557, 616C.490 and

5-30  617.459, the division shall adopt regulations incorporating the American

5-31  Medical Association’s Guides to the Evaluation of Permanent Impairment

5-32  by reference and may amend those regulations from time to time as it

5-33  deems necessary. In adopting the Guides to the Evaluation of Permanent

5-34  Impairment, the division shall consider the edition most recently published

5-35  by the American Medical Association.

5-36    2.  [If] Except as otherwise provided in subsection 6 of NRS

5-37  616C.490, if the Guides to the Evaluation of Permanent Impairment

5-38  adopted by the division contain more than one method of determining the

5-39  rating of an impairment, the administrator shall designate by regulation the

5-40  method which must be used to rate an impairment pursuant to NRS

5-41  616C.490.

5-42    Sec. 10.  NRS 616C.135 is hereby amended to read as follows:

5-43    616C.135  1.  A provider of health care who accepts a patient as a

5-44  referral for the treatment of an industrial injury or an occupational disease

5-45  may not charge the patient for any treatment related to the industrial injury

5-46  or occupational disease, but must charge the insurer. The provider of health

5-47  care may charge the patient for any other unrelated services which are

5-48  requested in writing by the patient.

6-1    2.  The insurer is liable for the charges for approved services if the

6-2  charges do not exceed:

6-3    (a) The fees established in accordance with NRS 616C.260 or the usual

6-4  fee charged by that person or institution, whichever is less; and

6-5    (b) The charges provided for by the contract between the provider of

6-6  health care and the insurer or the contract between the provider of health

6-7  care and the organization for managed care.

6-8    3.  A provider of health care may accept payment from an injured

6-9  employee who is paying in protest pursuant to section 5 of this act for

6-10  treatment or other services that the injured employee alleges are related

6-11  to the industrial injury or occupational disease.

6-12    4.  If a provider of health care, an organization for managed care, an

6-13  insurer or an employer violates the provisions of this section, the

6-14  administrator shall impose an administrative fine of not more than $250 for

6-15  each violation.

6-16    Sec. 11.  NRS 616C.330 is hereby amended to read as follows:

6-17    616C.330  1.  The hearing officer shall:

6-18    (a) Within 5 days after receiving a request for a hearing, set the hearing

6-19  for a date and time within 30 days after his receipt of the request;

6-20    (b) Give notice by mail or by personal service to all interested parties to

6-21  the hearing at least 15 days before the date and time scheduled; and

6-22    (c) Conduct hearings expeditiously and informally.

6-23    2.  The notice must include a statement that the injured employee may

6-24  be represented by a private attorney or seek assistance and advice from the

6-25  Nevada attorney for injured workers.

6-26    3.  If necessary to resolve a medical question concerning an injured

6-27  employee’s condition or to determine the necessity of treatment for which

6-28  authorization for payment has been denied, the hearing officer may refer

6-29  the employee to a physician or chiropractor of his choice who has

6-30  demonstrated special competence to treat the particular medical condition

6-31  of the employee. If the medical question concerns the rating of a permanent

6-32  disability, the hearing officer may refer the employee to a rating physician

6-33  or chiropractor. The rating physician or chiropractor must be selected in

6-34  rotation from the list of qualified physicians and chiropractors maintained

6-35  by the administrator pursuant to subsection 2 of NRS 616C.490, unless the

6-36  insurer and injured employee otherwise agree to a rating physician or

6-37  chiropractor. The insurer shall pay the costs of any medical examination

6-38  requested by the hearing officer.

6-39    4.  If an injured employee has requested payment for the cost of

6-40  obtaining a second determination of his percentage of disability pursuant to

6-41  NRS 616C.100, the hearing officer shall decide whether the determination

6-42  of the higher percentage of disability made pursuant to NRS 616C.100 is

6-43  appropriate and, if so, may order the insurer to pay to the employee an

6-44  amount equal to the maximum allowable fee established by the

6-45  administrator pursuant to NRS 616C.260 for the type of service performed,

6-46  or the usual fee of that physician or chiropractor for such service,

6-47  whichever is less.

6-48    5.  The hearing officer shall order an insurer, organization for

6-49  managed care or employer who provides accident benefits for injured

7-1  employees pursuant to NRS 616C.265 to reimburse an injured employee

7-2  for the payment of charges of a provider of health care if the conditions

7-3  of section 5 of this act are satisfied.

7-4    6.  The hearing officer may allow or forbid the presence of a court

7-5  reporter and the use of a tape recorder in a hearing.

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

7-7  after:

7-8    (a) The hearing; or

7-9    (b) He receives a copy of the report from the medical examination he

7-10  requested.

7-11    [7.] 8.  The hearing officer shall render his decision in the most

7-12  efficient format developed by the chief of the hearings division of the

7-13  department of administration.

7-14    [8.] 9.  The hearing officer shall give notice of his decision to each

7-15  party by mail. He shall include with the notice of his decision the necessary

7-16  forms for appealing from the decision.

7-17    [9.] 10.  Except as otherwise provided in NRS 616C.380, the decision

7-18  of the hearing officer is not stayed if an appeal from that decision is taken

7-19  unless an application for a stay is submitted by a party. If such an

7-20  application is submitted, the decision is automatically stayed until a

7-21  determination is made on the application. A determination on the

7-22  application must be made within 30 days after the filing of the application.

7-23  If, after reviewing the application, a stay is not granted by the hearing

7-24  officer or an appeals officer, the decision must be complied with within 10

7-25  days after the refusal to grant a stay.

7-26    Sec. 12.  NRS 616C.360 is hereby amended to read as follows:

7-27    616C.360  1.  A stenographic or electronic record must be kept of the

7-28  hearing before the appeals officer and the rules of evidence applicable to

7-29  contested cases under chapter 233B of NRS apply to the hearing.

7-30    2.  The appeals officer must hear any matter raised before him on its

7-31  merits, including new evidence bearing on the matter.

7-32    3.  If necessary to resolve a medical question concerning an injured

7-33  employee’s condition or to determine the necessity of treatment for which

7-34  authorization for payment has been denied, the appeals officer may refer

7-35  the employee to a physician or chiropractor of his choice who has

7-36  demonstrated special competence to treat the particular medical condition

7-37  of the employee. If the medical question concerns the rating of a permanent

7-38  disability, the appeals officer may refer the employee to a rating physician

7-39  or chiropractor. The rating physician or chiropractor must be selected in

7-40  rotation from the list of qualified physicians or chiropractors maintained by

7-41  the administrator pursuant to subsection 2 of NRS 616C.490, unless the

7-42  insurer and the injured employee otherwise agree to a rating physician or

7-43  chiropractor. The insurer shall pay the costs of any examination requested

7-44  by the appeals officer.

7-45    4.  If an injured employee has requested payment for the cost of

7-46  obtaining a second determination of his percentage of disability pursuant to

7-47  NRS 616C.100, the appeals officer shall decide whether the determination

7-48  of the higher percentage of disability made pursuant to NRS 616C.100 is

7-49  appropriate and, if so, may order the insurer to pay to the employee an

8-1  amount equal to the maximum allowable fee established by the

8-2  administrator pursuant to NRS 616C.260 for the type of service performed,

8-3  or the usual fee of that physician or chiropractor for such service,

8-4  whichever is less.

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

8-6  managed care or employer who provides accident benefits for injured

8-7  employees pursuant to NRS 616C.265 to reimburse an injured employee

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

8-9  of section 5 of this act are satisfied.

8-10    6.  Any party to the appeal or the appeals officer may order a transcript

8-11  of the record of the hearing at any time before the seventh day after the

8-12  hearing. The transcript must be filed within 30 days after the date of the

8-13  order unless the appeals officer otherwise orders.

8-14    [6.] 7.  The appeals officer shall render his decision:

8-15    (a) If a transcript is ordered within 7 days after the hearing, within 30

8-16  days after the transcript is filed; or

8-17    (b) If a transcript has not been ordered, within 30 days after the date of

8-18  the hearing.

8-19    [7.] 8.  The appeals officer may affirm, modify or reverse any decision

8-20  made by the hearing officer and issue any necessary and proper order to

8-21  give effect to his decision.

8-22    Sec. 13.  NRS 616C.390 is hereby amended to read as follows:

8-23    616C.390  1.  If an application to reopen a claim to increase or

8-24  rearrange compensation is made in writing more than 1 year after the date

8-25  on which the claim was closed, the insurer shall reopen the claim if:

8-26    (a) A change of circumstances warrants an increase or rearrangement of

8-27  compensation during the life of the claimant;

8-28    (b) [The primary] A substantial contributing cause of the change of

8-29  circumstances is the injury or disease for which the claim was originally

8-30  made; and

8-31    (c) The application is accompanied by the certificate of a physician or a

8-32  chiropractor showing a change of circumstances which would warrant an

8-33  increase or rearrangement of compensation.

8-34    2.  After a claim has been closed, the insurer, upon receiving an

8-35  application and for good cause shown, may authorize the reopening of the

8-36  claim for medical investigation only. The application must be accompanied

8-37  by a written request for treatment from the physician or chiropractor

8-38  treating the claimant, certifying that the treatment is indicated by a change

8-39  in circumstances and is related to the industrial injury sustained or

8-40  occupational disease contracted by the claimant.

8-41    3.  If a claimant applies for a claim to be reopened pursuant to

8-42  subsection 1 or 2 and a final determination denying the reopening is issued,

8-43  the claimant [shall] may not reapply to reopen the claim until at least 1 year

8-44  after the date on which the final determination is issued.

8-45    4.  Except as otherwise provided in subsection 5, if an application to

8-46  reopen a claim is made in writing within 1 year after the date on which the

8-47  claim was closed, the insurer shall reopen the claim only if:

8-48    (a) The application is supported by medical evidence demonstrating an

8-49  objective change in the medical condition of the claimant; and

9-1    (b) There is clear and convincing evidence that [the primary] a

9-2  substantial contributing cause of the change of circumstances is the injury

9-3  or disease for which the claim was originally made.

9-4    5.  An application to reopen a claim must be made in writing within 1

9-5  year after the date on which the claim was closed if:

9-6    (a) The claimant was not off work as a result of the injury[;] or disease;

9-7  and

9-8    (b) The claimant did not receive benefits for a permanent partial

9-9  disability.

9-10  If an application to reopen a claim to increase or rearrange compensation is

9-11  made pursuant to this subsection, the insurer shall reopen the claim if the

9-12  requirements set forth in paragraphs (a), (b) and (c) of subsection 1 are

9-13  met.

9-14    6.  If an employee’s claim is reopened pursuant to this section, he is not

9-15  entitled to vocational rehabilitation services or benefits for a temporary

9-16  total disability if, before his claim was reopened, he:

9-17    (a) Retired; or

9-18    (b) Otherwise voluntarily removed himself from the work force,

9-19  for reasons unrelated to the injury or disease for which the claim was

9-20  originally made.

9-21    7.  One year after the date on which the claim was closed, an insurer

9-22  may dispose of the file of a claim authorized to be reopened pursuant to

9-23  subsection 5, unless an application to reopen the claim has been filed

9-24  pursuant to that subsection.

9-25    8.  An increase or rearrangement of compensation is not effective

9-26  before an application for reopening a claim is made unless good cause is

9-27  shown. The insurer shall, upon good cause shown, allow the cost of

9-28  emergency treatment the necessity for which has been certified by a

9-29  physician or a chiropractor.

9-30    9.  A claim that closes pursuant to subsection 2 of NRS 616C.235 and

9-31  is not appealed or is unsuccessfully appealed pursuant to the provisions of

9-32  NRS 616C.305 and 616C.315 to 616C.385, inclusive, may not be reopened

9-33  pursuant to this section.

9-34    10.  The provisions of this section apply to any claim for which an

9-35  application to reopen the claim or to increase or rearrange compensation is

9-36  made pursuant to this section, regardless of the date of the injury or

9-37  accident to the claimant [.] or the date the occupational disease is

9-38  contracted by the claimant. If a claim is reopened pursuant to this section,

9-39  the amount of any compensation or benefits provided must be determined

9-40  in accordance with the provisions of NRS 616C.425[.] or 617.445, as

9-41  appropriate.

9-42    Sec. 14.  NRS 616C.475 is hereby amended to read as follows:

9-43    616C.475  1.  Except as otherwise provided in this section, NRS

9-44  616C.175 and 616C.390, every employee in the employ of an employer,

9-45  within the provisions of chapters 616A to 616D, inclusive, of NRS, who is

9-46  injured by accident arising out of and in the course of employment, or his

9-47  dependents, is entitled to receive for the period of temporary total

9-48  disability, 66 2/3 percent of the average monthly wage.

10-1    2.  Except as otherwise provided in NRS 616B.028 and 616B.029, an

10-2  injured employee or his dependents are not entitled to accrue or be paid

10-3  any benefits for a temporary total disability during the time the injured

10-4  employee is incarcerated. The injured employee or his dependents are

10-5  entitled to receive such benefits when the injured employee is released

10-6  from incarceration if he is certified as temporarily totally disabled by a

10-7  physician or chiropractor.

10-8    3.  If a claim for the period of temporary total disability is allowed, the

10-9  first payment pursuant to this section must be issued by the insurer within

10-10  14 working days after receipt of the initial certification of disability and

10-11  regularly thereafter.

10-12  4.  Any increase in compensation and benefits effected by the

10-13  amendment of subsection 1 is not retroactive.

10-14  5.  Payments for a temporary total disability must cease when:

10-15  (a) A physician or chiropractor determines that the employee is

10-16  physically capable of any gainful employment for which the employee is

10-17  suited, after giving consideration to the employee’s education, training and

10-18  experience;

10-19  (b) The employer offers the employee light-duty employment or

10-20  employment that is modified according to the limitations or restrictions

10-21  imposed by a physician or chiropractor pursuant to subsection 7; or

10-22  (c) Except as otherwise provided in NRS 616B.028 and 616B.029, the

10-23  employee is incarcerated.

10-24  6.  Each insurer may, with each check that it issues to an injured

10-25  employee for a temporary total disability, include a form approved by the

10-26  division for the injured employee to request continued compensation for

10-27  the temporary total disability.

10-28  7.  A certification of disability issued by a physician or chiropractor

10-29  must:

10-30  (a) Include the period of disability and a description of any physical

10-31  limitations or restrictions imposed upon the work of the employee;

10-32  (b) Specify whether the limitations or restrictions are permanent or

10-33  temporary; and

10-34  (c) Be signed by the treating physician or chiropractor authorized

10-35  pursuant to NRS 616B.527[.] or appropriately chosen pursuant to

10-36  subsection 3 of NRS 616C.090.

10-37  8.  If the certification of disability specifies that the physical limitations

10-38  or restrictions are temporary, the employer of the employee at the time of

10-39  his accident [is not required to comply with NRS 616C.545 to 616C.575,

10-40  inclusive, and 616C.590 or the regulations adopted by the division

10-41  governing vocational rehabilitation services if the employer offers] may

10-42  offer the employee temporary, light-duty employment. Any offer of

10-43  temporary, light-duty employment made by the employer must specify a

10-44  position that:

10-45  (a) Is substantially similar to the employee’s position at the time of his

10-46  injury in relation to the location of the employment and the hours he is

10-47  required to work; and

10-48  (b) Provides a gross wage that is:

11-1      (1) If the position is in the same classification of employment, equal

11-2  to the gross wage the employee was earning at the time of his injury; or

11-3      (2) If the position is not in the same classification of employment,

11-4  substantially similar to the gross wage the employee was earning at the

11-5  time of his injury.

11-6    Sec. 15.  NRS 616C.490 is hereby amended to read as follows:

11-7    616C.490  1.  Except as otherwise provided in NRS 616C.175, every

11-8  employee, in the employ of an employer within the provisions of chapters

11-9  616A to 616D, inclusive, of NRS, who is injured by an accident arising out

11-10  of and in the course of employment is entitled to receive the compensation

11-11  provided for permanent partial disability. As used in this section,

11-12  “disability” and “impairment of the whole man” are equivalent terms.

11-13  2.  Within 30 days after receiving from a physician or chiropractor a

11-14  report indicating that the injured employee may have suffered a permanent

11-15  disability and is stable and ratable, the insurer shall schedule an

11-16  appointment with the rating physician or chiropractor selected pursuant to

11-17  this subsection to determine the extent of the employee’s disability. Unless

11-18  the insurer and the injured employee otherwise agree to a rating physician

11-19  or chiropractor:

11-20  (a) The insurer shall select the rating physician or chiropractor from the

11-21  list of qualified rating physicians and chiropractors designated by the

11-22  administrator, to determine the percentage of disability in accordance with

11-23  the American Medical Association’s Guides to the Evaluation of

11-24  Permanent Impairment as adopted and supplemented by the division

11-25  pursuant to NRS 616C.110.

11-26  (b) Rating physicians and chiropractors must be selected in rotation

11-27  from the list of qualified physicians and chiropractors designated by the

11-28  administrator, according to their area of specialization and the order in

11-29  which their names appear on the list[.] unless the next physician or

11-30  chiropractor is currently an employee of the insurer making the

11-31  selection, in which case the insurer must select the physician or

11-32  chiropractor who is next on the list and who is not currently an employee

11-33  of the insurer.

11-34  3.  If an insurer contacts the treating physician or chiropractor to

11-35  determine whether an injured employee has suffered a permanent

11-36  disability and, thus, whether a rating is necessary, the insurer shall

11-37  deliver to the treating physician or chiropractor that portion of the

11-38  American Medical Association’s Guides to the Evaluation of Permanent

11-39  Impairment as adopted by the division pursuant to NRS 616C.110 that is

11-40  relevant to the type of injury incurred by the employee.

11-41  4.  At the request of the insurer, the injured employee shall, before an

11-42  evaluation by a rating physician or chiropractor is performed, notify the

11-43  insurer of:

11-44  (a) Any previous evaluations performed to determine the extent of any

11-45  of the employee’s disabilities; and

11-46  (b) Any previous injury, disease or condition sustained by the employee

11-47  which is relevant to the evaluation performed pursuant to this

11-48  section.

12-1  The notice must be on a form approved by the administrator and provided

12-2  to the injured employee by the insurer at the time of the insurer’s request.

12-3    [4.] 5.  Unless the regulations adopted pursuant to NRS 616C.110

12-4  provide otherwise, a rating evaluation must include an evaluation of the

12-5  loss of motion, sensation and strength of an injured employee if the injury

12-6  is of a type that might have caused such a loss. No factors other than the

12-7  degree of physical or psychological impairment of the whole man may be

12-8  considered in calculating the entitlement to compensation for a permanent

12-9  partial disability.

12-10  [5.] 6.  A rating evaluation of the spinal region must determine the

12-11  percentage of disability as it existed before any surgical procedures were

12-12  performed on the spinal region, unless the physician or chiropractor

12-13  determines that the injured employee experienced major complications

12-14  from the surgical procedure. If the physician or chiropractor determines

12-15  that an injured employee experienced major complications from a

12-16  surgical procedure performed on the spinal region, the physician or

12-17  chiropractor shall include the effect of the complications when

12-18  determining the percentage of disability of that injured employee. A

12-19  physician or chiropractor may use any method for rating the spinal

12-20  region authorized by the edition of the American Medical Association’s

12-21  Guides to the Evaluation of Permanent Impairment that has been most

12-22  recently adopted by the division pursuant to NRS 616C.110.

12-23  7.  The rating physician or chiropractor shall provide the insurer with

12-24  his evaluation of the injured employee. After receiving the evaluation, the

12-25  insurer shall, within 14 days, provide the employee with a copy of the

12-26  evaluation and notify the employee:

12-27  (a) Of the compensation to which he is entitled pursuant to this

12-28  section; or

12-29  (b) That he is not entitled to benefits for permanent partial disability.

12-30  [6.] 8.  Each 1 percent of impairment of the whole man must be

12-31  compensated by a monthly payment:

12-32  (a) Of 0.5 percent of the claimant’s average monthly wage for injuries

12-33  sustained before July 1, 1981;

12-34  (b) Of 0.6 percent of the claimant’s average monthly wage for injuries

12-35  sustained on or after July 1, 1981, and before June 18, 1993;

12-36  (c) Of 0.54 percent of the claimant’s average monthly wage for injuries

12-37  sustained on or after June 18, 1993, and before January 1, 2000; and

12-38  (d) Of 0.6 percent of the claimant’s average monthly wage for injuries

12-39  sustained on or after January 1, 2000.

12-40  Compensation must commence on the date of the injury or the day

12-41  following the termination of temporary disability compensation, if any,

12-42  whichever is later, and must continue on a monthly basis for 5 years or

12-43  until the claimant is 70 years of age, whichever is later.

12-44  [7.] 9.  Compensation benefits may be paid annually to claimants who

12-45  will be receiving less than $100 a month.

12-46  [8.] 10.  Where there is a previous disability, as the loss of one eye,

12-47  one hand, one foot, or any other previous permanent disability, the

12-48  percentage of disability for a subsequent injury must be determined by

12-49  computing the percentage of the entire disability and deducting therefrom

13-1  the percentage of the previous disability as it existed at the time of the

13-2  subsequent injury.

13-3    [9.] 11.  The division may adopt schedules for rating permanent

13-4  disabilities resulting from injuries sustained before July 1, 1973, and

13-5  reasonable regulations to carry out the provisions of this section.

13-6    [10.] 12.  The increase in compensation and benefits effected by the

13-7  amendment of this section is not retroactive for accidents which occurred

13-8  before July 1, 1973.

13-9    [11.] 13.  This section does not entitle any person to double payments

13-10  for the death of an employee and a continuation of payments for a

13-11  permanent partial disability, or to a greater sum in the aggregate than if the

13-12  injury had been fatal.

13-13  Sec. 16.  NRS 616C.495 is hereby amended to read as follows:

13-14  616C.495  1.  Except as otherwise provided in NRS 616C.380, an

13-15  award for a permanent partial disability may be paid in a lump sum under

13-16  the following conditions:

13-17  (a) A claimant injured on or after July 1, 1973, and before July 1, 1981,

13-18  who incurs a disability that does not exceed 12 percent may elect to receive

13-19  his compensation in a lump sum. A claimant injured on or after July 1,

13-20  1981, and before July 1, 1995, who incurs a disability that does not exceed

13-21  25 percent may elect to receive his compensation in a lump sum.

13-22  (b) The spouse, or in the absence of a spouse, any dependent child of a

13-23  deceased claimant injured on or after July 1, 1973, who is not entitled to

13-24  compensation in accordance with NRS 616C.505, is entitled to a lump sum

13-25  equal to the present value of the deceased claimant’s undisbursed award for

13-26  a permanent partial disability.

13-27  (c) Any claimant injured on or after July 1, 1981, and before July 1,

13-28  1995, who incurs a disability that exceeds 25 percent may elect to receive

13-29  his compensation in a lump sum equal to the present value of an award for

13-30  a disability of 25 percent. If the claimant elects to receive compensation

13-31  pursuant to this paragraph, the insurer shall pay in installments to the

13-32  claimant that portion of the claimant’s disability in excess of 25 percent.

13-33  (d) Any claimant injured on or after July 1, 1995, may elect to receive

13-34  his compensation in a lump sum in accordance with regulations adopted by

13-35  the administrator and approved by the governor. The administrator shall

13-36  adopt regulations for determining the eligibility of such a claimant to

13-37  receive all or any portion of his compensation in a lump sum. Such

13-38  regulations may include the manner in which an award for a permanent

13-39  partial disability may be paid to such a claimant in installments.

13-40  Notwithstanding the provisions of NRS 233B.070, any regulation adopted

13-41  pursuant to this paragraph does not become effective unless it is first

13-42  approved by the governor.

13-43  2.  If the claimant elects to receive his payment for a permanent partial

13-44  disability in a lump sum pursuant to subsection 1, all of his benefits for

13-45  compensation terminate. His acceptance of that payment constitutes a final

13-46  settlement of all factual and legal issues in the case. By so accepting he

13-47  waives all of his rights regarding the claim, including the right to appeal

13-48  from the closure of the case or the percentage of his disability, except:

14-1    (a) His right to reopen his claim according to the provisions of NRS

14-2  616C.390; and

14-3    (b) Any counseling, training or other rehabilitative services provided by

14-4  the insurer.

14-5  The claimant must be advised in writing of the provisions of this

14-6  subsection when he demands his payment in a lump sum, and has 20 days

14-7  after the mailing or personal delivery of this notice within which to retract

14-8  or reaffirm his demand, before payment may be made and his election

14-9  becomes final.

14-10  3.  Any lump-sum payment which has been paid on a claim incurred on

14-11  or after July 1, 1973, must be supplemented if necessary to conform to the

14-12  provisions of this section.

14-13  4.  Except as otherwise provided in this subsection, the total lump-sum

14-14  payment for disablement must not be less than one-half the product of the

14-15  average monthly wage multiplied by the percentage of disability. If the

14-16  claimant received compensation in installment payments for his permanent

14-17  partial disability before electing to receive his payment for that disability in

14-18  a lump sum, the lump-sum payment must be calculated for the remaining

14-19  payment of compensation.

14-20  5.  The lump sum payable must be equal to the present value of the

14-21  compensation awarded, less any advance payment or lump sum previously

14-22  paid. The present value must be calculated using monthly payments in the

14-23  amounts prescribed in subsection [6] 8 of NRS 616C.490 and actuarial

14-24  annuity tables adopted by the division. The tables must be reviewed

14-25  annually by a consulting actuary.

14-26  6.  If a claimant would receive more money by electing to receive

14-27  compensation in a lump sum than he would if he receives installment

14-28  payments, he may elect to receive the lump-sum payment.

14-29  Sec. 17.  NRS 616C.555 is hereby amended to read as follows:

14-30  616C.555  1.  A vocational rehabilitation counselor shall develop a

14-31  plan for a program of vocational rehabilitation for each injured employee

14-32  who is eligible for vocational rehabilitation services pursuant to NRS

14-33  616C.590. The counselor shall work with the insurer and the injured

14-34  employee to develop a program that is compatible with the injured

14-35  employee’s age, sex and physical condition.

14-36  2.  If the counselor determined in the written assessment developed

14-37  pursuant to NRS 616C.550 that the injured employee has existing

14-38  marketable skills, the plan must consist of job placement assistance only.

14-39  When practicable, the goal of job placement assistance must be to aid the

14-40  employee in finding a position which pays a gross wage that is equal to or

14-41  greater than 80 percent of the gross wage that he was earning at the time of

14-42  his injury. An injured employee must not receive job placement assistance

14-43  for more than 6 months after the date on which he was notified that he is

14-44  eligible only for job placement assistance because:

14-45  (a) He was physically capable of returning to work; or

14-46  (b) It was determined that he had existing marketable skills.

14-47  3.  If the counselor determined in the written assessment developed

14-48  pursuant to NRS 616C.550 that the injured employee does not have

14-49  existing marketable skills, the plan must consist of a program which trains

15-1  or educates the injured employee and provides job placement assistance.

15-2  Except as otherwise provided in NRS 616C.560, such a program must not

15-3  exceed:

15-4    (a) If the injured employee has incurred a permanent disability as a

15-5  result of which permanent restrictions on his ability to work have been

15-6  imposed but no permanent physical impairment rating has been issued,

15-7  or a permanent disability with a permanent physical impairment of 1

15-8  percent or more but less than 6 percent, 9 months.

15-9    (b) If the injured employee has incurred a permanent physical

15-10  impairment of 6 percent or more, but less than 11 percent, 1 year.

15-11  (c) If the injured employee has incurred a permanent physical

15-12  impairment of 11 percent or more, 18 months.

15-13  The percentage of the injured employee’s permanent physical impairment

15-14  must be determined pursuant to NRS 616C.490.

15-15  4.  A plan for a program of vocational rehabilitation must comply with

15-16  the requirements set forth in NRS 616C.585.

15-17  5.  A plan created pursuant to subsection 2 or 3 must assist the

15-18  employee in finding a job or train or educate the employee and assist him

15-19  in finding a job that is a part of an employer’s regular business

15-20  operations and from which the employee will gain skills that would

15-21  generally be transferable to a job with another employer.

15-22  6.  A program of vocational rehabilitation must not commence before

15-23  the treating physician or chiropractor, or an examining physician or

15-24  chiropractor determines that the injured employee is capable of safely

15-25  participating in the program.

15-26  [6.] 7.  If, based upon the opinion of a treating or an examining

15-27  physician or chiropractor, the counselor determines that an injured

15-28  employee is not eligible for vocational rehabilitation services, the

15-29  counselor shall provide a copy of the opinion to the injured employee, the

15-30  injured employee’s employer and the insurer.

15-31  [7.] 8.  A plan for a program of vocational rehabilitation must be

15-32  signed by a certified vocational rehabilitation counselor.

15-33  [8.] 9.  If an initial program of vocational rehabilitation pursuant to this

15-34  section is unsuccessful, an injured employee may submit a written request

15-35  for the development of a second program of vocational rehabilitation which

15-36  relates to the same injury. An insurer shall authorize a second program for

15-37  an injured employee upon good cause shown.

15-38  [9.] 10.  If a second program of vocational rehabilitation pursuant to

15-39  subsection [8] 9 is unsuccessful, an injured employee may submit a written

15-40  request for the development of a third program of vocational rehabilitation

15-41  which relates to the same injury. The insurer, with the approval of the

15-42  employer who was the injured employee’s employer at the time of his

15-43  injury, may authorize a third program for the injured employee. If such an

15-44  employer has terminated operations, his approval is not required for

15-45  authorization of a third program. An insurer’s determination to authorize or

15-46  deny a third program of vocational rehabilitation may not be appealed.

15-47  [10.] 11.  The division shall adopt regulations to carry out the

15-48  provisions of this section. The regulations must specify the contents of a

15-49  plan for a program of vocational rehabilitation.

16-1    Sec. 18.  NRS 616C.580 is hereby amended to read as follows:

16-2    616C.580  1.  Except as otherwise provided in this section, vocational

16-3  rehabilitation services must not be provided outside of this state. An

16-4  injured employee who:

16-5    (a) Lives within 50 miles from any border of this state on the date of

16-6  injury; or

16-7    (b) Was injured while temporarily employed in this state by an

16-8  employer subject to the provisions of chapters 616A to 617, inclusive, of

16-9  NRS who can demonstrate that, on the date of injury, his permanent

16-10  residence was outside of this state,

16-11  may receive vocational rehabilitation services at a location within 50 miles

16-12  from his residence if such services are available at such location.

16-13  2.  An injured employee, who:

16-14  (a) Is eligible for vocational rehabilitation services pursuant to NRS

16-15  616C.590; and

16-16  (b) Resides outside of this state but does not qualify to receive

16-17  vocational rehabilitation services outside of this state pursuant to

16-18  subsection 1,

16-19  may execute a written agreement with the insurer which provides for the

16-20  payment of compensation in a lump sum in lieu of the provision of

16-21  vocational rehabilitation services pursuant to NRS 616C.595. The amount

16-22  of the lump sum must not exceed [$15,000.] $25,000.

16-23  3.  An injured employee who resides outside of this state but does not

16-24  qualify to receive vocational rehabilitation services outside of this state

16-25  pursuant to subsection 1 may receive the vocational rehabilitation services

16-26  to which he is entitled pursuant to NRS 616C.545 to 616C.575, inclusive,

16-27  and 616C.590 if he relocates to:

16-28  (a) This state; or

16-29  (b) A location within 50 miles from any border of this state,

16-30  at his own expense, if such services are available at such location.

16-31  Sec. 19.  NRS 616C.590 is hereby amended to read as follows:

16-32  616C.590  1.  Except as otherwise provided in this section, an injured

16-33  employee is not eligible for vocational rehabilitation services, unless:

16-34  (a) The treating physician or chiropractor approves the return of the

16-35  injured employee to work but imposes permanent restrictions that prevent

16-36  the injured employee from returning to the position that he held at the time

16-37  of his injury;

16-38  (b) The injured employee’s employer does not offer employment that

16-39  [the] :

16-40     (1) The employee is eligible for considering the restrictions imposed

16-41  pursuant to paragraph (a); and

16-42     (2) Provides a gross wage that is equal to or greater than 80 percent

16-43  of the gross wage that the employee was earning at the time of his injury;

16-44  and

16-45  (c) The injured employee is unable to return to gainful employment

16-46  with any other employer at a gross wage that is equal to or greater than 80

16-47  percent of the gross wage that [he] the employee was earning at the time of

16-48  his injury.

17-1    2.  If the treating physician or chiropractor imposes permanent

17-2  restrictions on the injured employee for the purposes of paragraph (a) of

17-3  subsection 1, he shall specify in writing:

17-4    (a) The medically objective findings upon which his determination is

17-5  based; and

17-6    (b) A detailed description of the restrictions.

17-7  The treating physician or chiropractor shall deliver a copy of the findings

17-8  and the description of the restrictions to the insurer.

17-9    3.  If there is a question as to whether the restrictions imposed upon the

17-10  injured employee are permanent, the employee may receive vocational

17-11  rehabilitation services until a final determination concerning the duration

17-12  of the restrictions is made.

17-13  4.  Vocational rehabilitation services must cease as soon as the injured

17-14  employee is no longer eligible for the services pursuant to subsection 1.

17-15  5.  An injured employee is not entitled to vocational rehabilitation

17-16  services solely because the position that he held at the time of his injury is

17-17  no longer available.

17-18  6.  An injured employee or his dependents are not entitled to accrue or

17-19  be paid any money for vocational rehabilitation services during the time

17-20  the injured employee is incarcerated.

17-21  7.  Any injured employee eligible for compensation other than accident

17-22  benefits may not be paid those benefits if he refuses counseling, training or

17-23  other vocational rehabilitation services offered by the insurer. Except as

17-24  otherwise provided in NRS 616B.028 and 616B.029, an injured employee

17-25  shall be deemed to have refused counseling, training and other vocational

17-26  rehabilitation services while he is incarcerated.

17-27  8.  If an insurer cannot locate an injured employee for whom it has

17-28  ordered vocational rehabilitation services, the insurer may close his claim

17-29  21 days after the insurer determines that the employee cannot be located.

17-30  The insurer shall make a reasonable effort to locate the employee.

17-31  9.  The reappearance of the injured employee after his claim has been

17-32  closed does not automatically reinstate his eligibility for vocational

17-33  rehabilitation benefits. If the employee wishes to reestablish his eligibility

17-34  for such benefits, he must file a written application with the insurer to

17-35  reinstate his claim. The insurer shall reinstate the employee’s claim if good

17-36  cause is shown for the employee’s absence.

 

17-37  H