Assembly Bill No. 44–Committee on Commerce and
Labor
Prefiled January 26, 2001
(On Behalf of Legislative Committee on
Workers’ Compensation (NRS 218.5375))
____________
Referred to Committee on Commerce and Labor
SUMMARY—Makes various changes relating to
responsibilities of insurers who provide industrial insurance. (BDR 53‑772)
FISCAL NOTE: Effect on Local Government: No.
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EXPLANATION
– Matter in bolded italics is new; matter
between brackets [omitted material] is material to be omitted.
Green numbers along
left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
AN ACT relating to industrial insurance; revising the provisions requiring the
administrator of the division of industrial relations of the department of
business and industry to conduct audits of insurers; revising the provisions
governing maintenance of files of claims at the office of an insurer;
clarifying the authority of a board of trustees of an association of
self-insured public employers to invest certain money; requiring insurers, organizations
for managed care and certain employers to notify an injured employee if a
medical bill submitted on his behalf is denied and that the injured employee
has a right to appeal the denial; and providing other matters properly relating
thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1-1 Section 1. NRS 616B.003
is hereby amended to read as follows:
1-2 616B.003 1. The administrator shall cause to be conducted
at least
1-3 every [3] 5 years an audit of all
insurers who provide benefits to injured
1-4 employees pursuant to
chapters 616A to 616D, inclusive, or chapter 617 of
1-5 NRS. [The administrator shall cause to be conducted]
1-6 2. In addition to the audit conducted pursuant
to subsection 1, the
1-7 administrator:
1-8 (a) Shall, each year on a random basis [additional]
, cause to be
1-9 conducted partial audits of any insurer who has a history of violations of
1-10 the provisions of chapters
616A to 616D, inclusive, or chapter 617 of NRS,
1-11 or the regulations adopted
pursuant thereto, as determined by the
1-12 administrator.
2-1 [2.] (b) May,
at any time, cause to be conducted an audit that
2-2 examines a fewer number of files than the audit conducted pursuant
to
2-3 subsection 1 of any insurer who does not have a history of
violations of
2-4 the provisions of chapters 616A to 616D, inclusive, or chapter 617
of
2-5 NRS, or the regulations adopted pursuant thereto, as determined by
the
2-6 administrator.
2-7 3. The administrator shall require the use of standard auditing
2-8 procedures and shall
establish a manual to describe the standard auditing
2-9 procedures [.] for the audits conducted pursuant to
subsections 1 and 2.
2-10 The manual must include:
2-11 (a) Specific audit objectives;
2-12 (b) Standards for documentation;
2-13 (c) Policies for supervisory review;
2-14 (d) Policies for the training of auditors;
2-15 (e) The format for the audit report; and
2-16 (f) Procedures for the presentation, distribution and retention of
the
2-17 audit report [.
2-18 3.] ,
2-19 for each type of audit conducted pursuant to subsections 1 and 2.
2-20 4. In consultation with and with the permission
of the commissioner,
2-21 the audits required or authorized to be conducted pursuant to
subsections
2-22 1 and 2 may be conducted in conjunction with an audit or examination
2-23 conducted by the division of insurance of the department of
business and
2-24 industry or the commissioner pursuant to chapters 616A to 617,
2-25 inclusive, or Title 57 of NRS.
2-26 5. The commissioner and the administrator shall establish
a procedure
2-27 for sharing information
between the division of insurance of the
2-28 department of business and
industry and the division concerning the
2-29 qualifications of employers
as self-insured employers pursuant to NRS
2-30 616B.300 or as an
association of self-insured public or private employers
2-31 pursuant to NRS 616B.353.
2-32 [4.] 6. On or before March 1 of each year, the
administrator shall make
2-33 a report of each audit to
the legislature, if it is in session, or to the interim
2-34 finance committee if the
legislature is not in session.
2-35 Sec. 2. NRS 616B.021 is hereby amended to read as follows:
2-36 616B.021 1. An insurer shall provide access to the files
of claims in
2-37 its offices.
2-38 2. [A file is]
The physical records in a file
concerning a claim filed in
2-39 this state may be kept at an office located outside this state if
all records
2-40 in the file are accessible at offices located in this state on
computer in a
2-41 microphotographic, electronic or other similar format that produces
an
2-42 accurate reproduction of the original. Except as otherwise provided
in
2-43 this subsection, the records in a file concerning a claim filed in
this state
2-44 must be reproduced and available for inspection during regular business
2-45 hours within 24 hours after requested by the
employee or his designated
2-46 agent, the employer or his
designated agent [and] , or the
administrator or
2-47 his designated agent. If a claim filed in this state has been
closed, the
2-48 records in the file must be reproduced and available for inspection
3-1 during regular business hours within 30 calendar days after
requested by
3-2 such persons.
3-3 3. Upon request, the
insurer shall make copies or other
reproductions
3-4 of anything in the file and
may charge a reasonable fee for this service.
3-5 Copies or other reproductions of materials in the
file which are requested
3-6 by the administrator or his
designated agent, or the Nevada attorney for
3-7 injured workers or his
designated agent must be provided free of charge.
3-8 4. [If a claim has been closed for at least 1 year, the insurer
may
3-9 microphotograph or film any of its records relating to that claim.
The
3-10 microphotographs or films must be placed in convenient and
accessible
3-11 files.
3-12 5.] The administrator [shall]
may adopt
regulations concerning the:
3-13 (a) Maintenance of records in a file on current or closed claims; and
3-14 (b) Preservation, examination and use of records which have been
3-15 [microphotographed or filmed] stored on computer or in a
3-16 microphotographic, electronic or similar format by an insurer . [; and
3-17 (c) Location of a file on a
closed claim.
3-18 6.] 5. This
section does not require an insurer to allow inspection or
3-19 reproduction of material
regarding which a legal privilege against
3-20 disclosure has been
conferred.
3-21 Sec. 3. NRS 616B.027 is hereby amended to read as follows:
3-22 616B.027 1. Every insurer shall [provide:
3-23 (a) An] :
3-24 (a) Provide an office in this state
operated by the insurer or its third-
3-25 party administrator in
which:
3-26 (1) A complete file of each claim is [kept;] accessible, in accordance
3-27 with the provisions of NRS 616B.021;
3-28 (2) Persons authorized to act for the insurer and, if necessary,
3-29 licensed pursuant to chapter
683A of NRS, may receive information related
3-30 to a claim and provide the
services to an employer and his employees
3-31 required by chapters 616A to
617, inclusive, of NRS; and
3-32 (3) An employee or his employer, upon request, is provided with
3-33 information related to a
claim filed by the employee or a copy or other
3-34 reproduction of the information from the file for that claim [.
3-35 (b) Statewide,] ,
in accordance with the provisions of NRS 616B.021.
3-36 (b) Provide statewide toll-free telephone service
to [that] the office
3-37 maintained pursuant to paragraph (a) or accept collect calls from
injured
3-38 employees.
3-39 2. Each private carrier
shall provide:
3-40 (a) Adequate services to its insured employers in controlling
losses; and
3-41 (b) Adequate information on the prevention of industrial accidents
and
3-42 occupational diseases.
3-43 Sec. 4. NRS 616B.368 is hereby amended to read as follows:
3-44 616B.368 1. The board of trustees of an association of
self-insured
3-45 public or private employers
is responsible for the money collected and
3-46 disbursed by the
association.
3-47 2. The board of trustees
shall:
3-48 (a) Establish a claims account in a financial institution in this
state
3-49 which is approved by the
commissioner and which is federally insured or
4-1 insured by a private insurer
approved pursuant to NRS 678.755. Except as
4-2 otherwise provided in
subsection 3, at least 75 percent of the annual
4-3 assessment collected by the
association from its members must be
4-4 deposited in this account to
pay:
4-5 (1) Claims;
4-6 (2) Expenses related to those claims;
4-7 (3) The costs associated with the association’s policy of excess
4-8 insurance; and
4-9 (4) Assessments, payments and penalties related to the
subsequent
4-10 injury fund and the uninsured
employers’ claim fund.
4-11 (b) Establish an administrative account in a financial institution
in this
4-12 state which is approved by
the commissioner and which is federally
4-13 insured or insured by a
private insurer approved pursuant to NRS 678.755.
4-14 The amount of the annual
assessment collected by the association that is
4-15 not deposited in its claims
account must be deposited in this account to pay
4-16 the administrative expenses
of the association.
4-17 3. The commissioner may
authorize an association to deposit less than
4-18 75 percent of its annual
assessment in its claims account if the association
4-19 presents evidence to the
satisfaction of the commissioner that:
4-20 (a) More than 25 percent of the association’s annual assessment is
4-21 needed to maintain its
programs for loss control and occupational safety;
4-22 and
4-23 (b) The association’s policy of excess insurance attaches at less
than 75
4-24 percent.
4-25 4. [The]
Notwithstanding the provisions of
chapter 355 of NRS that
4-26 limit investments of public employers, the board of trustees of either an
4-27 association of self-insured private employers or an association of
self-
4-28 insured public employers may invest the money of the association not
4-29 needed to pay the
obligations of the association pursuant to chapter 682A
4-30 of NRS.
4-31 5. The commissioner shall
review the accounts of an association
4-32 established pursuant to this
section at such times as he deems necessary to
4-33 ensure compliance with the
provisions of this section.
4-34 Sec. 5. Chapter 616C of NRS is hereby amended by adding thereto a
4-35 new section to read as
follows:
4-36 1. If an insurer, organization for managed care
or employer who
4-37 provides accident benefits for injured employees pursuant to NRS
4-38 616C.265 denies payment for some or all of the services itemized on
a
4-39 statement submitted by a provider of health care on the sole basis
that
4-40 those services were not related to the employee’s industrial injury
or
4-41 occupational disease, the insurer, organization for managed care or
4-42 employer shall, at the same time that it sends notification to the
provider
4-43 of health care of the denial, send a copy of the statement to the
injured
4-44 employee and notify the injured employee that it has denied
payment.
4-45 The notification sent to the injured employee must:
4-46 (a) State the relevant
amount requested as payment in the statement,
4-47 that the reason for denying payment is that the services were not
related
4-48 to the industrial injury, and that, pursuant to subsection 2, the
injured
4-49 employee will be responsible for payment of the relevant amount if
he
5-1 does not, in a timely manner, appeal the denial pursuant to NRS
5-2 616C.305 and 616C.315 to 616C.385, inclusive, or appeals but is not
5-3 successful.
5-4 (b) Include an explanation
of the injured employee’s right to request a
5-5 hearing to appeal the denial pursuant to NRS 616C.305 and 616C.315
to
5-6 616C.385, inclusive, and a suitable form for requesting a hearing
to
5-7 appeal the denial.
5-8 2. An injured employee who does not, in a timely
manner, appeal the
5-9 denial of payment for the services rendered or, who appeals the
denial
5-10 but is not successful, is responsible for payment of the relevant
charges
5-11 on the itemized statement.
5-12 3. To succeed on appeal, the injured employee
must show that the:
5-13 (a) Services provided were
related to the employee’s industrial injury
5-14 or occupational disease; or
5-15 (b) Insurer, organization
for managed care or employer who provides
5-16 accident benefits for injured employees pursuant to NRS 616C.265
gave
5-17 prior authorization for the services rendered and did not withdraw
that
5-18 prior authorization before the services of the provider of health
care were
5-19 rendered.
5-20 Sec. 6. NRS 616C.135 is hereby amended to read as follows:
5-21 616C.135 1. A provider of health care who accepts a
patient as a
5-22 referral for the treatment
of an industrial injury or an occupational disease
5-23 may not charge the patient
for any treatment related to the industrial injury
5-24 or occupational disease, but
must charge the insurer. The provider of health
5-25 care may charge the patient
for any [other unrelated services
which are
5-26 requested in writing by the patient.] services that are not related to the
5-27 employee’s industrial injury or occupational disease.
5-28 2. The insurer is liable
for the charges for approved services related to
5-29 the industrial injury or occupational disease if the charges do not
exceed:
5-30 (a) The fees established in accordance with NRS 616C.260 or the
usual
5-31 fee charged by that person
or institution, whichever is less; and
5-32 (b) The charges provided for by the contract between the provider
of
5-33 health care and the insurer
or the contract between the provider of health
5-34 care and the organization
for managed care.
5-35 3. If a provider of health
care, an organization for managed care, an
5-36 insurer or an employer
violates the provisions of this section, the
5-37 administrator shall impose
an administrative fine of not more than $250 for
5-38 each violation.
5-39 Sec. 7. This act becomes effective on July 1, 2001.
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